Therapeutic Effect And Influencing Factors Of Chemotherapy Combined With Hepatic Artery In The Treatment Of Advanced Colorectal Cancer

Objective:XELOX(oxaliplatin,capecitabine)and FOLFOX4(oxaliplatin,leucovorin,5-fluorouracil)regimens were first-line treatment options for advanced colorectal cancer(ACRC).This study compared the efficacy and influencing factors of XELOX or FOLFOX4 combined with hepatic arterial infusion for the treatment of potentially resectable ACRC.Methods:The clinical data of 133 patients with potentially resectable advanced colorectal cancer who were first diagnosed in the Department of Oncology,the Third Affiliated Hospital of Soochow University were collected and divided into group A according to the chemotherapy regimen XELOX program:65 cases of Oxaliplatin and Capecitabine,group B(FOLFOX4 regimen:Oxaliplatin,Leucovorin,5-Fluorouracil)68 cases,of which A1 group had no liver metastasis alone with XELOX regimen 6 cases,A2 group Hepatic metastases were treated with XELOX regimen in 22 patients,A3 group with liver metastasis using XELOX combined with HAI FUDR regimen in 37 patients;B1 group without liver metastasis using FOLFOX4 regimen in 14 patients,and B2 group with liver metastasis using FOLFOX4 regimen in 32 patients,B3 group had Hepatic metastases were treated with FOLFOX4 combined with hepatic arterial infusion for 22 cases of hepatic arterial infusion floxuridine(HAI FUDR).SPSS25.0 statistical software were used to analyze the response rate,disease control rate,surgical conversion rate,median progression-free survival time,median overall survival time,adverse reactions and other items in the two groups.Survival curves were plotted using GraphPad Prism 7.0.Univariate and multivariate factors were used to analyze prognostic factors.Results:Group A had an RR of 43.1%,a DCR of 72.3%,a surgical conversion rate of 47.7%,a mPFS of 5.5 months,and a mOS of 12.9 months.Group B had an RR of 44.1%,a DCR of 76.5%,and a surgical conversion rate of 51.5%.mPFS was 7.7 months and mOS was 16.0 months.DCR in the two groups(?~2=0.246,P=0.032;?~2=0.309,P=0.038),surgical conversion rate(?~2=0.162,P=0.047;?~2=0.253,P=0.049).Group A hematologic toxicity(?~2=0.537,P=0.046),gastrointestinal symptoms(?~2=0.479,P=0.031),liver function damage(?~2=0.506,P=0.042),peripheral neurotoxicity(?~2=0.137,P=0.008)and the incidence of hand-foot syndrome(?~2=0.268,P=0.012)compared with group B,the difference was statistically significant.Univariate analysis showed that hepatic lobe metastasis(HR=1.673,95%CI:0.993-2.152,P=0.037),lymph node metastasis(HR=1.436,95%CI:0.509?2.053,P=0.012),serum CEA changes(HR=1.972,95%CI:0.946?2.758,P=0.026),serum CA199 changes(HR=2.137,95%CI:1.171?3.055,P=0.021)and long-term prognosis were statistically significant,surgery Conditions(HR=0.303,95%CI:0.193?0.465,P<0.001),postoperative chemotherapy(HR=0.310,95%CI:0.108?0.892,P=0.030),microsatellite status(HR=0.109,95%CI:0.023?0.509,P=0.005)was statistically significant with long-term prognosis.Cox multivariate analysis suggested that serum CEA increased(HR=1.754,95%CI:0.877-2.328,P=0.037)and serum CA199 increased(HR=1.975,95%CI:1.047?2.839,P=0.042)independent risk factors affecting the prognosis of ACRC,microsatellite status(HR=0.559,95%CI:0.101?3.099,P=0.025,MSS/MSI-H)was an independent protective factor affecting the prognosis of ACRC.Conclusion:The short-term efficacy,surgical conversion rate and long-term survival of XELOX compared with FOLFOX4 combined with hepatic arterial infusion for ACRC were similar,but XELOX was safer.Chemotherapy combined with hepatic arterial infusion for the treatment of ACRC could improve DCR and surgical conversion rate,but no significant increase in RR,PFS,OS.Serum CEA and CA199 changes,MSI-H could be used as an independent factor in the evaluation of ACRC prognosis.