微波消融治疗肺肿瘤的相关预后因素分析

目的:分析微波消融治疗肺部肿瘤患者预后的相关影响因素。方法:选取解放军第九六零医院和山东省第二人民医院2014年03月到2021年04月收治的行肺部微波消融术(microwave ablation, MWA)的肿瘤患者,重点回顾性分析微波消融患者的总生存期(overall survival, OS)、无进展生存期(progression-free-survival, PFS)及不良反应、并发症的相关影响因素。结果:54例患者入组,共消融75个病灶。单因素及多因素分析后显示：肿瘤位置：胸壁2 cm之外;气管、大血管和心脏2 cm之外的患者具有更长的PFS及OS(P均<0.05)。消融患者中40例(74.1%)患者出现了不良反应及并发症,消融的功率越大,不良反应和并发症的发生概率越高(P<0.05)。不良反应及并发症均通过相应的治疗得到缓解,没有相关的死亡病例发生。结论:肿瘤位置是微波消融治疗肺部肿瘤患者PFS和OS的独立预后因素,同时,消融功率的大小与不良反应、并发症的发生率有关。     

31例胃癌肝转移微波消融疗效分析

目的 探讨微波消融治疗对胃癌肝转移患者的治疗效果.方法 回顾性分析行微波消融治疗的31例胃癌肝转移患者的疗效及预后,并对患者的总体生存情况进行分析.结果 患者的中位随访时间为26个月(4～44个月),中位生存期为25个月(95％CI:11.5～38.5).1、2、3年总体生存率分别为80.3％、50.9％、25.4％.结论 微波消融可作为胃癌肝转移患者局部控制的安全、有效手段.     

CT引导下经皮微波消融术治疗结直肠癌肺转移的临床疗效分析

目的 探讨CT引导下微波消融技术在结直肠癌肺转移瘤治疗中的疗效及影响预后的因素。方法 收集2010年6月至2015年6月32例结直肠癌肺转移瘤患者,共48个转移灶,均采用CT引导下微波消融治疗。采用Kaplan-Meier法和Cox回归模型进行生存预后分析。结果 32例患者的48个病灶完全消融42个,完全消融率为87.5%。术后30天内无1例因微波消融治疗造成死亡,无1例发生针道转移,6例发生气胸。全组患者均获随访,中位无进展生存期为26个月（95%CI： 16.790~35.210个月）,1、2、3年无进展生存率分别为79.5%、62.8% 和43.1%。单因素分析显示,肿瘤大小、无瘤间期及转移瘤数目均与无进展生存期有关（P＜0.05）;多因素分析显示,肿瘤大小是影响无进展生存期的独立因素（P＜0.05）。结论 CT引导下微波消融治疗是治疗结直肠癌肺转移瘤安全、有效、微创的方法。     

原发纵隔恶性生殖细胞瘤32例临床分析

目的:探讨纵隔恶性生殖细胞瘤(malignant germ cell tumors,MGCT)的临床特点、治疗和预后。方法:32例纵隔MGCT患者,精原细胞瘤18例,非精原细胞瘤14例。所有患者均采用手术和(或)放疗和(或)化疗等多学科综合治疗的方法。结果:非精原细胞瘤患者中位生存期(OS)32.4个月,中位无进展生存期(PFS)18个月,5年无复发生存率和总生存率均为28.6%。精原细胞瘤患者5年无复发生存率和总生存率分别为83.3%和85.6%,中位OS和PFS均未到达。精原细胞瘤患者OS和PFS均明显好于非精原细胞瘤患者,P值分别为0.001 4和0.000 7。结论:纵隔精原细胞瘤采用多学科综合治疗方法能取得较好的治疗效果,本研究的结果与文献报道相符。纵隔非精原细胞瘤的治疗效果有待进一步提高。非精原细胞瘤是影响纵隔恶性生殖细胞瘤预后的重要因素。     

