p53基因治疗对鼻咽癌患者局部免疫及预后的影响  

Effect of p53 gene therapy on the local immunity and the prognosis in patients with nasopharyngeal carcinoma

作　　者：覃扬达[1] 翁敬锦[1] 司勇锋[1] 韦海明[2] 张政[1] 兰桂萍[1] 孙金杰[1] 

机构地区：[1]广西壮族自治区人民医院耳鼻咽喉头颈肿瘤科,南宁530021 [2]广西壮族自治区人民医院病理科,南宁530021

出　　处：《中国临床新医学》2015年第2期109-113,共5页CHINESE JOURNAL OF NEW CLINICAL MEDICINE

基　　金：广西卫生厅科研课题(编号:Z2008062);广西医疗卫生重点科研课题(编号:重200721)

摘　　要：目的探讨p53基因治疗后鼻咽癌患者的局部免疫变化及其对肿瘤复发和转移的影响。方法63例经病理确诊的初治中、晚期鼻咽癌患者分为p53治疗组[32例,采用p53腺病毒(r Ad-p53)鼻咽部瘤体内注射和同步放、化疗]和常规治疗组(31例,采用同步放、化疗)。采用免疫组织化学方法检测治疗前、后鼻咽部肿瘤浸润淋巴细胞的T细胞受体CD3和B细胞受体CD20的表达情况,了解肿瘤组织的局部免疫状态;统计患者在治疗后定期回院的复查结果以及随访资料,了解患者的生存率及肿瘤的复发和转移情况。结果p53治疗组治疗后肿瘤组织中的CD3表达比治疗前明显增加(P<0.05),治疗前、后CD20的表达差异无统计学意义(P>0.05)。p53治疗组和常规治疗组复发和转移率差异有统计学意义(P<0.05),p53治疗组5年无瘤生存率优于常规治疗组(P<0.05)。结论 p53基因治疗后鼻咽部肿瘤中的肿瘤浸润淋巴细胞增殖以T细胞为主,治疗后的局部细胞免疫状态较治疗前有明显提高,肿瘤的复发和转移率降低,基因治疗联合放化疗可能有助于改善鼻咽癌的预后。Objective To investigate the local immune function and prognosis in patients with nasopharyngeal carcinoma（ NPC） treated with p53 gene therapy. Methods Sixty-three cases of advanced nasopharyngeal carcinoma were divided into p53 therapy group（ n = 32） and conventional therapy group（ n = 31）. The p53 therapy group was treated by concurrent radiotherapy and chemotherapy plus nasopharynx intratumaral injection of r Ad-p53; the conventional therapy group was treated by concurrent radiotherapy and chemotherapy. The expression of CD3 and CD20 were examined by immunochemistry and their relationship with prognosis was also analyzed. Results The expression of CD3 was significantly increased after p53 gene treatment. There was no significant change in expression of CD20 after p53 gene treatment. Five-year disease-free survival rate in the p53 therapy group was higher than that in the conventional therapy group（ P〈0. 05）. Recurrence and metastasis rate was significantly different between p53 therapy group and the conventional therapy group（ P〈0. 05）. Conclusion T cells are the most important proliferative cell of tumor infiltrating lymphocyte in NPC patients after p53 gene therapy. The local cellular immune status in NPC patients is improved after p53 gene therapy with decrease of tumor recurrence rate and metastasis rate. Gene therapy combined with radiotherapy and chemotherapy may help to improve the prognosis of patients with NPC.

关 键 词：鼻咽肿瘤 RAD-P53 局部免疫 预后 

分 类 号：R739.63[医药卫生—肿瘤]