冷冻联合免疫疗法治疗无法手术的转移性乳腺癌/Cryotherapy combined with immunotherapy for inoperable metastatic breast cancer
周亮 姚飞 陈继冰 曾健滢 汪媛 李家亮 牛立志 徐克成
【摘要】
目的：研究冷冻联合DC-CIK(dendritic cell-cytokine-induced killer)免疫疗法治疗转移性乳腺癌的疗效。
方法：回顾性分析2002 年5 月至2012 年5 月本院收治的120 例转移性乳腺癌患者(共计222 个转移灶)的临床资料,其中35 例患者接受冷冻联合DC-CIK 免疫疗法治疗(冷冻联合免疫疗法组),29 例患者接受冷冻联合化疗(冷冻联合化疗组),27 例患者接受冷冻治疗(冷冻治疗组),29 例患者接受化疗(化疗组)。在27 例仅接受冷冻治疗的患者中,有18 例患者接受单次冷冻治疗,9 例患者接受多次冷冻治疗。对所有患者进行定期随访,总生存期以诊断为转移性乳腺癌时开始计算。采用单因素方差分析、Kruskal-Wallis 检验和Friedman 检验比较患者的一般情况。采用Kaplan-Meier 法绘制生存曲线,各组患者总生存期的比较采用Log-rank 检验。
结果：冷冻联合免疫疗法组中位生存期为83(69.5 ~113.0)个月,冷冻联合化疗组中位生存期为48(30.0~64.0) 个月,冷冻治疗组的中位生存期为43(30.5~53.0)个月,化疗组中位生存期为27(18.0 ~41.0)个月,4 组间差异有统计学意义(χ2=20.30,P=0.000);其中,冷冻联合免疫疗法组总生存期显著长于冷冻联合化疗组、冷冻治疗组和化疗组(χ2=27.58,P=0.000;χ2=27.76,P=0.000;χ2=74.21, P=0.000)。在冷冻治疗组中,多次冷冻组与单次冷冻组的中位生存期分别为54(37.0~67.0)个月和35(28.0~48.5)个月,多次冷冻组总生存期显著长于单次冷冻组(χ2=6.25,P =0.012)。各组乳腺癌患者均未发生严重的术后并发症。
结论：冷冻联合免疫疗法能显著延长无法手术的转移性乳腺癌患者的总生存期。
【关键词】冷冻外科手术; 乳腺肿瘤; 肿瘤转移; 免疫疗法; 化学疗法,辅助
[Abstract]
Objective To investigate the efficacy of cryotherapy plus dendritic cell-cytokine-induced killer (DC-CIK) immunotherapy for metastatic breast cancer.
Methods We retrospectively analyzed the clinical data of 120 patients with metastatic breast cancer (a total of 222 lesions) in Fuda Cancer Hospital from May 2002 to May 2012. In all patients, 35 patients received cryotherapy plus DC-CIK immunotherapy (cryotherapy plus immunotherapy group), 29 received cryotherapy plus chemotherapy ( cryotherapy plus chemotherapy group), 27 patients received cryotherapy ( cryotherapy group: 18 patients underwent single therapy and the other 9 underwent multiple therapies) and 29 patients received chemotherapy (chemotherapy group). All patients were followed up. Overall survival (OS) was started from diagnosis time of metastatic breast cancer and analyzed by Log-rank test. The one-way ANOVA, Kruskal-Wallis test and Friedman test were used to compare the general data. Survival curve was drawn using Kaplan-Meier method.
Results The median survival was 83 months (69.5-113.0 months) in cryotherapy plus immunotherapy group, 48 months (30.0- 64.0 months) in cryotherapy plus chemotherapy group, 43 months (30.5-53.0 months) in cryotherapy group and 27 months (18.0 - 41.0 months) in chemotherapy group. The difference in median survival were statistically significant ( χ2=20.30, P=0.000). The OS in cryotherapy plus immunotherapy group was significantly higher than that in cryotherapy plus chemotherapy group, cryotherapy group or chemotherapy group (χ2=27.58, P=0.000; χ2=27.76, P=0.000; χ2=74.21, P=0.000). In the patients only receiving
cryotherapy, the median survival in multiple therapy group was 54 months (37. 0-67.0 months), significantly higher than 35 months(28.0-48.5 months) in single therapy group(χ2= 6.25,P=0.012). No serious postoperative complications were found in the four groups. Conclusion Cryotherapy combined with immunotherapy can increase the OS in inoperable metastatic breast cancer patients.
[Key words] Cryosurgery; Breast neoplasms; Neoplasm metastasis; Immunotherapy; Chemotherapy, adjuvant
