基于肿瘤负荷评分评估TACE联合MWA治疗转移性肝癌的预后

目的评估肝动脉化疗栓塞术（TACE）联合微波消融术（MWA）治疗胃肠道转移性肝癌的有效性和安全性。探究肿瘤负荷评分（TBS）预测转移性肝癌患者术后生存预后的效能。 方法回顾性分析2015年1月至2020年4月于我院接受TACE联合MWA治疗的54例转移性肝癌患者临床资料，所有患者原发病灶均为胃肠道恶性肿瘤，分析局部肿瘤控制、生存结果、不良反应。采用TBS评估患者的肿瘤负荷，将患者分组并行组间比较：低负荷组（TBS≤3，n = 24）和高负荷组（3 < TBS < 6，n = 30）。使用时间依赖的ROC曲线及曲线下面积（AUC）分析评估TBS预测无进展生存期（PFS）和总生存期（OS）的能力。 结果54例转移性肝癌患者术后客观缓解率（ORR）为88.9%，疾病控制率（DCR）为96.3%。中位随访期为21.5个月，中位PFS和OS分别为8.2个月、23.8个月。术后半年、1年、2年、3年OS率分别为96.2%、79.2%、41.8%、24.3%。低负荷组和高负荷组中位PFS分别为9.8个月和6.6个月；两组中位OS分别为27.2个月和17.3个月。ROC曲线分析显示，TBS预测患者术后PFS和OS的AUC分别为0.720和0.606，高于肿瘤最大直径的AUC（0.695和0.575）和肿瘤数目的AUC（0.586和0.483）。不同肿瘤负荷组围手术期均无明显严重并发症。 结论TACE联合MWA是治疗胃肠道癌肝转移患者的一种安全、有效的治疗方式，能够显著改善局部肿瘤控制和延长患者总生存期。TBS可较好地预测胃肠道癌肝转移患者TACE联合MWA术后的生存预后情况。

Prognosis of TACE combined with MWA in the treatment of liver metastases based on tumor burden score

ObjectiveTo evaluate the efficiency and safety of transarterial chemoembolization (TACE) combined with microwave ablation (MWA, TACE-MWA) in patients with liver metastases from gastrointestinal cancers. To explore the ability of tumor burden score (TBS) in predicting the prognosis of patients with liver metastases after TACE-MWA. MethodsThis retrospective study involved 54 patients with liver metastases from gastrointestinal cancers who underwent TACE plus MWA between January 2015 and April 2020 in our hospital. Local tumor control, survival outcomes and complications were evaluated. TBS was used to evaluate the tumor burden of the patient. Patients were divided into low tumor burden group (TBS≤3, n = 24) and high tumor burden group (3 < TBS < 6, n = 30) and differences between the two groups were made. Time-dependent ROC analysis was conducted to evaluate the ability of TBS in predicting progression-free survival (PFS) and overall survival (OS). ResultsThe objective response rate (ORR) was 88.9% and the disease control rate (DCR) was 96.3% of the 54 patients. The median follow-up period was 21.5 months. Patients had a median PFS of 8.2 months and a median OS of 23.8 months. The 0.5-, 1- , 2-, and 3-year OS rates were 96.2%, 79.2%, 41.8%, and 24.3% respectively. The median PFS and OS were 9.8, 27.2 months in the low tumor burden group versus 6.6, 17.3 months in the high tumor burden group respectively (P < 0.05). Time-dependent ROC analysis showed that the AUC of TBS for predicting PFS and OS were 0.720 and 0.606, higher than that of maximum tumor diameter (0.695 and 0.575) and tumor number (0.586 and 0.483). No major complication related to treatment was observed in the two groups. ConclusionsTACE-MWA is a safe and effective treatment option for patients with liver metastases from gastrointestinal cancers with improved disease control and prolonged overall survival. TBS may be a good tool for predicting the prognosis of patients with liver metastases after TACE-MWA.