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目的探讨冷循环射频消融(RFA)治疗对肝癌(HCC)患者调节性T细胞(Treg)变化及其对预后的影响。方法流式细胞仪检测冷循环RFA治疗前,治疗后1、4、7和12个月后外周血Treg的变化。随访期间采用超声造影或肝脏增强CT评估疗效。采用受试者工作特征(ROC)曲线及Kaplan-Meier生存函数的方法分析Treg动态变化与肿瘤无进展生存期的关系。结果 RFA术后1个月,30例患者肿瘤缓解(TR)率93.3%(28/30),肿瘤进展(TP)率6.67%(2/30)。RFA术前Treg(9.42±1.16)%,术后1个月(6.55±0.97)%,较术前显著下降(t=15.325,P<0.01)。经12个月随访,TR率33.3%(10/30),TP率66.7%(20/30)。TR组术前Treg为(8.75±0.72)%,显著低于TP组(9.76±1.20)%(t=-2.448,P=0.021)。ROC曲线表明Treg谷值以4.82%为最佳临界值时,灵敏度为90.0%,特异度为60.0%;Treg达谷时间以5.5个月为最佳临界值,灵敏度为70.0%,特异度为85.0%。采用Kaplan-Meier曲线分析表明,肝癌RFA术后Treg谷值≤4.82%的肿瘤无进展生存率优于Treg谷值>4.82%的患者;Treg达谷时间≥5.5个月的患者预后优于Treg达谷时间<5.5个月的患者,Log-rank检验分别为χ2=5.207,P=0.023;χ2=22.079,P<0.01。结论冷循环RFA可以下调Treg水平,并且Treg谷值及Treg达谷时间在一定程度上反映RFA治疗HCC患者的预后。
Objective To investigate the effect of cold cycle radiofrequency ablation (RFA) on the changes of regulatory T cells (Tregs) and its prognosis in patients with hepatocellular carcinoma (HCC). Methods Flow cytometry was used to detect the changes of Treg in peripheral blood before, 1, 4, 7 and 12 months after treatment with cold-circulation RFA. Follow-up using ultrasound contrast or liver enhanced CT assessment of efficacy. The relationship between the dynamic changes of Treg and the progression-free survival of tumor was analyzed by receiver operating characteristic (ROC) curve and Kaplan-Meier survival function. Results One month after RFA, the tumor response (TR) rate was 93.3% (28/30) and the rate of tumor progression (TP) was 6.67% (2/30) in 30 patients. The preoperative Treg (9.42 ± 1.16)% and 1 month (6.55 ± 0.97)% after RFA were significantly lower than those before operation (t = 15.325, P <0.01). After 12 months of follow-up, the rate of TR was 33.3% (10/30) and the rate of TP was 66.7% (20/30). Preoperative Treg in TR group was (8.75 ± 0.72)%, which was significantly lower than that in TP group (9.76 ± 1.20)% (t = -2.448, P = 0.021). The ROC curve showed that the Treg valley value was 4.82%, the sensitivity was 90.0% and the specificity was 60.0%. The Treg drought time was 5.5 months as the best cutoff value, the sensitivity was 70.0% and the specificity was 85.0 %. The Kaplan-Meier curve analysis showed that the tumor progression-free survival rate of Tregs ≤4.82% after RFA was better than that of Tregs> 4.82%; Tregs ≥5.5 months had better prognosis than Tregs Log-rank tests for χ2 = 5.207, P = 0.023; χ2 = 22.079, P <0.01 for patients with a trough time <5.5 months. Conclusion Cold cycle RFA can down-regulate the level of Treg, and Treg valley and Treg up to valley time to a certain extent reflect the prognosis of patients with HCC treated with RFA.