CT引导^125I粒子植入治疗头颈部复发转移肿瘤近期疗效的影响因素分析  

Factors influencing the short-term efficacy of CT-guided 125I seeds implantation in the treatment of recurrent and metastatic tumors of head and neck

作　　者：陈恩立 张宏涛[2] 刘泽洲[2] 赵金鑫[2] 徐克 梁岩松 隋爱霞[2] 王娟[2] Chen Enli;Zhang Hongtao;Liu Zezhou;Zhao Jinxin;Xu Ke;Liang Yansong;Sui Aixia;Wang Juan(Graduate School of Hebei Medical University,Shijiazhuang 050017,China;SectionⅠ,Department of Oncology,Hebei General Hospital,Hebei Provincial Radioactive Seeds Brachytherapy Institute,Hebei Provincial Tumor Radioactive Seeds Implantation Diagnosis and Treatment Center,Shijiazhuang 050051,China)

机构地区：[1]河北医科大学研究生学院,石家庄050017 [2]河北省肿瘤放射性粒子植入诊疗中心、河北省放射性粒子近距离治疗研究所、河北省人民医院肿瘤一科,石家庄050051

出　　处：《中华核医学与分子影像杂志》2020年第2期93-97,共5页Chinese Journal of Nuclear Medicine and Molecular Imaging

基　　金：河北省重点研发计划项目(19277782D)。

摘　　要：目的分析CT引导^125I粒子植入治疗头颈部复发转移肿瘤近期疗效的影响因素。方法回顾性纳入2015年1月至2019年4月于河北省人民医院行^125I粒子植入治疗的73例头颈部复发转移肿瘤患者[男61例、女12例,年龄(59.1±11.5)岁],植入粒子活度11.1~29.6 MBq,处方剂量80.0~145.0 Gy。植入术后3个月行CT检查,参考实体瘤疗效评价标准(RECIST)1.1评价近期疗效:有效[完全缓解(CR)和部分缓解(PR)]和无效[病情稳定(SD)和病情进展(PD)]。将影响近期疗效的因素[性别、年龄、既往放疗史、卡氏功能状态(KPS)评分、病理类型、肿瘤最长径、植入方式、粒子活度、术后即刻90%大体肿瘤体积接受的剂量(D90)、术后是否行辅助化疗]先行单因素分析,将P<0.2的变量纳入logistic回归模型;另以所有影响因素为自变量、近期疗效为因变量,构建人工神经网络(ANN);最后对logistic分析和ANN分析共有影响因素行受试者工作特征(ROC)曲线分析。结果73例患者中,34例有效,39例无效。Logistic回归分析结果显示,肿瘤最长径、术后即刻D90、术后是否行辅助化疗对疗效有显著影响(Wald值:6.950、4.804、4.790,均P<0.05);ANN分析结果显示,预测疗效重要性的前5位因素依次为术后即刻D90、肿瘤最长径、年龄、粒子活度和性别。ROC曲线分析结果示,肿瘤最长径、术后即刻D90是近期疗效的最佳预测因子,最佳阈值分别为5.25 cm和110.05 Gy,对应的曲线下面积(AUC)分别为0.843和0.847(均P<0.001)。结论头颈部复发转移肿瘤^125I粒子植入治疗的近期疗效主要与肿瘤最长径和术后即刻D90有关;肿瘤最长径<5.25 cm、D90>110.05 Gy者疗效更好。Objective To analyze the factors influencing the short-term efficacy of CT-guided^125I seeds implantation in the treatment of recurrent and metastatic tumors in head and neck.Methods A total of 73 patients(61 males,12 females;age:(59.1±11.5)years)with head and neck tumors recurrence and metastasis treated by^125I seeds implantation in Hebei General Hospital from January 2015 to April 2019 were retrospectively enrolled.The implanted seeds activity was 11.1-29.6 MBq,and the prescription dose was 80.0-145.0 Gy.CT examination was conducted 3 months after^125I seeds implantation.According to Response Evaluation Criteria in Solid Tumors(RECIST)1.1,short-term efficacy was classified as effective(complete remission(CR),partial remission(PR))and ineffective(stable disease(SD),progressive disease(PD)).Univariate analysis of factors affecting short-term effect(gender,age,history of radiation therapy,Karnofsky performance status(KPS)scores,pathological type,the longest diameter of tumor,implantation patterns,seeds activity,immediate postoperative dose delivered to 90%gross tumor volume(D90),and with adjuvant chemotherapy post-surgery or not)were conducted.Variables with P<0.2 were enrolled in logistic multivariate regression analysis.In addition,artificial neural network(ANN)was constructed with all influencing factors as independent variables and short-term efficacy as dependent variables.Finally,receiver operating characteristic(ROC)curve analysis was performed for the common influencing factors in logistic regression analysis and ANN analysis.Results There were 34 with effective results and 39 with ineffective results.Logistic regression analysis indicated that the longest diameter of tumor,immediate postoperative D90,with adjuvant chemotherapy post-surgery or not had significant impacts on the short-term efficacy(Wald values:6.950,4.804,4.790,all P<0.05);According to results of ANN analysis,the top 5 in order of importance for short-term efficacy prediction were immediate postoperative D90,the longest diameter of tumor,

关 键 词：头颈部肿瘤 复发 肿瘤转移 近距离放射疗法 碘放射性同位素 放射疗法 影像引导 体层摄影术 X线计算机 

分 类 号：R730[医药卫生—肿瘤] R73[医药卫生—临床医学]