摘要
目的探讨CT引导下冷冻消融治疗软组织肉瘤(STS)的远期疗效及相关因素分析。方法回顾性分析解放军总医院第五医学中心收治的82例STS患者,实施CT引导下经皮穿刺氩氦冷冻消融治疗,根据改良的实体肿瘤反应评估标准(mRECIST)评价局部客观疗效,分析影响消融率的临床因素。参照国际介入放射学协会(SIR)标准评价治疗不良反应。随访统计5年累积生存率及肿瘤无进展生存率,分析影响生存率的相关临床因素。结果对82例患者102个病灶共进行170次冷冻消融治疗,平均消融率(75. 14±24. 33)%,完全缓解率(CR) 19. 60%,部分缓解率(PR) 45. 10%,核磁T2信号、肿瘤最大径是冷冻消融率的显著影响因素。主要不良反应包括:疼痛、皮肤损伤及发热。按SIR标准分级,A、B级发生率为32. 89%,C、D级发生率为4. 71%,未发生E、F级的严重不良反应。1、3、5年累积生存率和无进展生存率分别为63. 4%、30. 8%、15. 1%和57. 4%、24. 9%、15. 4%。多因素分析显示,肿瘤分期、是否完全消融是累积生存时间和无进展生存时间的显著影响因素。结论 CT引导下经皮穿刺氩氦刀冷冻消融治疗STS可获得较高的局部有效率,不良反应较少,肿瘤分期和局部消融疗效是影响患者长期生存的显著临床因素。
Objective To evaluate the long-term efficacy of CT-guided cryoablation in the treatment of soft tissue sarcoma( STS). Methods A retrospective analysis was performed of 82 patients with STS admitted to our hospital. CTguided percutaneous cryoablation was performed. The local objective efficacy was evaluated according to mRECIST evaluation criteria,and the clinical factors affecting the ablation rate were analyzed. Adverse reactions were evaluated according to the Society of Interventional Radiology( SIR) criteria. The 5-year overall survival rate and the progression-free survival rate were followed up,and the clinical factors affecting the survival rate were analyzed. Results A total of 170 times of cryoablation were performed for 102 lesions in 82 patients,with an average ablation rate of( 75. 14 ± 24. 33)%,complete response rate( CR) of 19. 60%,and partial response rate of 45. 10%. Major adverse reactions included pain,skin injury and fever. The rate of adverse reactions of grade A and grade B was 32. 89%,compared with 4. 71% for those of grade C and D. No serious adverse reactions of grade E or F occurred. The 1-year,3-year and 5-year overall survival rates and progression-free survival rates were 63. 4%,30. 8%,15. 1% and 57. 4%,24. 9%,15. 4% respectively.Multivariate analysis showed that tumor staging and complete ablation were significant factors that affected the overall survival time and the progression-free survival time. Conclusion CT-guided percutaneous cryoablation of STS can achieve a high local effective rate with fewer adverse reactions,and tumor staging and local ablation efficacy are significant clinical factors affecting long-term survival of patients.
作者
李静
刁立岩
祝宝让
周洁敏
陈建魁
杨武威
LI Jing;DIAO Li-yan;ZHU Bao-rang;ZHOU Jie-min;CHEN Jian-kui;YANG Wu-wei(The Fifth Medical Center,Chinese PLA General Hospital,Beijing 100071,China)
出处
《军事医学》
CAS
CSCD
北大核心
2018年第12期955-960,共6页
Military Medical Sciences
关键词
冷冻消融
软组织肉瘤
安全性
疗效
cryoablation
soft tissue sarcoma
security
efficacy