循环肿瘤细胞监测在结直肠癌肝转移微波消融治疗中临床价值的评估

目的 探讨利用循环肿瘤细胞（CTCs）评估结直肠癌肝转移微波消融治疗的疗效及其与预后的关系。方法 收集2014年1月至2018年5月在南京市第二医院因结直肠癌肝转移行肝脏病灶微波消融治疗的29例患者的临床资料,并纳入术前与术后CTCs检测结果。计数资料分析采用χ2检验或Fisher确切概率法;生存分析采用Kaplan-Meier法和Log-rank检验。结果 经影像学评估,29例患者局部病灶微波消融的近期疗效为完全消融者8例、部分消融16例和进展5例。29例患者微波消融术后CTCs测量值较术前升高,差异有统计学意义（Z=-2.489,P=0.013）;患者的年龄、性别、术后CTCs升高与否、结直肠癌原发部位、同时性或异时性肝转移与微波消融近期疗效均无关（P＞0.05）。微波消融术后CTCs数目＜7个／ml患者局部肝转移病灶的近期疗效优于术后CTCs数目≥7个／ml者（P=0.031）。29例患者的中位生存时间（OS）为30.0个月（95％CI：10.7～49.3个月）。入组患者的年龄、结直肠癌原发部位及肝转移后的治疗方式与中位OS相关（P＜0.05）,而性别、同时性或异时性肝转移、术后CTCs升高与否及术后CTCs值／ml与中位OS均无关（P＞0.05）。结论 微波消融是结直肠癌肝转移局部治疗的有效手段,治疗前后CTCs数量的监测可能有助于评估其近期疗效。     

胃肠间质瘤肝转移的临床特征及生存分析

目的 探讨胃肠间质瘤（GIST）肝转移患者的临床病理特征和预后因素。方法 回顾性分析2002年1月至2014年1月入组的复发或转移性GIST共138例患者,其中肝转移者74例。根据治疗前病灶部位将全组病例分为单纯肝转移组34例、腹盆腔转移组64例和肝腹盆腔转移组40例。均给予伊马替尼起始剂量400 mg／d口服。用Logistic回归分析近期疗效相关因素,生存分析用Kaplan-Meier法,预后多因素分析用Cox回归模型。结果 135例可评价近期疗效。74例肝转移患者中,CR 11例,PR 41例,SD 18例,PD 4例,有效率（RR）为70.3％,疾病控制率（DCR）为 94.6％。3组RR、DCR的差异均无统计学意义（P＞0.05）。Logistic回归分析显示,是否伴同时性肝转移是影响RR的独立因素。全组患者的中位无进展生存期（PFS）为52个月,中位总生存期（OS）为66个月,1、2、3和5年生存率分别为97.0％、89.6％、82.3％和60.0％。肝转移患者的中位PFS为45个月,中位OS为68个月,1、2、3和5年生存率分别为97.2％、92.5％、87.4％和59.2％。单纯肝转移组、腹盆腔转移组和肝腹盆腔转移组的中位PFS分别为61、56和30个月,中位OS分别为75、65和63个月。是否合并其他部位转移和近期疗效是影响PFS的独立因素,是否合并其他部位转移和年龄是影响其OS的独立因素。3组患者的主要不良反应为水肿、白细胞减少和腹泻,多为1～2级,3组不良反应发生率的差异均无统计学意义（P＞0.05）。结论 肝转移并未影响伊马替尼治疗晚期GIST的近期疗效,肝外病灶、年龄和近期疗效是影响GIST肝转移患者远期生存的重要因素。     

一线TKI联合放疗对EGFR基因突变的同时性寡转移非小细胞肺癌75例预后的影响分析

摘 要：［目的］ 探讨在接受一线表皮生长因子受体（epidermal growth factor receptor,EGFR）酪氨酸激酶抑制剂（EGFR-TKI）全身治疗的基础上联合放疗能否延长EGFR基因敏感突变的同时性寡转移非小细胞肺癌（non-small cell lung cancer,NSCLC）患者生存期。［方法］ 回顾性分析75例确诊为晚期NSCLC患者的临床资料,寡转移、EGFR基因敏感突变并且接受一线TKI治疗的患者纳入本研究,其中部分患者还接受原发灶和所有转移病灶的放疗。采用Kaplan-Meier法评估其无进展生存期（progression-free survival,PFS）和总生存期（overall survival,OS）。［结果］ 75例患者中32例（42.7%）接受了全部病灶的放疗（放疗组）,43例（57.3%）未接受放疗（未放疗组）。放疗组的PFS优于未放疗组（中位PFS：19.0个月 vs 13.0个月,P<0.001）,放疗组的OS也优于未放疗组（中位OS：35.0个月 vs 26.0个月,P=0.009）。Cox多因素回归分析显示转移灶数目不超过2个、对原发及转移灶进行放疗为PFS和OS的独立预后因素。放疗引起的3级及以上不良反应包括放射性肺炎（6.3%）和放射性食管炎（12.5%）。［结论］ 对于EGFR基因敏感突变的同时性寡转移NSCLC患者,在TKI一线治疗的基础上对所有病灶进行放疗是一种可行的选择,与未放疗的患者相比,可显著延长PFS和OS。     

