| Part1The influence of precise hyperthermic intraperitonealperfusion chemotherapy on the immune function in gastriccancer patients.ObjectiveTo study the influence of precise hyperthermic intraperitoneal perfusionchemotherapy on the immune function in patients with advanced gastric cancer.MethodsFlow cytometry was used to detect T-lymphocyte subsets, B lymphocyte and NKcell in peripheral blood of42patients with advanced gastric cancer before and afterpostoperative adjuvant chemotherapy, as well as HIPEC treatment.1.Experimental design42cases of advanced gastric cancer patients(Pathology affirmed),who weretreated in our hospital from2012December to2014March,were divided into venouschemotherapy group and HIPEC group according to the different methods of treatment.(1)Systemic chemotherapy group(20cases) Check through preoperative imagingevaluation or intraoperative visual assessment. It was proved that tumor did not breakthrough the serosa, and it has no distant metastasis, no operation indications andobvious indications for HIPEC. Systemic chemotherapy was performed in systemicchemotherapy group patients10to14days after surgery using Xelox regime(oxaliplatin injection130mg/m2, day1, capecitabine1g/m2/d, twice a day,1to14days).(2)HIPEC group(22cases) Check through preoperative imaging evaluation orintraoperative visual assessment. It was proved that tumor breakthrough the serosa, orit has distant metastasis.It has obvious indications for HIPEC. HIPEC usingBR-TRG-I hyperthermic perfusion intraperitoneal treatment system with1500~4000mL normal saline containing DDP, Oxaliplatin or5-Fu. Perfusion was kept attemperature at43℃,90min, with perfusion speed at400mL/min.2.Specimen collectionTwo microlitters of peripheral blood was collected using EDTA-K3anticoagulant vacuum tube before and one week after treatment.3.Sample disposalUsing direct immunofluorescence to detect the level of lymphocyte subsets inpatients with gastric cancer before and after treatment. Take100ul anticoagulatedwhole blood to each FACS tube, and then added20ul fluorescein-labeled CD3+,CD4+, CD8+, CD19+, CD16+CD56+monoclonal antibodies, mixed thoroughly, andincubated at room temperature in dark for20min. Then added1000ul erythrocytelysate to each tube, mixed, and incubated for20min, centrifuged at2000r/min,5min,abandoned red supernatant. Plus2ml PBS, centrifuge2000r/min,5min, washedtwice. If there were incomplete lysis of red blood cells, repeated the above steps.Finally, added500ulPBS to each tube to resuspend cells and detected on the machine.4.The lymphocyte analysisFlow-Jo software was used to analysis the lymphocytes subsets before and afterpostoperative adjuvant chemotherapy, as well as HIPEC. 5.Data processing and statistical methodsAll obtained data were processed by SPSS19.0software and were represented asthe mean and standard deviation(X±S). Two independent samples t test wasused for comparison. P<0.05was considered statistically significance.Results1.The percentage of CD3+T lymphocyte, CD4+T lymphocyte, CD8+T lymphocyte, Blymphocyte, NK cell in systemic chemotherapy group patients’ peripheral blood was:70.71±9.01%,37.20±7.18%,26.36±9.95%,4.62±4.39%,16.92±8.62%; which inHIPEC group patients’ peripheral blood was:60.64±16.18%,25.70±14.32%,25.97±9.64%,4.35±5.64%,24.47±14.54%. The ratio of CD4+/CD8+in systemicchemotherapy group patients’ peripheral blood was:1.32±0.51, which in HIPECgroup patients’ peripheral blood was:0.82±0.54. Among them, the percentage ofCD3+T lymphocyte, CD3+CD4+T lymphocyte is declined, as well as the ratio ofCD4+/CD8+, the difference is statistically significant(P <0.05).2. Before treatment, the percentage of CD3+T lymphocyte, CD4+T lymphocyte,CD8+T lymphocyte, B lymphocyte, NK cell in systemic chemotherapy grouppatients’ peripheral blood was:70.71±9.01%,37.20±7.18%,26.36±9.95%,4.62±4.39%,16.92±8.62%. After treatment the percentage was:60.68±13.10%,23.86±9.05%,27.93±10.54%,3.39±2.86%,25.79±13.41%. Before treatment the ratioof CD4+/CD8+in systemic chemotherapy group patients’ peripheral blood was:1.32±0.51; after treatment the ratio was:0.71±0.36. Among them, the percentage of CD3+T lymphocyte, CD3+CD4+T lymphocyte declined, as well as the ratio of CD4+/CD8+.the percentage of NK cell rised, the difference is statistically significant(P <0.05).3. Before treatment, the percentage of CD3+T lymphocyte, CD4+T lymphocyte,CD8+T lymphocyte, B lymphocyte, NK cell in HIPEC group patients’ peripheralblood was:60.64±16.18%,25.70±14.32%,25.97±9.64%,4.35±5.64%,24.47±14.54%;After treatment the percentage was:75.46±8.32%,41.50±10.18%,26.48±7.33%,5.66±5.38%,11.95±6.65%. Before treatment the ratio of CD4+/CD8+in HIPEC grouppatients’ peripheral blood was:0.82±0.54; After treatment the ratio was:1.41±0.52. Among them, the percentage of CD3+T lymphocyte, CD3+CD4+T lymphocyte rised,as well as the ratio of CD4+/CD8+. the percentage of NK cell declined, the differenceis statistically significant(P <0.05).Conclusion1. With the progress of advanced gastric cancer, the immune functions oftumor-bearing patients deteriorated.2. Postoperative adjuvant chemotherapy reduced tumor burden, while also attackedthe immune system non-selectively.3. HIPEC improved immune function of the tumor-bearing hosts, based onchemotherapy sensitization, which can be a further theoretical basis for improving thecurative effect.4. Immunofunction analysis of patients with gastric cancer using flow cytometrycould make us understand the immune function status, enhance the protection inPeroperative Period. We could evaluate the efficacy and prognosis by thepostoperative immunoanalyses of patients with gastric cancers. Part2The primary clinical application of hyperthermicintraperitoneal chemotherapy guided by B ultrasound in thetreatment of malignant ascites.ObjectiveTo investigate the feasibility and clinic efficacy of B ultrasound guidedhyperthermic intraperitoneal chemotherapy (HIPEC) in the treatment of malignantascites.MethodsForty-two patients with malignant ascites registered in Guangzhou MedicalCollege Affiliated Oncologic Hospital from Mach of2008to March of2012wererandomly divided into two groups: the therapeutic group (21patients) for Bultrasound-guided HIPEC and the control group (21patients) for laparoscope basedHIPEC. The therapeutic effects, postoperative complications, and in-hospital costsbetween the two groups were compared, and the clinical therapeutic effects werefollowed up.ResultsThere were no significant differences in the therapeutic efficacy between the twogroups (P>0.05). However, the in-hospital costs and surgery-related complicationswere obviously decreased in the therapeutic group (P<0.01).Conclusion1. B ultrasound guided HIPEC are superiored by less surgery invasion, KPS scoreimprovement and overall survival.2. Compared to laparoscopic-assisted HIPEC, B ultrasound-assisted HIPEC is asimpler operation, which has good prospects for clinical applications because ofits low medical cost, and the effective avoidance of abdominal wall metastasiscaused by stamp holes after laparoscope-assisted HIPEC. |
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