| 摘要: |
| 目的 研究动态超声造影定量评价抗血管靶向治疗对结直肠癌肝转移的早期疗效。方法 选取2018年1月至2021年5月于我院就诊的54例结直肠癌肝转移患者作为研究对象。其中25例患者进行贝伐单抗联合FOLFOX/FOLFIRI方案化疗治疗，为研究组，29例患者仅进行FOLFOX/FOLFIRI方案化疗，为对照组。对所有患者进行动态超声造影获取其定量参数，并比较其治疗前后差异，对靶病灶划定ROI区，绘制时间-强度曲线，了解预测疗效指标的临界值。结果：对照组患者中5例采用FOLFOX4方案，9例采用FOLFOX6方案，15例采用FOLFIRI方案；23例无效，6例有效。研究组患者中7例采用贝伐单抗+FOLFOX6方案，18例采用贝伐单抗+FOLFIRI方案；7例无效，18例有效。两组患者治疗前后肿瘤大小无显著差异。研究组患者中治疗前后的PI、Pw和AUC等超声造影定量参数均有统计学差异（P＜0.05），对照组患者治疗前后AUC有统计学差异（P＜0.05），余未见明显统计学差异（P＞0.05）。对两组患者进一步根据治疗有效与否进行分组后对超声造影定量参数进行比较后发现，研究组中有效者治疗后的PI和Pw均低于治疗前，呈现下降趋势，而无效者则高于治疗前。有效者治疗前和治疗后PI分别低于无效者两组前后，但无统计学差异（P＞0.05），但有效者治疗前后PI差值高于无效者，且有统计学差异（t=5.135，P=0.002＜0.05），有效者治疗治疗前和治疗后Pw分别低于无效者两组前后，但无统计学差异（P＞0.05），但有效者治疗前后Pw差值明显高于无效者，且有统计学差异（t=4.557，P=0.01＜0.05）。对照组治疗有效者与无效者之间PI和Pw治疗前后比较均无统计学差异（P＞0.05）。结论：治疗早期肿瘤大小无明显改变时，动态超声造影可通过肿瘤瘤体血流灌注预测抗血管生成靶向治疗方案对结肠癌肝转移的早期疗效，且对于瘤体Pw高水平的高血流速度和高血容量者，可有更好的临床疗效。 |
| 关键词: 超声造影 抗血管生成靶向治疗 化疗 结肠癌 肝转移 疗效评价 |
| DOI： |
| 投稿时间：2022-09-16修订日期：2022-09-16 |
| 基金项目: |
|
| Quantitatively evaluate the early efficacy of antivascular targeted therapy for colorectal cancer liver metastases bby dynamic contrast-enhanced ultrasound |
| liudaijiang |
| (Chongqing University Central Hospital) |
| Abstract: |
| Abstract Objective ：To quantitatively evaluate the early efficacy of antivascular targeted therapy for colorectal cancer liver metastases by dynamic contrast-enhanced ultrasound . Methods :A total of 54 patients with colorectal cancer liver metastases treated in our hospital from January 2018 to May 2021 were selected as the research objects. Among them, 25 patients were treated with bevacizumab combined with FOLFOX/FOLFIRI regimen as the study group, and 29 patients were treated with FOLFOX/FOLFIRI regimen only as the control group. The quantitative parameters of all patients were obtained by dynamic contrast-enhanced ultrasound (CEUS), and the differences before and after treatment were compared. The ROI area of the target lesions was delimited, and the time-intensity curve was drawn to understand the critical value of the predictive efficacy index. Results : In the control group, 5 patients received FOLFOX4 regimen, 9 patients received FOLFOX6 regimen, and 15 patients received FOLFIRI regimen. 23 cases were ineffective and 6 cases were effective. In the study group, 7 patients received bevacizumab +FOLFOX6 regimen, and 18 patients received bevacizumab +FOLFIRI regimen. 7 cases were ineffective and 18 cases were effective. There was no significant difference in tumor size between the two groups before and after treatment. The quantitative parameters of CEUS such as PI, Pw and AUC in the study group were statistically different before and after treatment (P<0.05), and the AUC in the control group was statistically different before and after treatment (P<0.05), but there was no significant difference in the other parameters (P>0.05).The quantitative parameters of contrast-enhanced ultrasound were further compared between the two groups according to whether the treatment was effective or not. It was found that the PI and Pw of the effective group after treatment were lower than those before treatment, showing a downward trend, while those of the ineffective group were higher than those before treatment. The PI of the effective group before and after treatment was lower than that of the ineffective group before and after treatment, but there was no statistical difference (P> 0.05). The PI difference of the effective group before and after treatment was higher than that of the ineffective group, and there was statistical difference (t=5.135, P=0.002<0.05). The Pw of the effective group before and after treatment was lower than that of the ineffective group before and after treatment, respectively. However, the difference of Pw before and after treatment in effective group was significantly higher than that in ineffective group, and the difference was statistically significant (t=4.557, P=0.01< 0.05). There was no significant difference in PI and Pw between the effective group and the ineffective group before and after treatment in the control group (P>0.05).Conclusion :When the tumor size does not change significantly in the early stage of treatment, dynamic contrast-enhanced ultrasound can predict the early efficacy of anti-angiogenesis targeted therapy for colon cancer liver metastases through tumor blood perfusion, and has better clinical efficacy for patients with high Pw level and high blood flow velocity and volume. |
| Key words: Contrast-enhanced ultrasound Anti-angiogenic targeted therapy Chemotherapy Colon cancer Spread to the liver Curative effect evaluation |
