CalliSpheres载药微球经肝动脉化疗栓塞治疗全身化疗失败的不可切除结直肠癌肝转移的疗效及预后因素分析

Efficacy and prognostic factors of CalliSpheres drug-eluting bead transarterial chemoembolization on unresectable colorectal cancer liver metastases with systemic chemotherapy failure

目的 观察CalliSpheres载药微球经肝动脉化疗栓塞术(drug-eluting bead transarterial chemoembolization,DEBTACE)治疗全身化疗失败的不可切除结直肠癌肝转移的疗效与安全性。方法 回顾性分析2018年6月—2020年6月山东省临沂市肿瘤医院收治的42例至少接受二线全身化疗失败的不可切除结直肠癌肝转移患者的临床资料,所有患者均接受100~300μm CalliSpheres载药微球加载伊立替康的TACE治疗,评价DEB-TACE术后的肿瘤反应情况,并分析不良反应、总生存期(overall survival,OS)、无进展生存期(progression-free survival,PFS)及影响OS的因素。结果接受DEB-TACE术后2、4、6个月的客观缓解率分别为83.3%、81.0%、71.4%,疾病控制率分别为100.0%、90.5%、80.9%,中位PFS为11.0个月,中位OS为16.0个月。主要不良反应有发热、疼痛、恶心呕吐等,均以1~2级为主,未见异位栓塞等严重并发症发生。多因素Cox回归分析显示,同时性肝转移(HR=0.446,95%CI:0.279~0.780,P=0.002)和肝外转移(HR=0.311,95%CI:0.134~0.968,P=0.007)是影响OS的独立危险因素。结论 DEB-TACE用于治疗全身化疗失败的不可切除结直肠癌肝转移患者可取得良好的临床疗效,不良反应可控,但同时性肝转移及合并肝外转移患者预后不良。

ObjectiveTo observe the efficacy and safety of Callispheres drug-eluting bead transarterial chemoembolization(DEBTACE) on the unresectable colorectal cancer liver metastases with systemic chemotherapy failure.MethodsThe clinical data of 42patients with unresectable colorectal cancer liver metastasis who failed at least second-line systemic chemotherapy and admitted to Linyi Cancer Hospital of Shandong province from June 2018 to June 2020 were retrospectively analyzed.All patients received TACE with 100-300 μm Callispheres microspheres loaded with irinotecan.The tumor response was evaluated after DEB-TACE,the overall survival(OS),progression-free survival(PFS),adverse reactions during treatment and the factors affecting the OS were analyzed.ResultsAt 2,4 and 6 months after DEB-TACE,the objective response rate(ORR) were 83.3%,81.0% and 71.4%,respectively;the disease control rate(DCR) were 100.0%,90.5% and 80.9%,respectively;the median PFS was 11.0 months and the median OS was16.0 months.The main adverse reactions were fever,pain,nausea and vomiting,which occurred mainly in grade 1-2 patients,and no serious complications such as ectopic embolism occurred.Multivariable Cox regression analysis showed that simultaneous liver metastasis(HR=0.446,95%CI:0.279-0.780,P=0.002) and extrahepatic metastasis(HR=0.311,95%CI:0.134-0.968,P=0.007) were independent risk factors affecting OS.ConclusionsDEB-TACE has certain clinical efficacy and manageable adverse reactions in the treatment of patients in unresectable colorectal cancer liver metastases with systemic chemotherapy failure,while the prognosis of patients with simultaneous liver metastasis or extrahepatic metastasis is poor.