4　肝癌的辅助免疫治疗

已有证据显示, 肝癌切除术后体内的免疫抑制得以解除,而且, 机体肿瘤负荷与免疫治疗效力呈负相关。因此, 辅助免疫治疗的策略即在治疗前最大限度地减少肿瘤负荷, 包括采取根治性肝癌切除术或肝癌减瘤切除术、肝癌无水酒精注射( TEI) 、肝癌射频消融术(RFA)等方法。同时, 导致肿瘤坏死或凋亡的局部治疗方法还可诱导内源性物质如热休克蛋白的释放, 这些物质作为天然佐剂可刺激机体的抗肿瘤免疫反应。有研究发现TEI和RFA治疗后可出现瞬时性DC激活,针对肝癌肿瘤相关抗原AFP的特异性CD4 +和CD8 + T细胞活力显著增强, 提示在主动和被动免疫治疗的同时结合局部辅助治疗可同步增强肝癌免疫治疗效力[ 13 ]。

5　结语

免疫治疗在肿瘤表达丰富特异性抗原蛋白时可以特异性识别并系统性清除体内肿瘤。目前, 多种不同的激活机体免疫的策略已经显示了抗肝癌的生物免疫活性和初步临床效力, 特别是应用过继性免疫治疗和针对肝癌新抗原靶点疫苗的临床试验证明, 这些方法能够影响肝癌复发和治疗后生存期。新的疫苗研究和开发可望进一步提高免疫治疗的敏感性和特异性, 在临床上发挥更重要的作用。

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