摘要
目的探讨超声支气管镜(endobronchial ultrasound,EBUS)引导下碘-125(iodine-125,^(125)I)粒子植入治疗肺癌中央区淋巴结转移患者的临床疗效、安全性以及对生存的影响。方法选取2021年1月1日至2024年11月1日接受EBUS引导下^(125)I粒子植入的中央区淋巴结转移的肺癌患者39例。术后1、3个月对目标病灶进行疗效评价,并对治疗前后3个月目标病灶直径、卡氏功能状态评分(karnofsky performance status,KPS)、癌胚抗原、神经元特异烯醇化酶、细胞角蛋白19片段等指标比较分析。根据术后3个月胸部计算机断层扫描(computed tomography,CT)复查结果进行疗效分组:将疾病稳定(stable disease,SD)纳入稳定组,部分缓解(partial response,PR)和完全缓解(complete response,CR)纳入缓解组。随访患者疾病进展、生存及死亡时间。Log-rank检验比较近期疗效稳定组与缓解组的生存差异。多因素Logistic分析近期疗效与术后90%靶体积接受的剂量(90%of target volume receiving dose,D90)的相关性,多因素Cox回归模型分析患者生存的独立影响因素。收集患者术前术后症状、术中不良反应及术后并发症的资料进行统计分析。结果患者粒子植入术后3个月的局部疗效评价为CR 7例(17.95%),PR 13例(33.33%),SD 19例(48.72%),无疾病进展(progressive disease,PD)患者客观缓解率(objective response rate,ORR)为51.28%,局部控制率(local control rate,LCR)为100%。且目标病灶处未发生气道再狭窄。治疗前后3个月肿瘤直径和KPS评分差异具有统计学意义(P<0.001)。随访时间范围6~12个月,中位随访时间为11个月,无进展生存期(progression-free survival,PFS)为3~12个月,总生存期(overall survival,OS)为3~12个月,生存率为69.23%。Log-rank分析示,近期疗效评估为缓解组患者的生存率高于稳定组患者,但差异无统计学意义(P=0.081)。多因素Logistic回归结果显示缓解组的术后D90高于稳定组(OR=1.115,95%CI:1.002~1.241,P=0.046),是近期疗效的独立影响因素。多因素Cox生存分析结果表明治疗线数(HR=0.181,95%CI:0.037~0.878,P=0.034)是患者生存的独立影响因素。观察术中有6例(15.38%)患者穿刺部位出血,经止血治疗后均缓解。术后3例(7.69%)患者出现少量痰中带血。所有患者随访过程中均无放射性食管炎、放射性肺损伤、心包炎等严重并发症。结论EBUS引导下行^(125)I粒子植入治疗肺癌中央区淋巴结转移的患者,近期疗效好,并发症少。术后D90为近期疗效的独立影响因素。近期疗效评估为CR及PR的患者预后好于疗效评估为SD的患者。治疗线数是患者生存的独立影响因素。
Objective To investigate the clinical efficacy,safety,and impact on survival of endobronchial ultrasound(EBUS)-guided iodine-125(^(125)I)seed implantation in patients with central lymph node metastases from lung cancer.Methods A total of 39 patients with central lymph node metastasis of lung cancer who underwent ^(125)I particle implan-tation guided by EBUS between 1,January 2021 and 1,November 2024 were selected for this study.The efficacy of the treatment was evaluated at one and three months after treatment on the target lesions.The diameters of the target lesions,karnofsky performance status(KPS)scores,carcinoembryonic antigen(CEA),neuron-specific enolase(NSE),and cytokeratin 19 fragments were compared before and three months after treatment.Subsequent chest CT reexamination at 3 months post-surgery resulted in the division of patients into two groups:stable disease(SD)cases were included in the stable group,while partial response(PR)and complete response(CR)cases were included in the remission group.The progression of the disease,survival rates,and mortality were the primary focus of the study.The survival differences between the stable group and the remission group were compared using the Log-rank test.Multivariate logistic regression analysis was performed to examine the correlation between recent efficacy and the dose delivered to 90%of the target volume(D90)post-surgery.Furthermore,multivariate Cox regression analysis was employed to identify independent factors affecting patient survival.Preoperative and postoperative symptoms,intraoperative adverse reactions,and postoperative complications were collated for the purpose of statistical analysis.Results Three months after the seed implantation procedure,local efficacy evaluations revealed a complete response(CR)in 7 patients(17.95%),a partial response(PR)in 13 patients(33.33%),stable disease(SD)in 19 patients(48.72%),and no progressive disease(PD),yielding an overall response rate(ORR)of 51.28%and a local control rate(LCR)of 100%.No occurrence of airway restenosis was observed at the target lesion site.Statistically significant differences were observed between baseline and 3-month post-treatment in tumor diameter(P<0.001)and KPS score(P<0.001).The follow-up period ranged from six to 12 months,with a median of 11 months.The progression-free survival(PFS)ranged from 3 to 12 months,the overall survival(OS)ranged from 3 to 12 months,and the survival rate was 69.23%.Log-rank analysis indicated higher survival in the response group than in the stable group,although the difference was not statistically significant(P=0.081).Multivariate logistic regression analysis revealed that postoperative D90 was higher in the response group than in the stable group(OR=1.115,95%CI:1.002-1.241,P=0.046),thereby identifying D90 as an independent factor influencing recent efficacy.Multivariate Cox regression analysis indicated that the number of prior treatment lines was an independent predictor of patient survival[hazard ratio(HR)=0.181,95%CI:0.037-0.878,P=0.034].During the procedure,6 patients(15.38%)experienced puncture-site bleeding,which resolved after hemostatic treatment,and postoperative minor hemoptysis occurred in 3 patients(7.69%).No severe complications,such as radiation esophagitis,radiation-induced lung injury,or pericarditis,were observed during the follow-up period.Conclusion Patients with central lymph node metastases from lung cancer who undego EBUS-guided ^(125)I seed implantation achieves favourable short-term efficacy with minimal complications.Postoperative D90 is identified as an independent predictor of short-term efficacy and patients who attain complete or partial response have a better prognosis than those with stable disease.The number of treatment lines is an independent determinant of patient survival.
作者
李懿原
马珊
李爱华
龙飞
LI Yiyuan;MA Shan;LI Aihua;LONG Fei(Department of Respiratory and Critical Care Medicine,The Third Affiliated Hospital of Shandong First Medical University,Jinan 250031,Shandong,China)
出处
《山东大学学报(医学版)》
北大核心
2025年第12期26-34,共9页
Journal of Shandong University(Health Sciences)
基金
山东省医药卫生科技发展计划(202403020996)。
关键词
碘-125粒子
超声支气管镜引导
术中植入
肺癌
淋巴结
Iodine-125 seed
Endobronchial ultrasound-guided
Intraoperative implantation
Lung cancer
Lymph nodes
