精准序贯介入治疗结直肠癌术后不可切除肝转移瘤的临床效果观察

汪鑫; 张辉; 何晓军; 李新慧; 刘洋; 张洪义

doi:10.3969/j.issn.1001-5256.2016.03.025

精准序贯介入治疗结直肠癌术后不可切除肝转移瘤的临床效果观察

DOI: 10.3969/j.issn.1001-5256.2016.03.025

1. 安徽医科大学空军临床学院
2. 解放军空军总医院肝胆外科

详细信息

中图分类号: R735.34
计量
- 文章访问数: 2042
- HTML全文浏览量: 20
- PDF下载量: 422
- 被引次数: 0
出版历程
- 出版日期: 2016-03-20

Clinical effect of precise sequential interventional therapy in patients with unresectable hepatic metastasis after surgery for colorectal cancer

Clinical College of Air Force, Anhui Medical University

摘要

摘要: 目的探讨精准序贯介入治疗结直肠癌术后难以切除肝转移瘤的疗效。方法收集2005年1月-2012年9月解放军空军总医院收治的63例结直肠癌术后不可切除肝转移瘤患者的临床资料。依据治疗方式不同分为两组:精准序贯介入治疗组（A组,n=33）和全身化疗组（B组,n=30）。A组采用肝动脉化疗栓塞术（TACE）联合射频消融（RFA）治疗,B组采用全身化疗治疗。所有患者均于首次治疗前后检测外周血CD3+、CD4+、CD8+阳性细胞百分比和CD4+/CD8+比值。检测并比较首次治疗前、末次治疗后患者血清肿瘤标志物癌胚抗原（CEA）的情况,随访观察患者肿瘤进展及患者生存情况。计量资料两组间比较采用t检验;计数资料组间比较采用χ2检验或Wilcoxon秩和检验;两组生存率比较采用Log-Rank检验。结果 A组首次治疗前与首次治疗后CD3+、CD4+、CD8+阳性细胞百分比及CD4+/CD8+比较,差异均有统计学意义（t值分别为4.52、-3.27、2.95、4.54,P值均<0.05）;A组治疗前后血清CEA水平比较差异有统计学意义[（38.76±9.57）μg/L vs（10.53±8.62）μ...
- 结直肠肿瘤 /
- 肿瘤转移 /
- 化学栓塞,治疗性 /
- 导管消融术 /
- 治疗结果
Abstract: Objective To investigate the clinical effect of precise sequential interventional therapy in patients with unresectable hepatic metastasis after surgery for colorectal cancer. Methods The clinical data of 63 patients with unresectable hepatic metastasis after surgery for colorectal cancer,who were admitted to Air Force General Hospital,PLA from January 2005 to September 2012,were collected. According to therapeutic methods,these patients were divided into precise sequential interventional therapy group( group A,33 patients) and systemic chemotherapy group( group B,30 patients). The patients in group A underwent transcatheter arterial chemoembolization and radiofrequency ablation,and those in group B underwent systemic chemotherapy. The percentages of peripheral blood CD3+,CD4+,and CD8+T cells and CD4+/ CD8+ratio were measured before and after the initial treatment. The level of carcinoembryonic antigen( CEA) was measured and compared before the initial treatment and after the final treatment,and follow- up was conducted to observe tumor progression and survival.The t- test was applied for comparison of continuous data between groups; the chi- square test was applied for comparison of categorical data between groups; the Wilcoxon rank sum test was applied for comparison of clinical effect; the Log- Rank test was applied for comparison of survival rate. Results In group A,the percentages of CD3+,CD4+,and CD8+T cells and CD4+/ CD8+ratio changed significantly after the initial treatment( t = 4. 52,- 3. 27,2. 95,and 4. 54,all P < 0. 05); serum CEA level also changed significantly after treatment( 38. 76 ± 9. 57) μg/ml vs( 10. 53 ± 8. 62) μg/ml,t = 2. 13,P = 0. 03). The serum level of CEA after the final treatment showed a significant difference between group A and group B( 10. 53 ± 8. 62) ug / L vs( 35. 21 ± 10. 22) μg / L; t = 5. 23,P < 0. 01). Group A had a significantly higher objective response rate than group B( 66. 7% vs 43. 3%; Z =- 2. 042,P = 0. 041). Group A had a significantly longer survival time than group B,and group A had a significantly higher surrival rate than group B( 45. 5% vs 23. 3%,χ2= 3. 97,P = 0. 046).Conclusion In patients with unresectable hepatic metastasis after surgery for colorectal cancer,precise sequential interventional therapy can improve their immune function,increase clinical outcome,and prolong survival time.
- colorectal neoplasms /
- neoplasm metastasis /
- chemoembolization,therapeutic /
- catheter ablation /
- treatment outcome

HTML全文

参考文献(18)

[1]LIU HZ,YANG BQ,LI YS,et al.Retrospective clinical analysis of 63 patients with liver metastasis of colorectal cancer[J/CD].Chin J Oper Proc Gen Surg:Electronic Edition,2012,6(2):41-43.(in Chinese)刘洪洲,杨丙全,李永胜,等.63例大肠癌肝转移患者的回顾性临床分析[J/CD].中华普外科手术学杂志:电子版,2012,6(2):41-43.

