125I粒子植入治疗放化疗后进展肺癌患者的临床疗效及影响因素分析  

Clinical efficacy and influencing factors of 125I seeds implantation in the treatment of patients with advanced lung cancer after radiotherapy and chemotherapy

作　　者：曹国辉 王娟[1] 王泽阳[1] 刘晓丽[1] 徐克 赵金鑫[1] 隋爱霞[1] 张宏涛[1] Cao Guohui;Wang Juan;Wang Zeyang;Liu Xiaoli;Xu Ke;Zhao Jinxin;Sui Aixia;Zhang Hongtao(SectionΙ,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》2023年第1期16-19,共4页Chinese Journal of Nuclear Medicine and Molecular Imaging

摘　　要：目的探讨125I粒子植入治疗放化疗后进展肺癌患者的临床疗效及预后影响因素。方法回顾性分析2017年1月至2019年12月间在河北省人民医院接受125I粒子植入治疗的放化疗后进展肺癌患者44例(男39例、女5例,年龄41~84岁)。随访≥12个月,观察其疗效。采用χ2检验比较不同组别有效率。通过建立ROC曲线,获得最佳术后90%大体肿瘤体积所接受的剂量(D90)界值。采用Kaplan-Meier法计算生存率,log-rank检验进行单因素分析;采用Cox比例风险模型进行多因素分析,探讨临床疗效影响因素。结果44例患者治疗后6个月的总有效率为72.73%(32/44)。ROC曲线示术后D90的最佳界值为120 Gy,AUC为0.771。术后D90≥120 Gy组的有效率(18/19)高于<120 Gy组[56.00%(14/25);χ^(2)=8.17,P=0.004]。44例患者的1年生存率为77.27%(34/44)。单因素分析示,年龄(χ^(2)=3.99,P=0.046)、术前Hb(χ^(2)=10.60,P=0.001)、肿瘤最大径(χ^(2)=11.50,P=0.001)、术后D90(χ^(2)=5.81,P=0.016)均可影响患者生存。多因素分析示,术前Hb[风险比(HR)=0.023,95%CI:0.001~0.882,P=0.043]、肿瘤最大径(HR=40.889,95%CI:1.458~1146.586,P=0.029)是预后因素。结论125I粒子植入治疗放化疗后进展肺癌患者疗效较好,术后D90≥120 Gy患者的近期疗效优于<120 Gy患者。术前Hb、肿瘤最大径是肺癌粒子植入术后患者的生存预后因素。Objective To investigate the clinical efficacy and prognostic factors of 125I seeds implantation in the treatment of patients with advanced lung cancer after radiotherapy and chemotherapy.Methods From January 2017 to December 2019,44 patients(39 males,5 females,age 41-84 years)with advanced lung cancer after radiotherapy and chemotherapy who received 125I seeds implantation in Hebei General Hospital were retrospectively analyzed.All patients were followed up for≥12 months,and the clinical efficacies were observed.χ^(2) test was used to analyze the difference of effective rates between groups.The cut-off value of postoperative dose delivered to 90%gross tumor volume(D90)was obtained by ROC curve analysis.Kaplan-Meier method was used to calculate the survival rate and log-rank test was used for univariate analysis.Cox proportional hazards model was used for multivariate analysis to find the influencing factors for clinical efficacy.Results The total effective rate was 72.73%(32/44)after 6 months treatment.The cut-off value of D90 was 120 Gy with the AUC of 0.771.The short-term effective rate of D90≥120 Gy group was better than that of D90<120 Gy group(18/19 vs 56.00%(14/25);χ^(2)=8.17,P=0.004).The 1-year survival rate was 77.27%(34/44).Univariate analysis showed that age(χ^(2)=3.99,P=0.046),preoperative Hb(χ^(2)=10.60,P=0.001),tumor maximum diameter(χ^(2)=11.50,P=0.001)and postoperative D90(χ^(2)=5.81,P=0.016)could affect the survival of patients.Multivariate analysis showed that preoperative Hb(hazard ratio(HR)=0.023,95%CI:0.001-0.882,P=0.043)and tumor maximum diameter(HR=40.889,95%CI:1.458-1146.586,P=0.029)were prognostic factors.Conclusions 125I seeds implantation shows a good effect in the treatment of lung cancer patients after the progress of radiotherapy and chemotherapy.The short-term effect of patients with D90≥120 Gy is better than that of patients with D90<120 Gy.Preoperative Hb and tumor maximum diameter are prognostic factors of survival after implantation.

关 键 词：肺肿瘤 近距离放射疗法 碘放射性同位素 治疗结果 

分 类 号：R734.2[医药卫生—肿瘤]