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  

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

作　　者：汪鑫[1] 张辉[2] 何晓军[2] 李新慧[1] 刘洋[1] 张洪义[1] 

机构地区：[1]安徽医科大学空军临床学院,合肥230023 [2]解放军空军总医院肝胆外科,北京100142

出　　处：《临床肝胆病杂志》2016年第3期518-521,共4页Journal of Clinical Hepatology

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)μg/L,t=2.13,P=0.03];A组与B组末次治疗后血清CEA水平比较差异有统计学意义[(10.53±8.62)μg/L vs(35.21±10.22)μg/L,t=5.23,P<0.01)];A组治疗客观有效率高于B组(66.7%vs 43.3%,Z=-2.042,P=0.041);A组生存时间长于B组,两组生存率比较差异有统计学意义(45.5%vs 23.3%,χ2=3.97,P=0.046)。结论对结直肠癌术后不可切除肝转移瘤的患者行精准序贯介入治疗能够改善患者免疫功能,提高治疗效果,延长患者生存时间。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 =

关 键 词：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 

分 类 号：R735.34[医药卫生—肿瘤]