冷冻消融联合全身静脉化疗治疗晚期非小细胞肺癌的临床疗效及安全性评价

Evaluation on clinical efficacy and safety of cryoablation combined with intravenous chemotherapy in treatment of advanced non small cell lung cancer

目的：探讨氩氦冷冻消融联合全身静脉化疗与单纯静脉化疗、单纯氩氦冷冻消融治疗晚期非小细胞肺癌（NSCLC）的临床疗效及安全性的差异。方法：回顾性分析89例放化疗失败后在天津医科大学肿瘤医院介入科住院治疗的晚期NSCLC患者的临床资料,分为单纯化疗组（26例）、单纯冷冻消融治疗组（30例）和冷冻消融联合全身静脉化疗组（联合治疗组,33例）。治疗后2个月观察不良反应及并发症的发生情况,以FACT-G量表评价治疗前后生活质量;术后每1～2个月进行增强CT随访,通过改良实体瘤治疗评价标准评价肿瘤客观反应率;以Kaplan-Meier法分析无进展生存期和总生存期,Log-rank检验比较生存率差异。结果：与单纯化疗组比较,联合治疗组患者骨髓抑制、胃肠道反应和肝肾功能损伤等不良反应发生率差异无统计学意义（P〉0.05）。治疗后2个月3组患者与治疗前比较生活质量总评分均有不同程度改善,其中联合治疗组和单纯冷冻治疗组与治疗前比较差异有统计学意义（P〈0.05）,单纯化疗组与治疗前比较差异无统计学意义（P〉0.05）。治疗后2个月,与单纯化疗组比较,联合治疗组和单纯冷冻组患者肿瘤客观反应率差异有统计学意义（P〈0.05或P〈0.01）;与单纯冷冻组比较,联合治疗组患者肿瘤客观反应率差异无统计学意义（P〉0.05）。中位随访期为17个月,3组患者中位无进展生存期分别为联合治疗组11.1个月、单纯冷冻组6.9个月、单纯化疗组6.1个月,联合治疗组与其他2组比较差异有统计学意义（P〈0.05）。3组患者中位生存期分别为联合组16个月、单纯冷冻组13个月、单纯化疗组10个月,联合治疗组与其他2组比较差异有统计学意义（P〈0.05）。结论：氩氦冷冻治疗联合全身静脉化疗治疗放化疗失败的晚期NSCLC是一种安全、有效的方法,疗效优于单纯静脉化疗和单纯氩氦冷冻治疗。

Objective To explore the differences of clinical efficacy and safety between Argon helium cryoablation combined with intraveneous chemotherapy and intravenous chemotherapy,argon helium cryoablation in the treatment of advanced non small cell lung cancer（NSCLC）.Methods The clinical materials of 89 patients with advanced NSCLC and failure in radiotherapy and（or）chemotherapy treated in Department of Interventional Radiology of Cancer Hospital of Tianjin Medical University were analyzed,and they were divided into chemotherapy alone group（n=26）,cryoablation alone group（n=30）,and cryoablation combined with chemotherapy group（combination group,n=33）.The adverse reactions and complications after 2months of treatment were analyzed.FACT-G scale was used to evaluate the life quality of the patients before and 2months after treatment.After the treatment,every 1-2months the follow-up with enhanced CT was performed,the objective response rate of the tumor was evaluated by modified response evaluation criteria in solid tumors（mRECIST）.The progression-free survival and overall survival were analyzed with Kaplan-Meier method,and Log-rank test was used to identify the differences in the survival rate.Results Compared with chemotherapy alone group,the incidence rates of bone marrow suppression,gastrointestinal reaction,liver and kidney function damage of the patients in combination group had no significant differences（P〉0.05）.Two months after treatment,compared with before treatment,the total scores of life quality of the patients in three groups were improved in different degrees,and there were significant differences between before treatment and after treatment in combination group and cryoablation alone group（P〈0.05）,but there was no significant difference between before treatment and after treatment in chemotherapy alone group（P〉0.05）.Two months after treatment,the tumor response rates（CR＋PR）in combination group and cryoablation alone group were higher than that in chemotherapy alone group,and there was no significant difference between combination group and cryoablation alone group（P〉0.05）.The median followup period was 17 months,the median progression free survival of the patients in three groups were 11.1months in combination group,6.9months in cryoablation alone group,and 6.1months in chemotherapy alone group;there were significant differences between combination group and other two groups（P〈0.05）.The median survival of the patients in combination group,cryoablation alone group and chemotherapy alone group were 16 months,13 months and 10 months;there were significant differences between combination group and other two groups（P〈0.05）.Conclusion Cryoablation combined with chemotherapy is a safe and effective method in the treatment of the patients with advanced NSCLC after failure in radiotherapy and（or）chemotherapy,and its curative effect is better than intravenous chemotherapy and cryoablation alone.