栓塞联合冷冻消融对比索拉菲尼治疗Ⅲ期肾癌疗效评价  

Efficacy comparison for the treatment of stage Ⅲ renal cell carcinoma: transcatheter renal arterial embolization combined with cryoablation vs. sorafenib

作　　者：刘长富[1] 郭志[1] 邢文阁[1] 刘方[1] 司同国[1] 杨雪玲[1] 

机构地区：[1]天津医科大学肿瘤医院肿瘤介入治疗科、国家肿瘤临床医学研究中心、天津市“肿瘤防治”重点实验室,300060

出　　处：《介入放射学杂志》2015年第11期964-968,共5页Journal of Interventional Radiology

摘　　要：目的 对比选择性肾动脉栓塞（TRAE）联合冷冻消融与索拉菲尼治疗Ⅲ期肾癌的临床疗效。方法 回顾性分析2008年1月至2012年1月61例不适合或拒绝外科手术的Ⅲ期肾癌患者临床资料,依据接受治疗情况分为两组：（1）TRAE联合冷冻消融治疗组33例,在TRAE治疗后2-3周,接受冷冻消融治疗。（2）单纯口服索拉菲尼组28例。肿瘤最大径（3.8-11.2）cm,平均（5.3±2.2）cm,总计68个瘤灶。患者术后随访行影像学（CT或MRI或B超）检查,观察治疗前后患者ECOG评分、肿瘤变化、转移淋巴结变化和生存预后。结果 随访时间（8-38）个月,平均19.3个月。治疗前两组患者的性别、年龄、病灶大小、ECOG评分差异无统计学意义。联合治疗组客观有效率（PR、CR）66.7%,疾病控制率（PR、CR、SD）93.9%,索拉菲尼组分别为21.4%、85.7%,两组比较,差异有统计学意义（P〈0.05）。联合治疗组中位无进展生存期（mPFS）23个月、中位总生存期（mOS）35个月;索拉菲尼组分别为mPFS 19个月、mOS 34个月,联合治疗组mPFS较索拉菲尼组明显延长,差异有统计学意义（P〈0.05）,mOS联合组较索拉菲尼组略有延长但差异无统计学意义（P〉0.05）。治疗后两组转移淋巴结变化差异不具有统计学意义（P〉0.05）。联合治疗组和索拉菲尼组临床症状缓解率分别为92.9%（13/14）、80.0%（8/10）差异有统计学意义（P〈0.05）。两组患者治疗前后肾功能变化及ECOG评分未见明显改变,差异无统计学意义（P〉0.05）。结论 TRAE联合冷冻消融治疗Ⅲ期肾癌可以有效改善临床症状,提高肿瘤客观有效率和疾病控制率,延长m PFS及mOS,是不能手术Ⅲ期肾癌切实有效的方法之一。Objective To compare the clinical effect of selective transcatheter renal arterial embolization （TRAE） combined with cryoablation with that of sorafenib in treating stage Ill renal cell carcinoma. Methods A total of 61 patients with stage 111 renal cell carcinoma, who were admitted to author＇ s hospital during the period from January 2008 to January 2012 and who were not suitable for or refused to surgical operation, were included in this study. The clinical data were retrospectively analyzed. According to the treatment plan, the patients were divided into the study group （n=33） and the control group （n=28）. Patients in the study group received TRAE, which was followed by cryoablation 2-3 weeks later, while patients in the control group received sorafenib only. A total of 68 tumor lesions were detected, the maximum diameter of the tumors was （3.8-11.2） cm with a mean of （5.3±2.2） cm. Follow-up check-up with CT, MRI or B ultrasound were employed, the changes of ECOG score and tumor size were calculated, the changes of metastatic lymph nodes were determined and the survival prognosis was evaluated. Results All the patients were followed up for 8-38 months, with a mean of 19.3 months. No statistically significant differences in sex, age, tumor size and ECOG score existed between the two groups. The effective rate （CR＋PR） and disease control rate （PR＋CR＋SD） of the study group were 66.67% and 93.94% respectively, which were 21.43% and 85.71% respectively in the control group; the differences between the two groups were statistically significant （P〈0.05）. The median progression free survival （mPFS） time and the median overall survival （mOS） time of the study group were 23 months and 35 months respectively, while those of the control group were 19 months and 34 months respectively. The mPFS of the study group was obviously longer than that of the control group, and the difference between the two groups was statistically significant （P〈0.05）. The mOS of the study g

关 键 词：肾癌 冷冻消融 栓塞 介入 索拉菲尼 

分 类 号：R737.11[医药卫生—肿瘤]