| Recently years,the morbidity of soft tissue sarcoma(STS)has been increased.Soft tissue sarcoma is a kind of highly heterogeneous malignant tumor which is derived from mesenchymal tissue,and the tissue subtypes of STS are variously that including more than 70 different histological subtypes that each of them with their own unique genetic composition and clinical behavior.A majority of carcinoma exhibits local aggressiveness,and the common distal metastatasis are lung,bone,liver,brain and retroperitoneum.Soft tissue sarcoma is a kind of malignant tumor that closely related to inflammation which plays a promoting role in the occurrence,recurrence and metastasis.Local recurrence and metastasis of soft tissue sarcoma are the knottyproblems in the clinical treatment frequently.The surgical resection might be the only radical thearapy for the STS patients,however,almost nearly 30% of the patients cannot be taken the surgery.In addition,according to the overview,the rate of postoperative recurrence and metastasis are getting as high as 50%.Furthermore,after STS recurrence,due to the lower constitution,incomplete resection,highly recurrence rate after re-operation or the high malignant degree,and other factors,many patients lost the surgical opportunity.With the developing acknowledgment of the biological behaviors of carcinomas,the individualized comprehensive treatment mode has been carried out.Imaged-guided tumor ablation techniques which as radiofrequency,microwave,cryoablation,ultrasound focusing,irreversible electroporation technology and so on,has been taken the important place of the comprehensive treatment for malignant tumors.The unique advantages of cryoablation are: firstly,the clinical benefit of the various solid tumors treatment;secondly,immunoregulation after cryoablation.This study discussed the ablation effect,long-term effect and related factors of CT-guided cryoablation for soft tissue sarcoma.,at the same time,through the immunoinflammatory scoring indexes of pre-operative and postoperative: Neutrophils lymphocyte ratio(NLR),improvement of modified Glasgow prognostic score(mGPS),to analyze the prognosis influence of soft tissue sarcomas after cryoablation therapy,so that more researches can be taken to find the changing of the cells and immune mechanisms after cryoablation,to provide the theoretical basis for cryoablation of clinical treatment,thereby,more patients can gain the benefit through this treatment.Chapter 1: Discuss the ablation rate and safety of CT-guided cryoablation of soft tissue sarcoma.Objective To investigate the local ablation rate and complications of CT-guided cryoablation for soft tissue sarcoma.Materials and methods Clinical data of 82 patients with soft tissue sarcoma in the minimally invasive treatment department of the fifth medical center of the PLA general hospital(the former 307 hospital of the PLA)were collected.CT-guided cryoablation was performed on 102 lesions to evaluate the efficacy and complications of local ablation.Results In 102 lesions of 82 patients,170 times of cryoablation were performed,and all of them successfully completed the ablation treatment.Average ablation rate was 75.14 24.33%,complete ablation(CR):19.60%(20/102),partial ablation(PR): 45.10%(46/102),stable(SD):17.65%(18/102),and target progression or deterioration(PD): 17.65%(18/102).The effective rate(CR+PR)was 64.70%,and the disease control rate(CR+PR+SD)was 82.35%.Univariate analysis showed that MRI T2 signal(P=0.041)and maximum tumor diameter(P=0.015)were related factors affecting the ablation rate,and patients with long T2 signal and maximum tumor diameter < 5cm achieved better ablation rate.In 170 cases of ablation,the incidence of adverse reactions was low,and all of them were mild or moderate adverse reactions.The most common adverse reactions were pain,skin injury and fever,and there were 7 cases of moderate adverse reactions(6 cases of nerve injury and 1 case of skin injury),which recovered after the corresponding treatment.No adverse reactions such as intestinal injury,cold shock,hepatic and renal insufficiency occurred,and no serious adverse reactions related to grade E and F surgery occurred.Conclusion 1.CT-guided cryoablation of soft tissue sarcoma has a low incidence of complications,and most of them are mild adverse reactions.2.Ct-guided cryoablation for soft tissue sarcoma has definite efficacy,and the influence factors of the ablation rate are the nuclear magnetic T2 signal and the maximum diameter of the tumor.Chapter 2: Long-term efficacy and influencing factors of CT-guided cryoablation for soft tissue sarcomaObjective To investigate the survival of soft tissue sarcoma by cryoablation under the guidance of CT,and to analyze the influencing factors of survival and the significance of some immune inflammatory factors on the prognosis of patients.Materials and methods Retrospective analysis of the people's liberation army general hospital medical center(formerly the people's liberation army 307 hospital)5 tumor minimally invasive treatment of 82 patients with soft tissue sarcomas,row CT guided cryoablation therapy clinical information,statistics,preoperative and postoperative NLR and mGPS immune inflammatory factors,and follow-up of patients with progression-free survival and overall survival time index,the cryoablation progression-free time,total survival time of patients with single factor and multiple factors analysis.Results In 102 lesions of 82 patients,170 times of cryoablation were performed,the median preoperative NLR was 3.01(0.65 ~ 19.91),the median postoperative NLR was 5.53(1.31 ~ 31.65),the median preoperative and postoperative mGPS were 1(0 ~ 2).Survival indicators: the median progression-free survival time was 15.3(1.0 ~ 90.4)months,and the median total survival time was 20.7(1.10 ~ 90.4)months.The 1-year,2-year,3-year,4-year and 5-year progression-free survival rates were 57.4%,39.2%,24.9%,20.5%,15.4%,and the 1-year,2-year,30%,45.0%,30.8%,23.2% and 15.1%,respectively.Single factor analysis showed that tumor stage,pathological differentiation,whether completely melting,preoperative NLR,NLR after operation,postoperative mGPS is the related factors influencing the progression-free survival time(P < 0.05),the largest tumor size,tumor stage,pathological differentiation degree,whether completely melting,preoperative NLR,NLR after operation,postoperative mGPS is the related factors influencing the total survival time(P < 0.05);Multivariate analysis showed that tumor staging and complete ablation were independent predictors of progression-free survival time and total survival time(P < 0.05).Conclusion 1.The long-term efficacy of ct-guided cryoablation for soft tissue sarcoma is definite.Tumor staging and complete ablation were the influencing factors of OS and PFS.2.Although NLR,mGPS and other immune inflammatory indicators in peripheral blood showed no clear statistical difference in the multivariate analysis,the higher the indicators were,the worse the prognosis of the patients was in the univariate analysis. |
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