脑转移瘤X线立体定向放射治疗的疗效及影响因素

背景与目的:X线立体定向放射治疗(X-ray stereotactic radiotherapy,SRT)是治疗脑转移瘤的有效方法之一,该研究意在评价脑转移瘤患者SRT的疗效以及影响预后的因素。方法:自1999年7月至2004年12月止,78例脑转移瘤患者在本中心接受SRT方式治疗。其中,49例为单发病灶,29例为多发(2～6个)病灶,总病灶数为122个。38个病灶采用SRT单次治疗,中位处方剂量为15Gy(11～24Gy)。84个病灶采用SRT分次(2～6次)治疗,中位处方剂量为24Gy(11～40Gy)。39例SRT联合全脑放疗30～40Gy。无进展生存率(progression-free survival,PFS)和总生存率(overall survival,OS)分析采用Kaplan-Meier法,单因素和多因素分析分别采用log-rank法和Cox模型。结果:中位生存时间12.9(1.7～77.4)个月。1年颅内PFS为87.4%,1和2年OS分别为53.9%和25.8%。单因素分析显示治疗前KPS(karnofsky performance state)≥70、颅外肿瘤获控制和SRT联合全脑放疗的...     

冷基循环微波消融治疗晚期周围型肺癌的疗效观察

目的探讨冷基循环微波消融技术对周围型肺癌治疗的可行性和临床疗效。方法选择36例晚期不能手术的周围型肺癌患者,先给予常规化、放治疗控制病情后,再采用冷基循环微波消融技术对残余肿瘤病灶进行消融减瘤、减症治疗,以期获得更好的远期生存结果和生活质量。结果手术完成36例,消融肿瘤病灶42个,完成率100%。术后3d咳嗽、咳痰、咯血和胸痛等症状缓解33例,缓解率91.67%;术后3～6个月,42个肿瘤病灶中完全坏死、吸收36个(85.71%),大部分坏死、吸收(≥90%)4个(9.52%),坏死、吸收50%～70%的病灶2个(4.76%);瘤体直径为0～3cm,比术前缩小2.5～5cm,平均缩小4cm。疗效评价:CR31例(86.11%),PR4例(11.11%),NC1例(2.78%),PD0例;总缓解率97.22%;临床获益率36例(100%);总生存期10～46个月,中位生存期28个月。结论冷基循环微波消融技术可以作为晚期周围型肺癌姑息治疗的有效方法。     

肝动脉化疗栓塞联合125Ⅰ粒子植入治疗原发性肝癌的临床研究

目的 观察肝动脉化疗栓塞(trans catheter arterial chemoembolization,TACE)联合125Ⅰ粒子植入治疗原发性肝癌的临床治疗效果以及安全性.方法 选取原发性肝癌患者57例,按照随机数字表将其分为治疗组(30例)和对照组(27例),治疗组采用肝动脉化疗栓塞联合125Ⅰ粒子植入进行治疗;对照组单纯用TACE治疗.观察两组患者的总生存期(overall survival,OS),无进展生存期(progression free survival,PFS),同时分析两组治疗后的有效率(response rate,RR)、疾病控制率(disease control rate,DCR)以及安全性.结果 治疗组OS、PFS显著优于对照组(9.8个月vs6.8个月;4.6个月vs 2.7个月)(P＜0.05);治疗组与对照组RR分别为73.3％ (22/30)和33.3％(9/27),两组差异具有统计学意义(P＜0.05);DCR分别为83.3％ (25/30)和51.9％ (14/27),差异具有统计学意义(P＜0.05),两组治疗过程中均未出现严重不良反应事件.结论 肝动脉化疗栓塞联合125Ⅰ粒子植入治疗原发性肝癌可有效的延长患者的OS以及PFS事件,同时可以提高其DCR和RR值,且具有良好的安全性.     

