Dong Baowei, Zhang Jing, Liang Ping, Yu Xiaoling, Su Li, Yu Dejiang, Ji Xiaolong, Yu Guo, Yin Zhiyu
Department of Ultrasound, Chinese PLA General Hospital, Beijing 100853, China.
Zhonghua Yi Xue Za Zhi. 2002 Mar 25;82(6):393-7.
To investigate the influencing factors of the local immunity in tissues of hepatocellular carcinoma (HCC) before and after percutaneous microwave coagulation therapy (PMCT).
Seventy-eight patients with HCC diagnosed by needle biopsy of liver underwent PMCT. Before the treatment and three and 17 days after the treatment specimens of carcinoma tissues were obtained by ultrasound-guided liver biopsy. The extents of infiltration of CD3(+) cell, natural killer cells (CD56(+)), and macrophages (CD68(+)), and the expression rate of proliferating cell nuclear antigen (PCNA) were evaluated by immunohistochemistry. The relation between the extents of immunocyte infiltration and the clinical parameters was analyzed with multiple regression.
Before PMCT infiltration of the three kinds of immunocytes was found in the carcinoma tissues to different degrees with a great variation among individuals. A remarkable increase in the extent of infiltration of the three kinds of immunocytes was found three days after the treatment and continued or remained till the 17th post-PMCT day (P < 0.01). The post-PMCT extent of immunocyte infiltration was positively correlated with the pre-PMCT extent (CD3(+): r = 0.256, P = 0.005; CD56(+): r = 0.257, P = 0.002; CD68(+): r = 0.275, P = 0.001). A negative correlation was found between the extent of immunocyte infiltration and serum alpha-fetal protein (AFP) and between the extent of immunocyte infiltration and tumor size (for serum AFP, CD3(+): r = -0.075, P = 0.049; CD56(+): r = -0.062, P = 0.041; CD68(+): r = -0.007, P = 0.035; for tumor size, CD3(+): r = -0.074, P = 0.051; CD56(+): r = -0.100, P = 0.012; CD68(+): r = -0.109, P = 0.038). No correlation was found between the extent of immunocyte infiltration and age of patient, Child-Pugh class of tumor, grade of tumor differentiation, and number of tumor. The extent of immunocyte infiltration was lesser in the carcinoma tissues with higher expression rate of PCNA. The extent of immunocyte infiltration was greater in the carcinoma tissues where PCNA expression was negative and carcinoma cells had necrotized but with their structure recognizable. No immunocyte infiltration was found in the necrotic and structureless tumor tissues.
The local immunocyte infiltration in patients with HCC was influenced by serum AFP and the grade of tumor cell necrosis pre- and post-PMCT. Destruction of tumor tissue in situs by PMCT is the premise of increase of immunocyte infiltration. Before PMCT improving the immune status of the patients helps enhance the local immune response.
探讨经皮微波凝固治疗（PMCT）前后肝细胞癌（HCC）组织局部免疫的影响因素。
78例经肝穿刺活检确诊为HCC的患者接受PMCT治疗。治疗前及治疗后3天和17天，通过超声引导下肝穿刺获取癌组织标本。采用免疫组织化学法评估CD3(+)细胞、自然杀伤细胞（CD56(+)）和巨噬细胞（CD68(+)）的浸润程度以及增殖细胞核抗原（PCNA）的表达率。采用多元回归分析免疫细胞浸润程度与临床参数之间的关系。
PMCT治疗前，癌组织中三种免疫细胞均有不同程度浸润，个体差异较大。治疗后3天，三种免疫细胞浸润程度显著增加，并持续至PMCT后第17天（P < 0.01）。PMCT后免疫细胞浸润程度与PMCT前程度呈正相关（CD3(+)：r = 0.256，P = 0.005；CD56(+)：r = 0.257，P = 0.002；CD68(+)：r = 0.275，P = 0.001）。免疫细胞浸润程度与血清甲胎蛋白（AFP）及肿瘤大小呈负相关（对于血清AFP，CD3(+)：r = -0.075，P = 0.049；CD56(+)：r = -0.062，P = 0.041；CD68(+)：r = -0.007，P = 0.035；对于肿瘤大小，CD3(+)：r = -0.074，P = 0.051；CD56(+)：r = -0.100，P = 0.012；CD68(+)：r = -0.109，P = 0.038）。免疫细胞浸润程度与患者年龄、肿瘤Child-Pugh分级、肿瘤分化程度及肿瘤数量无关。PCNA表达率较高的癌组织中免疫细胞浸润程度较低。PCNA表达阴性且癌细胞坏死但结构可辨认的癌组织中免疫细胞浸润程度较高。坏死且无结构的肿瘤组织中未发现免疫细胞浸润。
HCC患者局部免疫细胞浸润受血清AFP及PMCT前后肿瘤细胞坏死程度影响。PMCT原位破坏肿瘤组织是免疫细胞浸润增加的前提。PMCT治疗前改善患者免疫状态有助于增强局部免疫反应。
