| The first part: Analysis of clinical value of cryoablation in the treatment of recurrent or metastatic soft tissue sarcomaObjective To investigate the efficacy,safety and prognostic factors of CT-guided cryoablation for recurrent or metastatic soft tissue sarcoma.Methods The clinical data of 67 patients with recurrent or metastatic STS who underwent cryoablation were retrospectively analyzed.The efficacy of local ablation was evaluated with reference to the Modified Response Evaluation Criteria in Solid Tumors(m RECIST)and evaluate its safety.Follow-up statistics included cumulative survival,median overall survival(m OS)and median progression-free survival(m PFS),and the survival index(OS,PFS)related influential factors were statistically analyzed.The changes of KPS scores before and after cryoablation were analyzed to improve the physical condition of STS patients.Through subgroup observation,the effect of cryoablation combination therapy and treatment timing on disease control was preliminarily understood.Results A total of 189 cryoablation were performed in 67 patients with 104 lesions.The mean ablation rate was(77.92±24.55)%,the objective response rate(CR+PR)and disease control rate(CR+PR+SD)were 65.38%(68/104)and 86.54%(90/104)respectively.Adverse reactions of different degrees occurred in 36 cases,all of which were mild,and the incidence was 19.05%(36/189).The 1-,2-and 3-year overall survival rate and progression-free survival rate were 3.58%,70.15%,53.73%and 82.09%,59.70%,46.29% respective ly.The overall m OS was 28 months and the m PFS was 22 months.Univariate analysis showed that the efficacy of local ablation,postoperative combined therapy and the number of tumor metastasis were related to survival time,while multivariate analysis showed that the efficacy of local ablation and the number of tumor metastasis were independent influencing factors of OS and PFS(P < 0.05).After treatment,the KPS score was significantly increased,the preoperative score was(71.97±7.66)points,and the scores at 1 month and 3 months after cryoablation were(77.81±8.41)points(P < 0.05)and(73.48±8.69)points respectively(P < 0.05).Subgroup analysis of combination therapy regiments observed prolonged m PFS after cryoablation in patients with combination targeting and/or immunotherapy compared with those without combination therapy or preoperative combination therapy.Conclusion 1.Cryoablation of recurrent or metastatic STS can achieve a high local response rate,controllable complications,and improve the physical condition of patients.2.The efficacy of local ablation and the number of tumor metastases are independent risk factors affecting OS and PFS,which are helpful to select the beneficiaries of cryoablation.3.The m PFS of postoperative combined treatment was longer than that of non-combined treatment or preoperative combined treatment,which helped to provide reference for STS to develop personalized treatment plan.The second part: The role of partial inflammatory and immune markers in the prognostic evaluation of metastatic soft tissue sarcomaObjective To analyze the correlation between neutrophils/lymphocytes ratio(NLR),modified Glasgow prognostic score(m GPS),and peripheral blood T cell subsets expression levels and clinical prognosis of cryoablation.Methods The clinical data of 49 patients with metastatic STS who underwent cryoablation were retrospectively analyzed,and the data of NLR and m GPS before cryoablation were calculated based on the blood test results.Receiver operating characteristic curve(ROC)was used to determine the NLR cut-off value,and the m GPS score was recorded according to the internationally recognized system scoring standard.The relationship between baseline levels of NLR and m GPS and different clinical characteristic factors was analyzed.Univariate and multivariate analysis was used to study independent prognostic factors associated with metastatic STS.The CD3+,CD4 +,CD8 + T lymphocytes 、T-reg percentage and CD4 + / CD8 + ratio before and after cryoablation were detected,and Pearson correlation was used to analyze the correlation between the changes and the survival prognosis.Results Applying receiver operating curve analysis,we determined a cut-off value of NLR was 3.5.NLR level and m GPS score in peripheral blood of49 patients had no significant differences among different gender,age,tumor location and local ablation efficacy(P > 0.05),but had significant differences with maximum tumor diameter,pathological grade and whether postoperative combined therapy was performed(P < 0.05).Multivariate analysis showed that local ablation efficacy,NLR and m GPS were independent influencing factors for survival prognosis(P < 0.05).The CD3 +,CD4 +,CD8 + T lymphocytes percentage and CD4 + / CD8 + ratio in 22 patients were significantly increased after cryoablation compared with that before treatment,with statistical significance(P < 0.05).Pearson correlation analysis showed that there was no significant correlation between the difference(? value)of the CD3 +,CD4 +,CD8 + T lymphocytes、T-reg percentage and CD4 + / CD8 + ratio before and after cryoablation(? = post-treatment--pre-treatment)and OS(P>0.05).The difference of CD8+T cell percentage before and after cryoablation was positively correlated with PFS(r= 0.426,P= 0.048),that is,the higher the CD8+ percentage increased after cryoablation compared with that before cryoablation,the longer the patient’s PFS;The difference(? value)of the CD3+,CD4+ T cells、T-reg percentage and CD4+/CD8+ ratio before and after cryoablation had no significant correlation with PFS(P>0.05).Conclusion 1.NLR and MGPS,markers of peripheral blood inflammatory response before cryoablation,are independent prognostic factors for survival of metastatic STS,which can provide better prediction and evaluation for disease control.2,The CD3 +,CD4 +,CD8 + T lymphocytes percentage and CD4 + / CD8 + ratio were significantly increased after cryoablation,suggesting that cryoablation has immunomodulatory effect.At the same time,the difference of the CD8+T cells percentage(? value)before and after cryoablation is positively correlated with PFS,which is expected to provide ideas and basis for exploring the changes of tumor microenvironment after cryoablation and the study of new strategies for cryoimmunotherapy. |
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