RESUMO
Colorectal cancer is one of the leading causes of deaths in China. The initial stages of colorectal cancer can be treated by surgery, radiation, and chemotherapy. However, in the advanced stages, it warrants an application of multimodality treatment. With advances in the medical field, there are applications of new modality of treatment that could possibly provide the appropriate treatment for the advanced stage tumours. The first site of metastasis after colorectal cancer is the liver and the conventional treatment to cure the metastatic lesion involves the administration of chemotherapy. With further advancement, chemotherapy has been directly administered at the thorough transarterial chemoembolization (TACE) which is a vascular intervention. With further advancement, the nonvascular intervention, such as radiofrequency ablations (RFAs), has been administered to the patients. A large amount of data support the use of vascular intervention (TACE) with ablation for hepatic carcinoma; there is no sufficient literature to support the application of the modality in the metastatic liver lesion. In this prospective observational study, we have enrolled 80 patients with metastatic liver lesion from the adenocarcinoma of colon or rectum, treated the patients with a combination of the TACE and ablation therapy, and followed up the patients for a period of 3 years. A multivariate analysis of the various factors that influence the prognosis and outcome has been studied and it has been concluded that the combination therapy is medically beneficial for individuals with aggressive liver lesions, improving overall as well as progression-free life span.
RESUMO
BACKGROUND: The T lymphocyte subset levels are an indicator used to evaluate the immune status of the body. In recent years, many studies have investigated the correlation between T lymphocyte subset levels and postoperative infection. OBJECTIVES: To investigate the incidence of infection after liver cancer interventional therapy and its influence on T lymphocyte subset levels and toll-like receptors (TLRs). MATERIAL AND METHODS: A total of 325 patients with primary liver cancer receiving interventional therapy were divided into an infection group (n = 37) and a non-infection group (n = 288). The infection site and the distribution of pathogenic bacteria in the infection group were observed. The serum T lymphocyte subset level and TLR2 and TLR4 levels in peripheral blood mononuclear cells were compared. The clinical value of the postoperative TLR2 and TLR4 levels in evaluating infection was analyzed using receiver operating characteristic (ROC) curves. RESULTS: Among 51 strains of pathogens isolated from the infected patients, strains of Escherichia coli (27.45%) and Pseudomonas aeruginosa (19.61%) were the most commonly observed. After surgery, the levels of CD3+, CD4+ and CD4+/CD8+ decreased, while the level of CD8+ increased in both groups; the levels of TLR2 and TLR4 decreased in the non-infection group, while the levels of TLR2 and TLR4 increased in the infection group (all p < 0.05). Furthermore, the decreases and increases were more significant in the infection group than in the non-infection group (all p < 0.001). The area under the curve of postoperative TLR2 and TLR4 levels in evaluating infection were greater than 0.700 (p < 0.001). CONCLUSIONS: Gram-negative bacteria account for the majority of infections in patients after liver cancer interventional therapy, and the main infection sites are the lung and abdomen. The infected patients show changes in T lymphocyte level and decreased immune function. The TLR2 and TLR4 can be used as auxiliary indicators to evaluate infection after surgery.
