Clinical Research Of The Effects On Immunological Function And Hepatic Function Of Patients With Hepatic Carcinoma After Laparoscopic Radiofrequency Ablation Therapy

Hepatic carcinoma is a common neoplasm in China, Patients with liver cancerhave high mortality and recurrence rate and poor prognosis.SO far, the treatment ofliver cancer is still surgical resection as the preferred. Due to occult onset of livertumor, multi-center of the tumor and early dissemination, transfer, and in somepatients with cirrhosis, and insufficient liver function, the surgical resection rate isvery low~[1]. The patients who are not suitable for surgical treatment often acceptnon-surgical treatment.Ultrasound-guided radiofrequency ablation is a new technology of topicaltreatment for liver cancer in the past10years. It is safe, minimally invasive, effective,repeatable, fewer complications, and so on, and it has become an emerging treatmenttherapy of cancer~[2,3]. The ways of radiofrequency ablation include: percutaneousradiofrequency ablation by ultrasound or CT-guided,laparoscopic radiofrequencyablation and laparotomy radiofrequency ablation under direct vision.Ultrasound-guided laparoscopic radiofrequency ablation therapy which is set oflaparoscopy and intra-operative ultrasound in has its own unique advantages, it iswidely appreciated more and more. Especially, the location of some tumors areadjacent to the intrahepatic large biliary tracts, located in the liver surface or adjacentto gallbladder, then the operator can manipulate under direct vision, and immediatelysee the the extent of tumor ablation and the presence of bleeding, to avoid theoccurrence of serious complications, and improve the ablation effect~[4,5].But the researchs of the effects on immune state and hepatic function of patientswith hepatocellular carcinoma after laparoscopic radiofrequency ablation therapy are little, and there is a dispute at home and abroad. TO study the effects onimmunological functions,hepatic function and efficacy of patients with hepaticcarcinoma after laparoscopic radiofrequency ablation therapy, we have chosen22cases of patients who were treated by laparoscopic ultrasound-guided radiofrequencyablation from March2011to February2012. We investigated the changes of immunefunction, liver function and AFP before and after treatment, and compared theseindexes with which after surgical resection, transcatheter arterial chemoembolization,designed to evaluate the status and value of LRFA in the treatment of liver cancer.Objective To investigate and evaluate the changes of Immunological parameters,liver function indexes and AFP of peripheral blood in patients with hepatic carcinomaafter laparoscopic radiofrequency ablation therapy. To evaluate the influence of LRFAon the immunity function, liver function and efficacy.Methods （1） Sixty-two patients were divided into three groups: one group（22cases）were treated with LRFA, one group (20cases) were treated with transcatheterarterial chemoembolization, and the other group (20cases) treated with radicaloperation. Before and after treatment, the percentage of lymphocyte subsets (CD3~+Tcells, CD4~+T cells, CD8~+T cells, NK cells and CD19~+T cells) of peripheral bloodwere determined with flow cytometry. The results were compared.（2）Compared ofthe changes of liver function indicators in patients with different size of the tumorbefore and after treatment LRFA.(3) Contrast the serum levels of AFP of LRFAtreatment and surgical treatment.Results （1）The percentages of CD3~+, CD4~+, NK cells and the ratio of CD4~+/CD8~+of peripheral blood in the three groups of patients were significantly lower than thosefrom normal control group(P＜0.01) while the percentage of CD8~+cell was slightlyhigher than that from control group. After1week of the treatment, CD3~+, CD4~+Tlymphocyte，NK cells and the ratio of CD4~+/CD8~+of the LRFA group were higherthan those on preoperative day significantly(P＜0.05), CD8~+T lymphocyte wassignificantly lower than that on preoperative day (P＜0.05), And2weeks to4weeksafter treatment, the level of these indicators were able to maintain better than those before therapy. After1week of the treatment, CD3~+, CD4~+, CD8~+T lymphocyte，NKcells and CD4~+/CD8~+of the TACE group were not obviously different from thosebefore therapy. After2weeks of the treatment, CD3~+, CD4~+T lymphocyte，NK cellsand CD4~+/CD8~+increased, the difference was significant（P＜0.01）. After1week ofthe treatment, CD3~+, CD4~+, CD8~+T lymphocyte，and the ratio of CD4~+/CD8~+of thesurgical procedures group were not obviously different from those preoperative, butthe level of Nk cell was significantly lower than that on preoperative day.2-3weeksafter surgery, these indicators have improved,4weeks after surgery, the number ofCD3~+, CD4~+T lymphocyte，NK cells and CD4~+/CD8~+were significantly higher thanthose before treatment, CD8~+T lymphocyte was significantly lower than thatpreoperative（P＜0.05）.(2) After3days of LRFA treatment, Patients with nodular hepatocellularcarcinoma whose tumor diameter <5cm may occur with mild hepatic dysfunction,mainly manifested ALT, TBIL increased compared with the preoperative (P＜0.05).7days after treatment, liver function recovered to preoperative levels. While patientswith massive-type hepatocellular carcinoma whose tumor diameter5-10cm may occurwith severe hepatic function damage, mainly manifested transaminases and bilirubinwere significantly elevated, albumin synthesis decreased, and the recovery time isrelatively slow.1week after treatment has not been restored to the preoperative level.(3) After1week of LRFA and operation treatment, the degree of AFP of the twogroups decreased slightly (P＞0.05). After1month and3months of LRFA andoperation therapy, the degree of AFP of the two groups were significantly lower thanthose before therapy respectively (LRFA group P <0.05, the surgical procedures groupP <0.01). But the degree of AFP decline between two groups was not obviouslydifferent (P＞0.05).Conclusions（1）1week after LRFA treatment, the patient’s cellular immune functionwas significantly improved. But1week after TACE and surgical resection treatment,the patient’s cellular immune function is further suppressed.2weeks after procedure,the cellular immune function of patients treated by TACE is significantly improvedcompared with preoperative. The cellular immune function of patients who underwent surgical resection can be restored after4weeks of postoperative. Therefore, theimprovement of the three kinds of methods of treatment for liver cancer on thecellular immune system: LRFA＞TACE＞surgical resection.(2) The extent of damage of the liver function is associated with tumor size afterLRFA treatment. Patients with nodular hepatocellular carcinoma whose tumordiameter <5cm may occur with transient mild hepatic dysfunction, mainly manifestedALT, TBIL elevated compared with the preoperative. Patients with massive-typehepatocellular carcinoma whose tumor diameter5-10cm may occur with severehepatic function damage, and the recovery time is relatively slow. Therefore, It is veryimportant to assess of the patient’s liver function adequately and correctly grasp theindications for therapy.(3) Laparoscopic radiofrequency ablation treatment can effectively kill tumor cells,thereby eliminate the source of the AFP, and inhibit the proliferation of tumor tissueand blood vessels, playing a role similar to the surgical treatment of the effect of the"removal" tumor.