基于超声引导下微波消融胰腺癌肝转移的疗效探讨及其受益人群筛选

Analysis of the therapeutic effect of ultrasound-guided microwave ablation in the treatment of liver metastasis of pancreatic cancer and the selection of beneficiaries

目的评价超声引导下微波消融治疗胰腺癌肝转移的疗效,筛选消融治疗受益人群。方法选取于我院行超声引导下微波消融治疗的胰腺癌肝转移患者41例,对肝脏转移病灶均行完全消融,以患者死亡为随访终点,分析患者总体生存时间、并发症发生情况。收集患者一般资料及实验室检查结果,采用单因素及多因素Cox回归分析筛选胰腺癌肝转移患者预后的独立影响因子,并建立预测患者术后半年和1年生存率的联合诊断模型;绘制校准曲线和决策曲线评估该模型的有效性和临床收益;绘制时间依赖受试者工作特征曲线并根据约登指数最大值将纳入患者分为高危组和低危组,绘制生存曲线评估并比较两组生存情况的差异。结果41例胰腺癌肝转移患者中位随访时间12(4,15)个月;其中19例在1年内死亡,22例存活1年以上,中位生存时间12(6,14)个月;所有患者微波消融后均无主要并发症发生。单因素及多因素Cox回归分析显示,糖类抗原(CA)125、病灶综合大小均为胰腺癌肝转移患者预后的独立影响因子(HR=1.004、1.110,P=0.012、0.021)。基于CA199、CA125、病灶综合大小建立联合预测模型,校准曲线显示该模型具有良好的区分能力和校准度;决策曲线显示该模型预测胰腺癌肝转移患者术后半年和1年生存率均可获得临床收益。以列线图总分33分为截断值,将纳入患者分为高危组18例和低危组23例,两组中位生存时间比较[7(5,11)个月vs.15(13,18)个月],差异有统计学意义(P=0.046)。结论胰腺癌肝转移低危患者接受超声引导下微波消融治疗后生存时间明显延长,可以获得较好的临床收益。

Objective To evaluate the therapeutic effect of ultrasound-guided microwave ablation in the treatment of liver metastasis of pancreatic cancer,and to select the beneficiaries.Methods A total of 41 patients with liver metastasis of pancreatic cancer who received microwave ablation in our hospital were collected.The metastatic lesions of the liver were ablated completely.With death as the end point of follow-up,the overall survival time and complications of the patients were analyzed.General data and laboratory test results were collected.Univariate analysis and multivariate Cox regression analysis were used to screen independent influencing factors for prognosis in patients with liver metastasis of pancreatic cancer model for predicting the survival rate of patients at 6 months and 1 year after operation were established.Calibration curve and decision curve were drawn to evaluate the effectiveness and clinical benefit of the model.Time-dependent subject work characteristic curve was drawn and the patients were divided into high-risk group and low-risk group according to the Youden index,and survival curves was drawn to compare the difference in survival between the two groups.Results The median follow-up time of 41 patients with liver metastasis of pancreatic cancer was 12(4,15)months,19 of them died within 1 year,and 22 of them survived for more than 1 year,the median survival time was 12(6,14)months.No serious complications occurred in all patients after microwave ablation.Univariate analysis and multivariate Cox regression analysis showed that CA125,comprehensive lesion size were independent influencing factors for prognosis in patients with liver metastasis of pancreatic cancer(HR=1.004,1.110,P=0.012,0.021).The combined prediction model was established based on CA199,CA125 and the comprehensive size of lesions.The calibration curve showed that the model had good differentiation ability and calibration degree.The decision curve showed that the model has clinical benefits in predicting 6 months and 1 year survival in patients with liver metastasis of pancreatic cancer.All patients were divided into high-risk group(18 cases)and low-risk group(23 cases)according to the cut-off value of the total score of the nomogram(33),and the median survival time between the two groups was statistically significant[7(5,11)months vs.15(13,18)months,P=0.046].Conclusion Low-risk patients with pancreatic cancer liver metastasis have significantly longer survival time after microwave ablation treatment,and significant clinical benefits could be obtained.