Combined microwave ablation and systemic chemotherapy for liver metastases from oesophageal cancer: Preliminary results and literature review

Purpose: Oesophageal cancer is a highly aggressive disease with about 50% of patients presenting with advanced or metastatic disease at initial diagnosis. In this study we assessed combined microwave ablation (MWA) and systemic chemotherapy in the treatment of liver metastases arising from oesophageal squamous cell carcinoma (OSCC). Materials and methods: Between February 2009 and June 2014, OSCC patients who underwent percutaneous MWA?+?concurrent systemic chemotherapy and systemic chemotherapy alone for liver metastases were enrolled in this study. Overall survival (OS) and progression-free survival (PFS) were recorded and compared between groups. Results: In total 15 patients with 25 liver metastases who underwent ultrasound-guided percutaneous MWA and chemotherapy were enrolled in this study. Technical success was achieved in 96% (24/25) of metastatic liver tumours. No major or minor complications associated with MWA procedures were observed. The median OS and PFS from initial MWA were 13 months and 4 months. The 1-, 2-, 3-, 4-year OS rates after MWA were 53.3%, 26.7%, 13.3%, and 13.3%, respectively. The 1- and 2-year PFS rates after MWA were 26.7% and 13.3%. The OS and PFS of the MWA?+?systemic chemotherapy group were superior than those of patients who received systemic chemotherapy alone (P?=?0.011 and 0.030, respectively). Conclusions: Combined MWA with systemic chemotherapy is a feasible, safe and effective treatment for liver metastases from OSCC.     

Microwave ablation for colorectal cancer metastasis to the liver: a single-center retrospective analysis

BackgroundThe purpose of this study is to evaluate the safety and intermediate-term efficacy of percutaneous microwave (MW) ablation for the treatment of colorectal liver metastases (CRLM) at a single institution.MethodsA retrospective review was performed of all CRLM treated with MW ablation from 3/2011 to 7/2020 (102 tumors; 72 procedures; 57 patients). Mean age was 60 years (range, 36–88) and mean tumor size was 1.8 cm (range, 0.5–5.0 cm). The patient population included 19 patients with extra-hepatic disease. Chemotherapy (pre- and/or post-ablation) was given in 98% of patients. Forty-five sessions were preceded by other focal CRLM treatments including resection, ablation, radiation, and radioembolization. Kaplan-Meier curves were used to estimate local tumor progression-free survival (LTPFS), disease-free survival (DFS), and overall survival (OS) and multivariate analysis (Cox Proportional Hazards model) was used to test predictors of OS.ResultsTechnical success (complete ablation) was 100% and median follow-up was 42 months (range, 1–112). There was a 4% major complication rate and an overall complication rate of 8%. Local tumor progression (LTP) rate during the entire study period was 4/98 (4%), in which 2 were retreated with MW ablation for a secondary LTP-rate of 2%. LTP-free survival at 1, 3, and 5 years was 93%, 58%, and 39% and median LTP-free survival was 48 months. OS at 1, 3, and 5 years was 96%, 66%, 47% and median OS was 52 months. There were no statistically significant predictors of OS.ConclusionsMW ablation of hepatic colorectal liver metastases appears safe with excellent local tumor control and prolonged survival compared to historical controls in selected patients. Further comparative studies with other local treatment strategies appear indicated.     

