CAJ | 학술논문

目的比较FOLFOX-6方案全身化疗与传统以氟尿嘧啶为主的肝动脉灌注化疗对结直肠癌术后肝转移病人的疗效并分析影响结直肠癌术后肝转移病人的预后因素.方法 46名结直肠癌术后肝转移病人随机分配到全身化疗组(实验组)和介入治疗组(对照组),对比观察近远期疗效、毒副作用和生活质量.将影响预后的临床特征和治疗方式进行单因素和多因素分析.结果实验组、对照组总生存率差异有统计学意义(P=0.048),中位生存时间分别为15.0个月和11.2个月(P＜0.05);治疗总有效率两组差异有统计学意义(50%和10%;P=0.011);两组治疗期间的PS评分差异无统计学意义(P=0.126).毒副作用除骨髓抑制、腹痛外,其它比较差异均无统计学意义.单因素分析显示,原发病灶是否浸润浆膜、肝转移灶分布、肝转移病灶最大直径、肝转移灶数目、原发癌有无淋巴结转移以及治疗方式与预后相关.多因素分析后发现,肝转移灶最大直径、肝转移病灶数目、原发癌灶是否浸透浆膜层和治疗模式为影响预后的独立因素.结论以草酸铂为主的FOLFOX-6方案比传统的以氟尿嘧啶为主的肝动脉灌注化疗有更好的治疗缓解率和远期疗效;肝转移灶最大直径＞5 cm、肝转移灶多发和原发病灶浸透浆膜层提示病人预后不良,采取以草酸铂为主的全身化疗,预后更好.传统药物介人治疗需要改进,局部介入与全身治疗结合的方式值得进一步探究.
목적 비교FOLFOX-6방안전신화료여전통이불뇨밀정위주적간동맥관주화료대결직장암술후간전이병인적료효병분석영향결직장암술후간전이병인적예후인소.방법 46명결직장암술후간전이병인수궤분배도전신화료조(실험조)화개입치료조(대조조),대비관찰근원기료효、독부작용화생활질량.장영향예후적림상특정화치료방식진행단인소화다인소분석.결과 실험조、대조조총생존솔차이유통계학의의(P=0.048),중위생존시간분별위15.0개월화11.2개월(P＜0.05);치료총유효솔량조차이유통계학의의(50%화10%;P=0.011);량조치료기간적PS평분차이무통계학의의(P=0.126).독부작용제골수억제、복통외,기타비교차이균무통계학의의.단인소분석현시,원발병조시부침윤장막、간전이조분포、간전이병조최대직경、간전이조수목、원발암유무림파결전이이급치료방식여예후상관.다인소분석후발현,간전이조최대직경、간전이병조수목、원발암조시부침투장막층화치료모식위영향예후적독립인소.결론 이초산박위주적FOLFOX-6방안비전통적이불뇨밀정위주적간동맥관주화료유경호적치료완해솔화원기료효;간전이조최대직경＞5 cm、간전이조다발화원발병조침투장막층제시병인예후불량,채취이초산박위주적전신화료,예후경호.전통약물개인치료수요개진,국부개입여전신치료결합적방식치득진일보탐구.
Objective To compare the efficacy and side effects between systemic chemotherapy and hepatic arterial infusion by combination of oxaliplatin and 5-fluorouracil (FOLFOX-6) with 5-fluorouracil in the patients who have developed hepatic metastasis after colorectal cancer operation. The factors that would affect the prognosis without operational treatment were also analyzed. Methods 46patients who had signed the informed consents were allocated into two groups: the group with general chemotherapy (Trial Group includes 26 cases) and the one with hepatic arterial infusion chemotherapy (Control Group includes 20 cases). The total effective rate, the prognosis, the cytoxicitic side effects,quality of life, the total survival rate and the responses were the main parameters determined. Kaplan-Meier was used to analyze Mono-factor to the prognostic responses and the Cox mode was used to analyze poly-factor to the prognostic responses. Results The overall survival rate was significantly higher by using systemic treatment versus HAI(median, 15. 0 v 11.2 months;P＜0.05). The difference in overall responsive rate (CR+PR) between the two groups was statistically significant (50% v 10%;P=0. 011). No significant difference was found in PS scale during the treatment. (P=0. 126). Except for myelosuppression and abdominal pain, no significant difference was found in the other side effects. Univariate analysis revealed that the invasive lesions to serosa, the distribution of liver metastases, the size and number of liver metastases, primary carcinoma involving lymph nodes and the treatment were correlated with prognoses. Cox regression analysis showed that the larger diameter of liver metastases, the number of liver lesions, primary carcinomas involved in serosal layer and the treatment modules were independent prognostic factors. Conclusions The oxaliplatin-based FOLFOX-6 chemotherapy regiment has a better responsive rate and survival rate than the traditional infusion with 5-fluorouracil to the main hepatic artery for interventional therapy. The diameter of the hepatic metastasis larger than 5em, multiple hepatic metastasis and the primary lesions penetrating serosal layer suggest the poor prognosis. The oxaliplatin-based systematic chemotherapy has a better prognosis. Therefore,it is worth carrying on further study on modification of traditional hepatic arterial infusion and on evaluation of therapy by combination of the hepatic arterial infusion with the systematic chemotherapy.