Preliminary Exploration On The Detection O F Endothelial Cells In Malignant Ascites And Its Clinical Relevance

Objective To observe the clinical efficacy of intraperitoneal injection of recombinant human vascular endostatin combined with 5-florouracil(5-FU) in patients with malignant ascites, and to detect the change of percentage of endothelial cells(ECs) in ascites before and after treatment, in order to explore the clinical value of endothelial cells in treatment of malignant ascites.Methods To collect 39 cases of malignant ascites in Anhui Provincial Hospital from 2013 February to 2014 August(including 21 cases of gastric cancer,4 cases of colorectal cancer, 2 cases of pancreatic cancer, 6 cases of gallbladder cancer, 6 cases of unexplained malignant ascites),all the diagnosis were confirmed by cavity effusion cytology and none had received any anti-tumor therapy within two months. After thorough release of ascites,each patient receive intraperitoneal chemotherapy of recombinant human endostatin 60 mg combined with fluorouracil(5-FU) 1.0g treatment. Patients were asked to turn over in bed frequently after treatment within 30 min, so that the medicine can fully contact with all parts of the abdominal cavity.Each week counted as a treatment cycle. Observed therapy of malignant ascites, quality of life(QOL) and adverse reactions after completing two cycles; Endothelial cells were measured before treatment(baseline), after two treatment cycles(before the first 3 cycles of treatment) performed by flow cytometry ascites, referring to WHO ascites therapy evaluation criteria, Karnofsky score and the US National Cancer Institute common toxicity criteria drugs(NCI-CTC4.0 version).Results(1) All patients received two cycles of endostatin combined with fluorouracil intraperitoneal chemotherapy. 39 patients, CR1 patients, PR16 cases, SD 14 例, PD8 cases. Objective response rate(CR + PR) 43.6%(17/39);(2) in 39 patients, 21 patients(53.8%) QOL improvement, 11 cases of QOL stable(28.2%), 7 cases(17.9 %) QOL decreased;(3) There were 10 occurrence of G 3/4 toxicity, including leukopenia 5.1%(2/39), platelets decreased 2.6%(1/39), anemia 5.1%(2/39), nausea 10.3%(4/39) and diarrhea 2.6%(1/39), and no other serious adverse reactions;(4) endothelial cells in malignant ascites clinically effective before treatment(0.22 ± 0.06)%, after treatment(0.12 ± 0.08),quality of life improved before treatment(0.19 ± 0.08)%, after treatment(0.13 ± 0.08)%,clinical responders(PR) EC decreased significantly after treatment(P = 0.005) has statistically significant, clinically ineffective(SD + PD) before and after treatment has no significant difference(P= 0.114),quality of life improved in EC decreased significantly after treatment has statistically significantly(P=0.032),no improvement in the quality of life has no significant difference before and after treatment(P = 0.359).Conclusion Intraperitoneal application of recombinant human endostatin combined with fluorouracil treatment of malignant ascites has a good short term effect, and can improve the quality of life, adverse reactions were mild, this method is safe and feasible.endothelial cells in malignant ascites have some changes before and after treatment,the change of endothelial cells in ascites has certain guiding significance in predicting efficacy and is worthy of further exploration studies.