Hepatic artery chemoembolization for 110 gastrointestinal stromal tumors: response, survival, and prognostic factors

BACKGROUND: The efficacy of hepatic artery chemoembolization (HACE) was evaluated for gastrointestinal stromal tumors (GISTs) metastatic to the liver. METHODS: Records for patients with metastatic GIST who underwent HACE between January 1993 and March 2005 were reviewed and cross-sectional images were used to determine objective tumor response. Progression-free survival in the liver (PFS-liver) and overall survival (OS) were calculated with the Kaplan-Meier method. Patient, tumor, and treatment variables were analyzed to identify factors influencing survival. RESULTS: Of the 110 patients identified, the radiologic response to HACE could be evaluated in 85 patients, 12 of whom (14%) demonstrated partial responses, 63 of whom (74%) demonstrated stable disease, and 10 of whom (12%) demonstrated progressive disease. PFS-liver rates were 31.2%, 8.2%, and 5.4% at 1, 2, and 3 years, respectively; the median PFS time was 8.2 months. OS rates were 62% at 1 year, 32% at 2 years, and 20% at 3 years; the median OS time was 17.2 months. Patients who had >5 liver metastases and received only 1 HACE treatment were found to have a shorter PFS compared with patients with fewer metastases or those who received > or =2 HACE sessions. Extensive liver involvement, the presence of extrahepatic metastases, and progression of liver disease after HACE were associated with poor OS. Use of imatinib prolonged OS time. CONCLUSIONS: HACE produced a durable tumor response or disease stabilization in the majority of patients with GISTs metastatic to liver. Extent of liver disease, presence of extrahepatic disease, number of embolization treatments, and use of imatinib were found to have prognostic influence on PFS, OS, or both.     

Effectiveness of liver metastasectomies in patients with metastatic colorectal cancer treated with FIr-B/FOx triplet chemotherapy plus bevacizumab

BackgroundIntensive medical treatment increases resection rate of liver metastases in patients with metastatic colorectal cancer (MCRC). The effectiveness of liver metastasectomies was evaluated in patients with MCRC who were treated with previously reported FIr-B/FOx (triplet chemotherapy plus bevacizumab).Patients and MethodsFifty patients with MCRC enrolled in the reported phase II study were classified according to involved metastatic sites (liver-only metastatic site, multiple metastatic sites) and the extent of liver metastases (single, multiple). Surgical resectability of liver metastases was evaluated at baseline and every 3 cycles of FIr-B/FOx treatment. The resection rate of liver metastases, activity, and efficacy were evaluated; progression-free survival (PFS) and overall survival (OS) were compared by using the log-rank test.ResultsPatients with liver MCRC were 33 of 50 consecutive unselected patients with MCRC: liver limited, 22 patients; multiple metastatic sites, 11 patients. Liver metastasectomies were performed in 13 patients: 26% of 50 patients with MCRC, 39% of 33 patients with liver MCRC. In patients with liver-only MCRC, a secondary liver surgery was performed in 54%: 6 of 9 single and 6 of 13 multiple liver metastases. Also, 1 liver and lung metastasectomy was performed. Pathologic complete responses were achieved in 2 patients (15%). The conversion rate of unresectable liver metastases was 83%. Objective response rate, PFS, OS were, respectively: 84%, 11 and 23 months in 33 liver MCRC; 86%, 17 and 44 months in 22 liver-limited patients. PFS and OS were significantly increased in patients with liver-limited metastases compared with multiple metastatic sites and single compared with multiple liver metastases.ConclusionThe FIr-B/FOx regimen may increase the resection rate of liver metastases and improve clinical outcome of patients with liver-only MCRC.     

Intra-hepatic Mitomycin C bolus infusion in the treatment of extensive liver metastases of breast cancer

BACKGROUND : In the treatment of extensive liver metastasis of breast cancer (LMBC), locally administered Mitomycin C (MMC) to the liver might be an effective approach with limited toxicity. PATIENTS AND METHODS : We retrospectively reviewed the records of 30 patients with LMBC treated with intra-hepatic MMC at our institution. MMC (12 mg) was administered by transcatheter bolus infusion into the hepatic arteries every 4 weeks. Tumour response according to RECIST criteria, progression free survival (PFS), overall survival (OS) and duration of response (DR) were used to evaluate efficacy. RESULTS : There was a local response in the liver and a global response in respectively 33 and 26%. The median PFS, DR and OS were 3, 4 and 7 months, respectively. There was more benefit in patients without documented metastases outside the liver and without severe liver dysfunction. Thrombocytopenia, leucocytopenia and an allergic reaction were observed after MMC administration in 20 (67%), 12 (40%) and 4 patients (13%), respectively. CONCLUSION : Intra-hepatic MMC bolus infusion as treatment of extensive LMBC is associated with limited toxicity and has a significant response rate in the liver. Prospective investigations are required to define the place of this modality for treating patients with breast cancer liver metastases.     

