冷冻消融治疗中低位直肠癌及肛管癌的安全性、有效性及影响治疗效果的因素  

Safety and efficacy of cryoablation for treating middle and low rectal cancer and anal carcinoma and the impact factors of therapeutic effect

作　　者：蒋学军[1] 吉祖进 雷新益 王丙开 刘小倩 袁方均[1] JIANG Xuejun;JI Zujin;LEI Xinyi;WANG Bingkai;LIU Xiaoqian;YUAN Fangjun(Department of Colorectal and Anal Surgery,Sinopharm Dongfeng General Hospital,Hubei University of Medicine,Shiyan 442008,China)

机构地区：[1]湖北医药学院附属国药东风总医院结直肠肛门外科,湖北十堰442008

出　　处：《中国介入影像与治疗学》2023年第7期410-414,共5页Chinese Journal of Interventional Imaging and Therapy

基　　金：湖北省卫生健康委员会科研项目(WJ2023F092);十堰市科学技术局引导性科研项目(22Y74)。

摘　　要：目的观察冷冻消融治疗中低位直肠癌(MLRC)及肛管癌的有效性、安全性及影响治疗效果的因素。方法回顾性分析40例接受冷冻消融治疗的MLRC及肛管癌患者,包括4例中位直肠癌、33例低位直肠癌(其中26例超低位直肠癌)及3例肛管癌,29例T分期为T0~2期、11例为T3期;观察治疗后并发症,对比治疗前与治疗后1个月癌胚抗原(CEA)的变化。治疗后规律随访至2022年1月,将肿瘤无复发及转移定义为临床完全缓解(CCR),统计CCR率。以肿瘤复发或转移为终点事件,将患者年龄、性别及肿瘤最大径、肿瘤至肛缘距离、病理类型、T分期等参数纳入单、多因素Cox回归分析,观察冷冻消融治疗MLRC及肛管癌效果的影响因素。绘制Kaplan-Meier生存曲线,采用Log-rank检验比较T0~2与T3期患者累积无进展生存率的差异。结果对40例均完成消融治疗。4例出现并发症,包括2例便血、直肠狭窄及肛周感染各1例,予对症治疗后好转;未见其他并发症。治疗后1个月CEA[(2.74±0.21)μg/L]较治疗前降低[(4.31±0.74)μg/L,t=2.53,P=0.02]。随访4~72个月,中位随访时间32个月,无因肿瘤死亡病例,总生存率100%;5例发生局部复发或淋巴结转移,CCR率为87.50%(35/40)。肿瘤T分期为冷冻消融治疗MLRC及肛管癌效果的独立影响因素(HR=12.40,P=0.02)。Kaplan-Meier曲线显示,T0~2期患者累积无进展生存率高于T3期患者(P<0.05)。结论冷冻消融治疗T0~2N0M0期MLRC及肛管癌安全、有效;肿瘤T分期为疗效的独立影响因素。Objective To observe the safety and efficacy of cryoablation for treating middle and low rectal cancer(MLRC)and anal carcinoma,and to explore the impact factors of its therapeutic effect.Methods Totally 40 patients with MLRC or anal carcinoma who underwent cryoablation were enrolled,including 4 cases of middle rectal cancer,33 cases of low rectal cancer(26 with ultra-low rectal cancer)and 3 cases of anal carcinoma,29 cases with T0-2 stage and 11 with T3 stage tumors.The complications of treatment were observed,and carcinoembryonic antigen(CEA)was compared before and 1 month after treatment.Regular follow-up was conducted after treatment until January 2022,and clinical complete response(CCR,no tumor recurrence nor metastasis)rate was calculated.Taken tumor recurrence or metastasis as the endpoint event,patients'age,gender,maximum tumor diameter,the distance of tumor to anal border,pathological type as well as T stage were enrolled in univariate and multivariate Cox regression analysis,and the impact factors of therapeutic effect of cryoablation for treating MLRC and anal carcinoma were analyzed.Kaplan-Meier survival curve was drawn,and Log-rank test was used to compare cumulative progression-free survival rate between patients with stage T0-2 and T3 tumors.Results All 40 patients completed cryoablation,complications developed in 4 cases,including 2 of hematochezia,1 of rectal stenosis and 1 case of perianal infection,all improved after symptomatic treatments.No other complication occurred.One month after treatment,CEA decreased from(4.31±0.74)μg/L to(2.74±0.21)μg/L(t=2.53,P=0.02).The follow-up time was 4-72 months,with a median of 32 months.No one died of tumor,and overall survival rate was 100%.Local recurrence or lymph node metastasis was detected in 5 cases,and CCR rate was 87.50%(35/40).Tumor T stage was the independent impact factor of therapeutic effect of cryoablation for treating MLRC and anal carcinoma(HR=12.40,P=0.02).Kaplan-Meier curve showed that the cumulative progression-free survival rate of pat

关 键 词：直肠肿瘤 治疗结果 冷冻消融 

分 类 号：R735.3[医药卫生—肿瘤] R815[医药卫生—临床医学]