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Objective: The aim of the study was to evaluate the efficacy and safety of cytokine-induced killer(CIK) cell combined with transcatheter arterial chemoembolization(TACE) therapy in the treatment of hepatocellular carcinoma(HCC).Methods: Randomized controlled trials(RCTs) on CIK cells combination with TACE based-therapy were identified by electronic searches in the Cochrane Library, MEDLINE, Pubmed, Wanfang, VIP, CNKI and other electronic databases. We included any RCTs evaluating CIK cell combination with TACE for the treatment of hepatocellular cancers. The quality of RCTs meeting inclusion criteria was evaluated and data on short-term and long-term curative effects, quality of life, liver function and immunologic function were extracted. For quantitative data, we conducted meta-analysis with ReMan 5.1 software and the GRADE System was used to rate the level of evidence and strength of recommendation. For qualitative data, data mainly adopted descriptive methods. Results: The 9 RCTs involving 870 cases meeting the inclusion criteria were included. The meta-analysis showed significant survival benefit on 0.5-year survival rate(RR = 1.51, 95% CI, 1.35-1.69, P < 0.00001) in favor of CIK based therapy. This effect was consistent at other prospective dates, including 1-year survival rate(RR = 2.30, 95%CI, 1.94-2.72, P < 0.00001), 2-year survival rate(RR = 7.03, 95% CI, 3.83-12.91, P < 0.0001). Meanwhile, the CIK-based group also demonstrated a significantly prolonged time-to-progression(TTP)(SD = 1.62, 95% CI, 1.30-1.94, P < 0.0001) and overall survival(OS)(SD = 20.6, 95% CI, 20.2-21.18, P < 0.0001). Moreover, a favored response rate(RR = CR + PR)(RR =2, 95% CI, 1.65-2.43, P < 0.00001) and the quality of life improvement rate(KPS)(RR = 1.76, 95% CI, 1.26-2.45, P = 0.0008)were also observed in patients receiving CIK cells and TACE therapy. Furthermore, patients in the CIK group showed lower AFP(SD = -165.23, 95% CI, -178.51 - -151.94, P < 0.00001), ALT(SD = -33.14, 95% CI, -40.30 - -36.37, P < 0.00001),and AST(SD = -15.57, 95% CI, -17.05 - -14.09, P < 0.00001) levels. In terms of T-lymphocyte subsets in peripheral blood,the analysis also showed the percentage of CD3+, CD4+ cells and the ratio of CD4+/CD8+ cells in the CIK group increased compared with the non-CIK group. Based on GRADE, the level of evidence was GRADE 2C, and the strength of recommendation was 2. Conclusion: CIK cells combined with TACE therapy demonstrated a significant superiority in improving recent and forward curative effects, immunity function, quality of life and liver function of HCC patients. Based on GRADE, the level of evidence was GRADE 2C, and the strength of recommendation was 2. In the light of the limitations of this study, large-scale,high-quality clinical trials should be carried out to further confirmed the above conclusion.
Objective: The aim of the study was to evaluate the efficacy and safety of cytokine-induced killer (CIK) cell combined with transcatheter arterial chemoembolization (TACE) therapy in the treatment of hepatocellular carcinoma (HCC). Methods: Randomized controlled trials (RCTs) on CIK cells combination with TACE based-therapy were identified by electronic searches in the Cochrane Library, MEDLINE, Pubmed, Wanfang, VIP, CNKI and other electronic databases. We included any RCTs assigned CIK cell combination with TACE for the treatment of hepatocellular cancers. The quality of RCTs meeting was evaluated and data on short-term and long-term curative effects, quality of life, liver function and immunologic function were extracted. For quantitative data, we conducted meta-analysis with ReMan 5.1 software and the GRADE System was used to rate the level of evidence and strength of recommendation. For qualitative data, data mainly adopted descriptive methods. Results: The 9 RCTs i The meta-analysis showed significant survival benefit on 0.5-year survival rate (RR = 1.51, 95% CI, 1.35-1.69, P <0.00001) in favor of CIK based therapy. This effect was consistently at other prospective dates, including a 1-year survival rate (RR = 2.30, 95% CI, 1.94-2.72, P <0.00001) <0.0001). The CIK-based group also demonstrated a significantly prolonged time-to-progression (TTP) (SD = 1.62, 95% CI, 1.30-1.94, 20.6, 95% CI, 20.2-21.18, P <0.0001). Moreover, a favored response rate (RR = CR + PR) Further, patients in the CIK group showed lower AFP (SD = -165.23, P = 0.0008) 95% CI, -178.51 - -151.94, P <0.00001), ALT (SD = -33.14, 95% CI, -40.30- -36.37, P <0.00001), and AST (SD = -15.57, 95% CI, -17.05- -14.09, P <0.00001) also showed the percentage of CD3 +, CD4 + cells and the ratio of CD4 + / CD8 + cells in the CIK group increased compared with the non-CIK group. Based on GRADE, the level of evidence was GRADE 2C, and the strength of recommendation was 2. Conclusion: CIK cells combined with TACE therapy demonstrated a significant superiority in improving recent and forward curative effects, immunity function, quality of life and liver function of HCC patients. Based on GRADE, the level of evidence was GRADE 2C, and the strength of recommendation was 2. In the light of the limitations of this study, large-scale, high-quality clinical trials should be carried out further to confirm the above conclusion.