[2]DAI Z,ZHENG RS,ZOU XN,et al.Analysis and prediction of colorectal cancer incidence trend in China[J].Chin J Prevent Med,2012,46(7):598-603.(in Chinese)代珍,郑荣寿,邹小农,等.中国结直肠癌发病趋势分析和预测[J].中华预防医学杂志,2012,46(7):598-603.

[3]WENG HW,CAI XL.Investigation of quality of life and psychological conditions in patients with colorectal cancer[J/CD].J Dig Oncol:Electronic version,2014,6(1):23-27.(in Chinese)翁慧雯,蔡晓琳.结直肠患者生活质量及心理状况的调查研究[J/CD].消化肿瘤杂志:电子版,2014,6(1):23-27.

[4]KUMAR R,PRICE TJ,BEEKE C,et al.Colorectal cancer survival:an analysis of patients with metastatic disease synchronous and metachronous with the primary tumor[J].Clin Colorectal Cancer,2014,13(2):87-93.

[5]ABDALLA EK,JEAN-NICOLAS V,ELLIS LM,et al.Recurrence and outcomes following hepatic resection,radiofrequency ablation,and combined resection/ablation for colorectal liver metastases[J].Ann Surg,2004,239(6):818-827.

[6]GLEISNER AL,CHOTI MA,LIA A,et al.Colorectal liver metastases:recurrence and survival following hepatic resection,radiofrequency ablation,and combined resection-radiofrequency ablation[J].Arch Surg,2008,143(12):1204-1212.

[7]PULITANC,BODINGBAUER M,ALDRIGHETTI L,et al.Liver Resection for colorectal metastases in presence of extrahepatic disease:results from an international multi-institutional analysis[J].Ann Surg Oncol,2011,18(5):1380-1388.

[8]MICHAEL V,LAURA K,ROHI A,et al.Radiological-pathological analysis of WHO,RECIST,EASL,mRECIST and DWI:imaging analysis from a prospective randomized trial of Y90±sorafenib.[J].Hepatology,2013,58(5):1655-1666.

[9]DONG JH,HUANG ZQ.Precise liver resection——new concept of liver surgery in 21st century[J].Chin J Surg,2010,47(21):1601-1605.(in Chinese)董家鸿,黄志强.精准肝切除——21世纪肝脏外科新理念[J].中华外科杂志,2010,47(21):1601-1605.

[10]CABIBBO G,LATTERI F,ANTONUCCI M,et al.Multimodal approaches to the treatment of hepatocellular carcinoma[J].Nat Clin Pract Gastroenterol Hepatol,2009,6(3):159-169.

[11]ZHANG HY,FENG ZQ,ZHANG HY,et al.Efficacy of precise sequential therapy for primary liver cancer[J].Chin J Digest Surg,2012,11(1):73-78.(in Chinese)张洪义,冯志强,张宏义,等.原发性肝癌精准序贯治疗的疗效分析[J].中华消化外科杂志,2012,11(1):73-78.

[12]CANNON R,ELLIS S,HAYES D,et al.Safety and early efficacy of irreversible electroporation for hepatic tumors in proximity to vital structures[J].J Surg Oncol,2013,107(5):544-549.

[13]VOGL TJ,FARSHID P,NAGUIB NN,et al.Thermal ablation of liver metastases from colorectal cancer:radiofrequency,microwave and laser ablation therapies[J].Radiol Med,2014,7(119):451-461.

[14]WAITZ R,SOLOMON S.Can local radiofrequency ablation of tumors generate systemic immunity against metastatic disease?[J].Radiology,2009,251(1):1-2.

[15]HAEN SP,PEREIRA PL,SALIH HR,et al.More than just tumor destruction:immunomodulation by thermal ablation of cancer[J].Clin Dev Immunol,2011,2011:160250.

[16]GOLDBERG SN.Science to practice:can we expand focal interventional oncologic ablation treatments into an effective systemic therapy?[J].Radiology,2013,267(2):321-323.

[17]DROMI S,WALSH MS,TRAUGHBER B,et al.Radiofrequency ablation induces antigen-presenting cell infiltration and amplification of weak tumor-induced immunity[J].Radiology,2009,251(1):58-66.

[18]WISSNIOWSKI TT,HAENSLER J,SCHUPPAN D,et al.Activation of tumor specific T-lymphocytes caused by radio frequency ablation of liver tumors-a patient study[J].Gastroenterology,2003,124(4):a772.

施引文献

资源附件(0)

访问统计