Treg|免疫治疗前用TACE铺路，或是肝癌治疗的全新妙招！( 二 ) 妙招|组织|研究|分析表明|患者

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图4. T-与T+两组患者瘤内（Intratumoral）与癌旁(Peritumoral)组织PD-L1、IDO-1、Lag-3、CTLA-4、Tim-3表达分析对比
鉴于T细胞克隆可作为反映抗肿瘤治疗有效性的重要指标(7, 8) ，研究团队还检测了肿瘤组织内的T细胞克隆水平。结果发现，与未经TACE治疗相比， TACE治疗后肿瘤组织内的T细胞扩增克隆类型未见明显改变，表明TACE治疗无法影响肿瘤内T细胞克隆扩增（图5），看来TACE治疗并不能扩大“剑客”组织呀。

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图5. T-与T+两组患者肿瘤组织内T细胞克隆水平分析对比
TACE治疗对于中晚期肝癌患者具有一定疗效，但仍有局限性，结合免疫治疗也许可以为提升其效果带来突破。本篇研究从免疫微环境角度入手，揭示了TACE治疗引起肝癌内CD8+/PD-1+细胞和Treg细胞减少，同时促进了微环境内的免疫应答、炎性反应，表现出压下反派、举起利剑的架势。
阻断免疫检查点或VEGF等靶点是当下肿瘤治疗领域的大热点。已有研究报道CTLA-4抗体Tremelimumab与射频消融或热消融联用，在治疗进展期肝癌中能够明显促进CD8+ T细胞在肿瘤组织中的积累，呈现了较好的治疗效果(9) 。另外，抑制血管生成因子（VEGF）能够减弱Treg细胞的分化(10) 。以上提示TACE与ICI或VEGF抗体联用治疗肝癌是有很大研究空间的。
尽管本研究存在一定局限性，例如，未收集TACE治疗前的肿瘤标本，无法对比TACE治疗前后免疫微环境的变化，但其揭示的免疫微环境变化为后续探索更多免疫治疗手段或靶点带来了新的启示。

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