^(125)I粒子植入治疗肝癌多发肺转移瘤的疗效分析  

Efficacy analysis of ^(125)I seed implantation for multiple pulmonary metastases from hepatocellular carcinoma

作　　者：杨崇双 何闯 李良山 袁晶 黄学全 YANG Chongshuang;HE Chuang;LI Liangshan;YUAN Jing;HUANG Xuequan(Department of Radiology,Tongren People's Hospital,Guizhou 554300,China)

机构地区：[1]铜仁市人民医院放射科,贵州554300 [2]陆军军医大学第一附属医院微创介入与放射性粒子诊疗中心 [3]陆军特色医学中心放射科

出　　处：《介入放射学杂志》2022年第10期1003-1006,共4页Journal of Interventional Radiology

基　　金：重庆市科委资助项目(cstc-2016shms-ztzx0045);重庆市技术创新与应用发展-科技扶贫专项项目(cstc2019jscx-kjfp0005)。

摘　　要：目的探讨^(125)I粒子植入治疗肝细胞癌(HCC)多发肺转移瘤的临床疗效及其预后的影响因素。方法回顾性分析陆军军医大学第一附属医院微创介入与放射性粒子诊疗中心45例行CT引导下^(125)I粒子植入治疗HCC多发肺转移瘤患者的临床及影像资料。随访观察肿瘤近期局部疗效及并发症,用Kaplan-Meier法分析粒子植入后的总体生存率,用Cox比例风险模型对潜在危险因素进行多变量分析。结果共对177个肺转移瘤进行粒子植入治疗,6个月后评估近期疗效显示46.3%的肺转移瘤为CR、32.8%的肺转移瘤为PR、11.3%的肺转移瘤为SD、9.6%的肺转移瘤为PD;DCR为90.4%。中位随访期为22个月,粒子植入后1年、2年和3年的OS率分别为71.1%、45.7%和25.7%。血管侵犯(HR=3.01,95%CI:1.26~7.21,P=0.01)、肺转移瘤的数量(HR=2.69,95%CI:1.05~6.89,P=0.04)是粒子植入治疗HCC多发肺转移瘤的独立危险因素。结论CT引导下^(125)I粒子植入是HCC多发肺转移瘤患者的治疗选择,且无血管侵犯及肺转移瘤数≤3的患者^(125)I粒子植入治疗后的生存预后更好。Objective To evaluate the curative effect of^(125)I seed implantation in treating multiple pulmonary metastases from hepatocellular carcinoma(HCC)and to analyze the factors influencing prognosis.Methods The clinical data and imaging findings of 45 patients with multiple pulmonary metastases of HCC,who received CT-guided^(125)I seed implantation at the Minimally Invasive Intervention and Radioactive Seed Diagnosis and Treatment Center of First Affiliated Hospital of Army Medical University of China,were retrospectively analyzed.The patients were followed up to check the short-term local curative effect and complications.Kaplan-Meier method was used to analyze the overall survival rate after^(125)I seed implantation,and Cox proportional hazards model was adopted to make multivariate analysis for potential risk factors.Results^(125)I seed implantation was performed for a total of 177 pulmonary metastatic lesions.Postoperative 6-month short-term evaluation showed that complete remission(CR),partial remission(PR),stable disease(SD)and progress disease(PD)of pulmonary metastatic lesions were obtained in 46.3%,32.8%,11.3%and 9.6%of lesions respectively,with a disease control rate(DCR)of 90.4%.The median follow-up period was 22 months.The postoperative one-,2-and 3-year overall survival(OS)rates were 71.1%,45.7%and 25.7%respectively.Vascular invasion(HR=3.01,95%CI=1.26-7.21,P=0.01)and number of pulmonary metastatic lesions(HR=2.69,95%CI=1.05-6.89,P=0.04)were independent risk factors for^(125)I seed implantation for multiple pulmonary metastases of HCC.Conclusion CT-guided^(125)I seed implantation is a preferred treatment for multiple pulmonary metastases of HCC,especially for these patients who have no vascular invasion and in whom the number of pulmonary metastatic lesions is≤3,as in such patients an obviously better prognosis can be surely expected.(J Intervent Radiol,2022,31:1004-1006)

关 键 词：肝细胞癌 肺转移瘤 ^(125)I粒子 预后因素 

分 类 号：R735.7[医药卫生—肿瘤] R730.55[医药卫生—临床医学]