肝动脉灌注化疗序贯载药微球经肝动脉化疗栓塞治疗结直肠癌肝转移的有效性随机对照研究

doi:10.3969/j.issn.1006-5725.2025.17.016

Abstract

Abstract:

Objective To analyze the efficacy of hepatic arterial infusion chemotherapy （HAIC） sequential drug-eluting beads transcatheter arterial chemoembolization （DEB-TACE） in the treatment of liver metastases from colorectal cancer. Methods 86 patients with colorectal cancer liver metastasis admitted to multiple centers from September 2022 to September 2023 were selected and divided into a control group （43 cases） and an experimental group （43 cases） according to the random number table method. The control group was treated with HAIC， and the experimental group was treated with HAIC sequential DEB-TACE. The clinical data and the changes of tumor markers and liver function indexes before and after treatment were compared between the two groups， and the short-term and long-term efficacy was evaluated， and the adverse reactions were recorded. Results After treatment， the levels of carcinoembryonic antigen， carbohydrate antigen 125， carbohydrate antigen 199， carbohydrate antigen 242， aspartate aminotransferase， alanine aminotransferase， alkaline phosphatase and γ-glutamyl transpeptidase in the two groups decreased （P < 0.05）， and those in the experimental group were lower than the control group （P < 0.05）. The proportion of repeated treatment in the experimental group was lower than that in the control group （P < 0.05）. The objective remission rate and disease control rate in the experimental group were 60.00% and 82.50% respectively， which were higher than 30.95% and 61.90% in the control group （P < 0.05）. There was no significant difference in the incidence of adverse reactions between the control group and the experimental group （P > 0.05）. The results of Kaplan-Meier survival curve showed that the overall survival rate and progression-free survival rate of the experimental group were higher than those of the control group （P < 0.05）. Conclusions HAIC sequential DEB-TACE can effectively remove tumor cells and improve liver function in patients with colorectal cancer liver metastasis， and it has good clinical efficacy and can prolong the survival time of patients.

Key words: colorectal cancer, liver metastasis, hepatic artery infusion chemotherapy, drug-eluting beads transcatheter arterial chemoembolization, randomized controlled trial

CLC Number:

R735.3

Mengying ZHANG,Yaokai MA,Yifan DU,Wei ZHANG,Bo ZHOU,Xiyi YANG. A Randomized controlled study on the efficacy of HAIC sequential DEB⁃TACE in the treatment of colorectal cancer liver metastasis[J]. The Journal of Practical Medicine, 2025, 41(17): 2721-2728.

Figures/Tables 7

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References 23

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临床资料	对照组（n = 42）	研究组（n = 40）	t/χ² 值	P值
年龄（x ± s）/岁	52.36 ± 7.16	53.13 ± 7.54	0.474	0.637
性别/［例（%）］			0.160	0.689
男	27（64.29）	24（60.00）
女	15（35.71）	16（40.00）
BMI（x ± s）/（kg/m²）	23.46 ± 1.29	23.31 ± 1.06	0.574	0.568
原发部位/［例（%）］			0.201	0.905
右半结肠	17（40.48）	16（40.00）
左半结肠	13（30.95）	14（35.00）
直肠	12（28.57）	10（25.00）
肿瘤大小/［例（%）］			0.152	0.697
< 5 cm	13（30.95）	14（35.00）
≥ 5 cm	29（69.05）	26（65.00）
肝转移灶数量/［例（%）］			0.149	0.699
≤ 3个	12（28.57）	13（32.50）
> 3个	30（71.43）	27（67.50）
肿瘤边缘/［例（%）］			0.303	0.582
光滑	15（35.71）	12（30.00）
不光滑	27（64.29）	28（70.00）
大血管侵犯/［例（%）］			0.441	0.507
是	11（26.19）	8（20.00）
否	31（73.81）	32（80.00）
Child-Puge分级/［例（%）］			0.042	0.837
A级	23（54.76）	21（52.50）
B级	19（45.24）	19（47.50）

组别	例数	CEA/（μg/L）		CA125/（kU/L）		CA199/（kU/L）		CA242/（kU/L）
组别	例数	治疗前	治疗后	治疗前	治疗后	治疗前	治疗后	治疗前	治疗后
对照组	42	93.15 ± 20.53	15.46 ± 3.67^?	79.85 ± 16.94	46.61 ± 9.35^?	173.48 ± 36.15	61.85 ± 15.46^?	36.94 ± 7.95	15.73 ± 3.64^?
研究组	40	94.07 ± 18.95	12.34 ± 3.21^?	81.42 ± 17.16	40.03 ± 8.87^?	171.94 ± 37.27	51.13 ± 13.24^?	35.41 ± 7.24	12.97 ± 3.28^?
t值		0.211	4.089	0.417	3.266	0.190	3.365	0.910	3.601
P值		0.834	< 0.001	0.678	0.002	0.850	0.001	0.366	0.001

组别	例数	AST		ALT		ALP		GGT
组别	例数	治疗前	治疗后	治疗前	治疗后	治疗前	治疗后	治疗前	治疗后
对照组	42	70.62 ± 19.46	33.13 ± 8.12^?	62.85 ± 16.24	31.67 ± 7.92^?	163.86 ± 32.16	130.14 ± 27.42^?	58.62 ± 9.63	42.30 ± 6.41^?
研究组	40	68.96 ± 20.75	27.46 ± 6.67^?	60.72 ± 16.92	26.18 ± 6.43^?	161.53 ± 33.98	110.97 ± 23.04^?	59.20 ± 8.72	38.27 ± 5.92^?
t值		0.374	3.446	0.582	3.436	0.319	3.419	0.285	2.954
P值		0.710	0.001	0.562	0.001	0.751	0.001	0.776	0.004

组别	例数	CR	PR	SD	PD	客观缓解率	疾病控制率
对照组	42	1（2.38）	12（28.57）	13（30.95）	16（38.10）	13（30.95）	26（61.90）
研究组	40	4（10.00）	20（50.00）	9（22.50）	7（17.50）	24（60.00）	33（82.50）
Z/χ² 值		2.783				6.981	5.224
P值		0.005				0.008	0.022

组别	例数	发热	疼痛	恶心	呕吐	乏力	骨髓抑制	腹泻	肝功能异常
对照组	42	38（90.48）	15（35.71）	20（47.62）	19（45.24）	25（59.52）	13（30.95）	6（14.29）	15（35.71）
研究组	40	37（92.50）	21（52.50）	23（57.50）	17（42.50）	21（52.50）	16（40.00）	3（7.50）	13（32.50）
χ² 值		0.107	2.344	0.802	0.062	0.410	0.734	0.965	0.094
P值		0.743	0.126	0.370	0.803	0.522	0.392	0.326	0.759

A Randomized controlled study on the efficacy of HAIC sequential DEB⁃TACE in the treatment of colorectal cancer liver metastasis

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亚组特征	研究组 ORR	对照组 ORR	ORR差异（Δ）	P值
肝转移灶≤ 3个	76.9%	41.7%	+35.2%	0.047
肝转移灶> 3个	51.9%	26.7%	+25.2%	0.051
原发灶：右半结肠	62.5%	35.3%	+27.2%	0.131
原发灶：左半结肠	64.3%	23.1%	+41.2%	0.037
原发灶：直肠	50.0%	33.3%	+16.7%	0.418

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