| Background and Objective: With the change of living standards and dietary structure, more and more people suffer from digestive system tumors.As one of the common malignant tumors in the digestive system, the incidence rate of colorectal cancer is increasing year by year.In the whole body metastasis of colorectal cancer, the liver accounts for first, and the main cause of death in patients with colorectal cancer is liver metastasis of colorectal cancer。Prompt diagnosis and treatment is beneficial to the patient’s prognosis.Liver tumor resection is the only possible cure.However, due to various factors, about 80%-90% of colorectal cancer patients with liver metastases is not suitable for surgical resection.Transcatheter arterial chemoembolization(TACE) and radiofrequency ablation(RFA) as at present the liver tumor is one of the most important methods for treatment of surgical treatment in home and abroad are widely used for the treatment of liver metastases from colorectal cancer.This study aimed at comprehensive sequential hepatic metastasis of colorectal cancer in interventional treatment of TACE combined with RFA) specific methods were studied, and observe its efficacy and safety, to explore its clinical application value and colorectal cancer liver metastasis were prognostic factors.Methods: 1. The methodology of sequential interventional therapy for liver metastasis from colorectal cancer This study retrospectively analyzed the clinical data of 40 patients with liver metastases from colorectal cancer who received comprehensive sequential intervention therapy, and the survival time of the patients were followed up.The patient’s gender, age, tumor size, number, location, liver function, the first liver metastases were found in serum CEA and CA19-9 levels and other general clinical data were collected and sorted out.Compare the level of liver function before and after treatment in combination with 3 days after treatment, and compare the level of liver function before and after treatment in 1 weeks.According to the American Association for the study of liver diseases(AASLD), the evaluation criteria(m RECIST) for evaluating the efficacy of modified solid tumors in the treatment of hepatocellular carcinoma.Analysis of the survival time of patients with combined sequential interventional therapy. 2. Clinical outcome and prognostic factors of sequential interventional therapy for liver metastasis from colorectal cancer. The clinical data of 52 cases of colorectal cancer with liver metastasis were analyzed retrospectively, and two groups were divided into groups. Comprehensive sequential interventional therapy(TACE combined with RFA) group of 23 cases, 29 cases of systemic chemotherapy treatment group. The gender, age, number, size, location, liver function, serum CEA value and CA19-9 value of the two groups were collected and compared with the clinical data of the two groups. Efficacy evaluation criteria(m RECIST) of two groups of patients with modified solid tumor. Compare the changes of CEA level and CA19-9 level before and after treatment. Survival time of the two groups were compared. Kaplan-Meier and COX regression were used to analyze the prognosis of liver metastasis of colorectal cancer by univariate and multivariate analysis, and to understand the influence of sex, age, tumor size, number, location and other factors on the survival of patients with colorectal cancer.Results: 1. The methodology of sequential interventional therapy for liver metastasis from colorectal cancer(1) all patients first found liver metastases were treated with TACE combined with RFA, and then each time depending on the patient’s condition and tumor progression, TACE or combined RFA treatment. 27 cases of initial treatment, 40 cases of patients with fever after treatment, 18 cases of liver discomfort, pain, 22 cases of patients with nausea and vomiting symptoms. 1 cases of patients with subcutaneous hematoma puncture, no bone marrow suppression performance. These complications were improved after symptomatic treatment.(2) Patients with TACE combined with RFA therapy, liver function damage, after the symptomatic treatment, 1 week after recovered to the preoperative level.(3) According to the modified solid tumor response evaluation criteria m RECIST, comprehensive and sequential interventional therapy, the complete remission(CR) in seven patients(17.5%), partial remission(PR) patients in 5 cases(12.5%), stable disease(SD) in 6 cases(15.0%), progressive disease(PD) patients in 22 cases(55.0%). Objective effective rate(ORR) 30%. The median survival time was 26 months, and the 95% confidence interval was 21.5-31.1. 2. Clinical outcome and prognostic factors of sequential interventional therapy for liver metastasis from colorectal cancer(1) Data were collected from two groups of patients with combined sequential interventional therapy group and systemic chemotherapy group. There was no significant difference between the two groups(P > 0.05).(2) 23 of the patients who received comprehensive sequential intervention therapy, 19 patients had fever, 21 patients suffered from liver discomfort, pain, and 20 patients suffered from nausea and vomiting. 23 cases of patients with liver function after the treatment of varying degrees of damage, most of the performance of the ALT(AST) increased. There was no inhibition of bone marrow suppression in all patients, and no severe toxicity. 29 patients received systemic chemotherapy, all patients had nausea, vomiting and other gastrointestinal reactions. 20 cases of patients with varying degrees of elevated aminotransferase, 8 patients with grade I bone marrow suppression, 11 patients with grade II bone marrow suppression, grade III bone marrow suppression in 5 patients, no grade IV patients with bone marrow suppression.(3) According to the modified solid tumor curative effect evaluation standard(m RECIST), comprehensive sequential intervention therapy group and systemic chemotherapy treatment group two groups of tumor treatment curative effect comparison difference has statistics significance(P < 0.05). Two groups of patients before and after treatment of cancer embryo antigen CEA value of the difference was statistically significant(P < 0.05). There was no significant difference in CA19-9 values between the two groups before and after treatment(P > 0.05).(4) Comprehensive sequential interventional treatment group of 20 cases of death, 3 patients survived, systemic chemotherapy treatment group died 27 people, 2 people survived. The cumulative survival rates of 1, 2 and 3 years were 86.96%, 43.48% and 21.74%, respectively. The cumulative survival rates of 1, 2 and 3 years were 79.31% 27.58% and 13.79% respectively.(5) Univariate analysis showed that the factors related to the prognosis of liver metastasis from colorectal cancer included sex, age, tumor size, tumor size, and CEA level were 5 factors. Other factors such as the number of hepatic lobes, the Child-Puge grading of patients, the normal or no CA19-9 of tumor markers had no significant influence on the survival time.(6) Multivariate regression analysis showed that gender, tumor size, tumor size, CEA level were correlated with the cumulative survival rate after liver metastasis of colon cancer, which were independent factors influencing the prognosis.Conclusion: Liver metastasis from colorectal cancer can not be operated with various factors, and the combined sequential interventional therapy is one of the effective treatment options. Prognostic factors of colorectal cancer, the prognosis of female patients is better than men, the number of metastatic tumors, large diameter and high CEA level of patients with poor prognosis. For patients with liver metastases from colorectal cancer who can not be treated by surgical resection, transcatheter arterial chemoembolization combined with radiofrequency ablation can effectively prolong the survival time of patients with colorectal cancer. |
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