Interventionelle Tumordestruktion durch thermische Verfahren

The aim of this article is to present interventional therapy methods based on thermal ablation, such as radiofrequency ablation (RFA), laser-induced thermotherapy (LITT) and microwave ablation (MWA) for palliative therapy of secondary malignant liver and lung tumors. This report provides information on data about local tumor control rates, survival data, progression-free survival (PFS) and complications. In liver metastases of colorectal carcinoma (CRC) the local tumor control rate is 85% for RFA, 95% for LITT and 93% for MWA, long-time survival is 22 months for RFA, 37 months for LITT and 32 months for MWA, progression-free survival is 84 months for RFA, 97 months for LITT and 93 months for MWA. Recent studies showed improved results with combined systemic and regional chemotherapy (e.g. TACE). Local recurrences of head and neck malignoma, lymph node infiltration and pelvic neoplasia are less frequent indications for tumor ablation.     

寡转移状态下初治鼻咽癌的预后及治疗模式探讨

目的 寡转移状态是鼻咽癌转移的一个特殊阶段,本研究主要探讨其预后因素及治疗模式。方法 2002-2010年共149例寡转移状态下初治鼻咽癌患者纳入研究,其中合并骨转移、肝转移、肺转移分别为94、32、22例,转移灶1个、2~5个分别为51、98例。所有患者均接受了以铂类为基础联合化疗,中位化疗周期为5个(1~12个),其中115例患者接受原发灶放疗,57例接受转移灶局部处理。将患者临床特点、肿瘤状态及治疗模式等因素纳入生存分析中。Kaplan-Meier法计算OS,单因素分析及差异检验采用Logrank法,Cox模型多因素分析。结果 中位生存时间为31个月(2~144个月),所有患者3、5年OS率分别为52.7%、37.7%。化疗后转移灶CR+PR、SD、PD率分别为59.7%、31.5%、5.4%,近期疗效主要与转移灶数目(P=0.01)、化疗疗程(P=0.00)相关。影响患者OS因素包括合并肝转移(P=0.00)、乳酸脱氢酶>245 IU/L (P=0.00)、化疗疗效包括SD及PD (P=0.00)、原发灶未接受放疗(P=0.01)。原发灶接受放疗者5年OS为46.2%,未接受者无5年生存。结论 寡转移是初治转移鼻咽癌预后相对较好的一个亚组,其不良预后因素包括乳酸脱氢酶>245 IU/L、肝转移、化疗疗效包括SD及PD和原发灶无放疗等,原发灶放疗能进一步提高寡转移状态下初治鼻咽癌患者OS。     

微波消融联合125I粒子植入治疗腹腔恶性软组织肿瘤的临床观察

目的：软组织肿瘤复发率及转移率高,复发或转移后没有统一的治疗方案。探讨 CT 引导下经皮穿刺微波消融术联合125 I 粒子植入治疗腹腔恶性软组织肿瘤的安全性、有效性及应用价值。方法回顾性分析山东省医学科学院附属医院2013-02-01－2015-03-01收治的25例腹腔恶性软组织肿瘤患者临床资料,先给予微波消融治疗,术后1周复查CT,根据 TPS 计划系统拟定125 I 粒子植入计划,并按计划植入125 I 粒子。按照1979年 WHO 实体瘤疗效评价标准评价疗效并随访患者生存情况。结果25例患者中位无进展生存期（progression-free survival,PFS）为5个月,疾病完全缓解（complete remission,CR）6例（24％）,部分缓解（partial response,PR）10例（40％）,稳定（stable disease,SD）7例（28％）,疾病进展（progressive disease,PD）2例（8％）,有效率（response rate,RR）为64％,疾病控制率（disease control rate,DCR）为92％。术后重度并发症为0／25（0）。生存24例,随访时间6～32个月,平均生存期14个月,死亡1例。结论 CT 引导下微波消融联合125 I 粒子植入治疗腹腔恶性软组织肿瘤微创、安全、有效。