应用经皮氩氦冷冻消融术姑息性治疗恶性实体肿瘤后肿瘤进展的相关因素分析

Factors of Tumor Progression after Percutaneous Cryoablation for Non-radical Treatment of Solid Malignant Tumor

目的:分析应用经皮氩氦冷冻消融术姑息性治疗恶性实体肿瘤后肿瘤进展的相关因素。方法:回顾性搜集2012年8月-2017年6月上海市第一人民医院收治的因患有恶性实体肿瘤行姑息性经皮氩氦冷冻消融术患者的相关临床资料,并随访至2017年11月,搜集患者随访结束时的临床资料。将总消融例数根据消融后肿瘤进展情况分为比较肿瘤进展和肿瘤非进展组,比较患者的一般临床特征。将消融后进展的病例列出,比较消融前和进展时相关检验结果差异,探寻肿瘤进展原因。结果:共82次经皮氩氦冷冻消融术在2012年8月-2017年6月间进行,35名患者所行的41次消融被纳入本研究,所有病人接受的经皮氩氦冷冻消融术次数均不大于2次,41次经皮氩氦冷冻消融术共消融42枚病灶,其中一次消融术同时消融了2枚肝内病灶。35名患者按照肿瘤全身进展与否分为肿瘤进展组(n=26)及肿瘤非进展组(n=9),有统计学差异的指标包括:消融处为原发肿瘤,随访截止/进展时间,消融前至随访截止/肿瘤进展时存在化疗相关性粒细胞缺乏,消融前粒细胞与淋巴细胞比值(ratio of peripheral neutrophils to lymphocyte,NLR)>3。对于消融后判定为全身肿瘤进展的30次经皮氩氦冷冻消融术,对比消融前及进展时的各项指标,有统计学意义的指标是血浆白蛋白值和NLR>3。最后,应用上述有统计学意义的计数资料通过Cox回归分析评定为肿瘤进展的30次消融的无进展生存时间,结果均无统计学意义。结论:作为综合治疗的一部分,氩氦冷冻消融术姑息性治疗恶性实体肿瘤后的肿瘤进展因素中,对于原发肿瘤的消融是肿瘤进展的不利因素,化疗相关性粒细胞缺乏、NLR>3、低血浆白蛋白水平是肿瘤进展的有利因素。

Objective： To investigate the influence factors of tumor progression after percutaneous cryoablation for non-radical treatment of solid malignant tumor. Methods： We retrospectively analyzed parameters of all patients receiving cryoablation for non-radical treatment from Aug 2012 to Jun 2017, and provided follow-ups until Nov 2017. We separated the cryoablation into two groups by tumor progression to analyze the significance, and analyzed laboratory results before ablations and at the time of progression of the ablations applied to the whole-body tumor progression. Results： There were 82 cryoablations performed from August 2012 to June 2017. 41 times（35 patients, 42 lesions） of cryoablations remained according to the following conditions： uncontrolled distance lesions beside the ablation one（s） or a very large lesion which can＇t be ablated completely. Among the 41 cryoablations, no more than twice of the ablations were performed for one same patient. The two lesions that ablated in one of the cryoablation treatment were both hepatic lesions. 35 patients were separated into two groups by tumor progression of the whole body： progression group（n=26） and non-progression group（n=9）. The statistical significant comparisons of the two groups included ablation for primary tumor, time of follow-up/progression,chemotherapy-induced neutropenia until follow-up/progression, neutrophil/lymphocyte〉3 at pre-ablation period. We analyzed the lab results of the 30 ablations with the whole-body tumor progression before ablations and at the time of progression, and then separated them into two groups according to the time. The statistical significant comparisons of different times of the two groups included albumin, neutrophil/lymphocyte〉3. Then for the progression-free survival of 30 ablations that applied to the whole-body tumor progression, the statistical significant comparisons in Table 2, including ablation for primary tumor, chemotherapy-induced neutropenia until progression and neutrophil/lymphocyte3 at preablation period, were analyzed by using multivariate analysis with a Cox proportional-hazards model, estimating hazard ratios（HRs） and 95% confidence intervals（CIs）, but none of them were statistical significant comparisons. Conclusions：For non-radical treatment of solid malignant tumors via percutaneous cryoablation with or without other anti-neoplastic treatments, ablation for primary tumor is a protective factor for tumor progression, and the prognostic factors for tumor progression include： chemotherapy-induced neutropenia, NLR3, a low level of serum albumin.