载药微球TACE联合全身系统治疗方案在消化道恶性肿瘤肝转移患者中的疗效观察

Drug-eluting beads transcatheter arterial chemoembolization plus systematic chemotherapy in treating patients with digestive tract cancer complicated by liver metastasis: observation of its clinical efficacy

目的评价载药微球经动脉介入化疗栓塞术(D-TACE)联合全身治疗方案在消化道恶性肿瘤肝转移患者中的疗效。方法选择2019年6月1日至2021年3月1日简阳市人民医院和成都医学院第一附属医院收治的晚期消化道恶性肿瘤患者50例,随机分为实验组和对照组,每组25例。实验组采用D-TACE联合系统治疗,对照组仅采用系统治疗。观察两组间肝内病灶疗效、整体疗效、肝内无疾病进展时间、整体无疾病进展时间、进展部位、治疗相关不良反应、整体化疗周期及次均费用等指标。结果实验组与对照组患者的肝内病灶总缓解率为76%比36%、整体总缓解率为48%比20%、肝内病灶无疾病进展时间为(6.80±0.56)个月比(4.84±0.35)个月、整体无疾病进展时间为(4.76±0.34)个月比(3.84±0.29)个月,差异均有统计学意义(χ^(2)=8.117、4.367,t=9.243、4.312,均P<0.05)。实验组患者肝内进展例数少于对照组分别为7例和14例(χ^(2)=4.023,P=0.045)。实验组患者的肝区疼痛、肝功能异常和发热多于对照组分别为48%比20%、36%比12%、56%比8%,差异均有统计学意义(χ^(2)=4.367、3.947、13.235,均P<0.05)。实验组化疗周期数为(4.28±1.31)次,差异无统计学意义(t=-1.664,P=0.103)。对照组为(3.64±1.41)次,实验组次为(26311.24±7646.89)元,对照组为(9187.92±1711.35)元,差异有统计学意义(t=-10.926,P<0.01)。结论D-TACE联合全身系统治疗方案在消化道恶性肿瘤肝转移患者中的疗效确切,在提高患者肝内病灶的控制率的同时也有助于整体疾病的控制。

Objective To evaluate the clinical efficacy of CalliSpheres drug-eluting beads transcatheter arterial chemoembolization(DEB-TACE)plus systematic chemotherapy in treating patients with digestive tract malignancy complicated by liver metastasis.Methods A total of 50 patients with advanced digestive tract malignancy,who were admitted to Jianyang Municipal People's Hospital or First Affiliated Hospital of Chengdu Medical College of China to receive treatment between January 1,2019 and March 1,2021,were enrolled in this study.The patients were randomly divided into study group(n=25)and control group(n=25).DEB-TACE plus systematic chemotherapy was adopted for the patients of the study group,while only systematic chemotherapy was employed for the patients of the control group.The total remission rate of the intrahepatic lesion,the overall response rate(ORR),the progression-free survival(PFS)of intrahepatic lesion,the overall PFS,the recurrent site,the treatment-related adverse events,the total chemotherapy cycle and the average cost of each therapeutic cycle of the two groups were calculated.Results In the study group and the control group,the total remission rate of the intrahepatic lesion was 76%and 36%respectively(P=0.004),the ORR was 48%and 20%respectively(P=0.037),the PFS of intrahepatic lesion was(4.84±0.35)months and(6.80±0.56)months respectively(χ^(2)=9.243,P=0.002),and the overall PFS was(3.84±0.29)months and(4.76±0.34)months respectively(χ^(2)=4.312,P=0.038),the differences in all the above indexes between the two groups were statistically significant(P<0.05).Intrahepatic lesion progression was seen in 7 patients in the study group,which was seen in 14 patients in the control group(χ^(2)=4.023,P=0.045).The incidences of hepatalgia,liver dysfunction and fever in the study group were 48%,36%and 56%respectively,which in the control group were 20%,12%and 8%respectively,and the differences in all the above indexes between the two groups were statistically significant(χ^(2)=4.367,χ^(2)=3.947 andχ^(2)=13.235,respectively,all P<0.05).The mean chemotherapy cycles performed in the control group were(3.64±1.41)times,which in the study group were(4.28±1.31)times,the difference between the two groups was not statistically significant(t=-1.664,P=0.103).The average cost of each therapeutic cycle in the control group was(9187.92±1711.35)RMB,which in the study group was(26311.24±7646.89)RMB,the difference between the two groups was statistically significant(t=-10.926,P<0.01).Conclusion For the treatment of patients with digestive tract malignancy complicated by liver metastasis,DEB-TACE plus systematic chemotherapy carries reliable efficacy.While improving the control rate of intrahepatic lesions,this therapeutic scheme also contributes to the overall control of the disease.(J Intervent Radiol,2022,31:995-999)