Clinical Observation Of Bronchoscopic Cryotherapy Combined With Chemotherapy In Patients With Stage Ⅲ And Ⅳ Central Lung Cancer

Objective This study analyzed the different clinical efficacy between bronchoscopy combined with chemotherapy and chemotherapy alone in patients with stage Ⅲ and Ⅳ central lung cancer,and explored the effects of bronchoscopic cryotherapy combined with chemotherapy on progression-free survival,objective response rate and overall survival.Methods This study retrospectively analyzed 60 patients with advanced central lung cancer were treated by the Department of Respiratory and Critical Care Medicine of Minda Hospital Affiliated to Hubei Minzu University from January 1,2018 to December 31,2021.Up to January 31,2021.The enrolled patients were divided into observation group and control group.The observation group（29 people）received platinum-based two-drug combination chemotherapy and bronchoscopy freezing treatment,while the control group（31people）received platinum-based two-drug combination chemotherapy alone.The primary study endpoint was progress free survival（PFS）,Secondary study endpoints were objective response rate（ORR）,disease control rate（DCR）,overall survival（OS）,serum carcinoembryonic antigen（CEA）and adverse reactions,The basic data of 60 patients were analyzed by single factor analysis of PFS.Data processing adopts spss260 software,and P<0.05 was considered statistically significant.Results There were no statistically significant differences in gender,age,smoking history,Karnofsky behavior status score（KPS score）,pathological classification（small cell lung cancer,squamous cell carcinoma）and clinical stage（Ⅲ and Ⅳ）between 2 groups（P>0.05）.At the end of follow-up（January 31,2021）,18 patients were still alive while 11 died in the observation group and 20 patients were still alive while 11 died in the control group,both groups did not reach the median OS.In the observation group,the median PFS was 6.74 months（95%CI 4.87-8.61）,the mean PFS was 7.05±0.63 months,ORR was13.8%,and DCR was 65.5%.In the control group,the median PFS was 4.39 months（95% CI 3.39-5.38）,the mean PFS was 5.32±0.58 months,ORR was 6.4%,and DCR was 38.7%.There were statistical differences in the relative ratio of median PFS and DCR between 2 groups（P<0.05）.There was no significant difference in ORR between the two groups（P>0.05）.CEA in the observation group decreased more significantly than that in the control group（1.62±2.50vs0.54±1.55）,the difference was statistically significant（P<0.05）.There was no significant difference in the incidence of adverse reactions between the two groups（P>0.05）.Single factor analysis of PFS was found that smoking history,pathological stage and treatment group were significantly correlated with PFS of 60 patients with central lung cancer,with P values of 0.019,0.041 and 0.049,respectively,all less than 0.05.Multivariate analysis was conducted by COX proportional risk regression model.The results showed that smoking history,pathological stage and treatment group were all independent factors affecting PFS in patients with central lung cancer（P<0.05）.Conclusion Bronchoscopy combined with chemotherapy can make patients with stage Ⅲ and Ⅳ central lung cancer achieve better clinical benefit,to a certain extent than simple chemotherapy.It can prolong median PFS of patients with central lung cancer and play a positive role in improving the DCR and ORR,reducing serum CEA in effective and safe way.There was no increase in the incidence of adverse reactions.Previous smoking history,pathological stage Ⅳ and chemotherapy alone were the risk factors for PFS.Nonsmokers and patients with stageⅢ central lung cancer could benefit most from bronchoscopic cryotherapy combined with chemotherapy.In the end,it can alleviate patients’ clinical symptoms and improve the quality of life.So it is worthy of clinical application.