CT引导下^(125)I粒子植入术联合化疗治疗结直肠癌肺转移瘤的临床疗效和预后因素分析

CT-guided ^(125)I seeds implantation combined with chemotherapy in treatment of lung metastatic tumors from colorectal cancer:an analysis of clinical efficacy and prognostic tactors

目的:探讨计算机断层扫描(CT)引导下经皮穿刺^(125)I粒子植入术联合化疗治疗结直肠癌肺转移瘤的可行性,评估其临床疗效并分析预后影响因素。方法:回顾性分析2016年1月1日至2020年12月31日温州医科大学附属第五医院收治的97例结直肠癌肺转移瘤患者,根据不同的治疗方法分为联合治疗组(n=43)和对照组(n=54),联合治疗组接受经皮穿刺植入^(125)I粒子并联合化疗治疗,对照组采用单纯常规化疗治疗。收集患者一般临床资料,比较2组疗效及不良反应,末次随访时间为2022年1月1日。结果:联合治疗组靶病灶客观缓解率(ORR)、疾病控制率(DCR)高于对照组(P<0.05)。联合治疗组患者的中位无进展生存期(PFS)和总生存期(OS)均明显优于对照组(P<0.05)。治疗后联合治疗组CA19-9低于对照组(P<0.05)。2组患者所有不良反应均为1~2轻度不良反应。Cox回归模型显示,粒子植入术后(HR=0.35)、原发肿瘤TNM分期为Ⅰ-Ⅱ期(HR=2.59)、无瘤间期(DFI)>12个月(HR=1.71)以及ECOG评分0~1分(HR=2.18)患者PFS更长;原发TNM分期为Ⅰ-Ⅱ期(HR=2.08)、转移瘤数目≤3个(HR=2.27)及转移瘤部位为单肺(HR=2.61、3.30)患者OS更长。结论:CT引导下^(125)I粒子植入术联合化疗治疗结直肠癌肺转移瘤的疗效肯定,可作为主要治疗手段,且原发肿瘤TNM分期为影响PFS以及OS的独立危险因素,患者ECOG评分以及DFI与PFS有关,术前CA19-9水平、转移瘤数目及部位与OS有关。

Objective:To investigate the feasibility of percutaneous ^(125)I implantation guided by computed tomography combined with chemotherapy in the treatment of lung metastases of colorectal cancer,and to evaluate its clinical efficacy and prognostic factors.Methods:Retrospective analysis was performed on 97 patients with lung metastatic tumor of colorectal cancer admitted to the Fifth Affiliated Hospital of Wenzhou Medical University from January 1,2016 to December 31,2020.According to different treatment,they were divided into combination treatment group(n=43)and control group(n=54).The combination treatment group received percutaneous ^(125)I seed implantation combined with chemotherapy,while the control group was treated with conventional chemotherapy alone.With general clinical data collected,we compared the efficacy and adverse reactions of the two groups.The last follow-up was January 1,2022.Results:The target objective response rate(ORR)and the disease control rate(DCR)of the combined treatment group was 72.1%and 93.0%,respectively,with statistical difference(P<0.05).The survival time analysis of the two groups showed the median PFS and OS of the combined treatment group were significantly better,up to 13(7.0,16.0)months and 20.0(14.0,40.0)months,with significant difference(P<0.05).After 3 months of treatment,CA19-9 in the combined treatment group was lower than the control group,with statistical significance(P<0.05).There was no significant difference in the rate of adverse reactions after chemotherapy between the two groups(P>0.05).All adverse reactions in both groups were 1-2 mild adverse reactions.Cox proportional risk regression model analysis showed that after particle implantation(HR=0.35),the TNM stage of the primary tumor was stage I-II(HR=2.59),DFI>12 months(HR=1.71)and ECOG score 0-1(HR=2.18)patients had longer PFS;Patients with primary TNM stage I-II(HR=2.08),no more than 3 metastases(HR=2.27),and metastatic sites in a single lung(HR=2.61,3.30)had longer OS.Conclusion:CT-guided ^(125)I seed implantation combined with chemotherapy can be used as the preferred treatment for its effectiveness in the treatment of colorectal cancer lung metastases.The TNM stage of the primary tumor is found to be an independent risk factor affecting PFS and OS,with the ECOG score and DFI of patients related to PFS,and the preoperative CA19-9 level,the number and site of metastases related to OS.Therefore,patients with primary colorectal cancer stage TNM I and II benefit the most from ^(125)I seed implantation combined with chemotherapy.