Evaluation Of Ultrasound Guided Microwave Ablation Combined With TACE In The Treatment Of Hepatic Metastasis Of Colorectal Cancer

Objective To evaluate retrospectively the therapeutic effect of microwave ablation under ultrasound guidance,hepatic artery chemoembolization and the combination of both in patients with hepatic metastasis of colorectal cancer,analyze the factors affecting the prognosis of CRLM,and personalize the treatment of CRLM patients optimize measures.Methods From January 2016 to January 2019,CRLM patients treated with MWA,TACE and MWA combined TACE were collected.A total of 122 patients were selected after screening,divided into 40 cases in the MWA group,38 cases in the TACE group,44 cases in the combined group(MWA+TACE).The cumulative survival rate,recurrence rate and complications of the three groups were compared,and the survival curve was drawn by Kaplan-Meier method;The factors affecting the prognosis of CRLM were analyzed.log-rank test and Cox regression model were used for single factor and multiple factor analysis respectively;To study the therapeutic effects of these three methods in the subgroups with the maximum diameter ?3cm and 3-5cm of metastatic foci respectively;Follow-up is up to December 2019 or 36 months.Results 1.The cumulative survival rates for 1,2 and 3 years after treatment in the combined group were 100%,93.4% and 34.5% respectively,96.3%,85.2% and 20.3% in MWA group and 94.1%,50.7% and 0% in TACE group,log-rank test was used to test the survival curves of each group respectively,the cumulative survival rates in the combined group were higher than those in MWA group and TACE group respectively,and the difference was statistically significant(P=0.017,P<0.001).The cumulative survival rate in MWA group was higher than that in TACE group,and the difference was statistically significant(P = 0.001);The recurrence rates of the combined group,MWA group and TACE group were 29.5%,47.5% and 78.9%,respectively,there was no statistically significant difference between the combined group and the MWA group(P = 0.091).The recurrence rate of the combined group and the MWA group were lower than those of the TACE group,and the differences were statistically significant(P<0.001,P=0.003);Complications such as hypothermia,local pain,pleural effusion,abdominal cavity bleeding,nausea and vomiting,and transient damage to liver function occurred in the three groups of patients,there was statistical difference in the occurrence of nausea and vomiting complications in the three groups(P = 0.003),but there was no statistical difference in the occurrence of complications such as hypothermia,local pain,pleural effusion,abdominal hemorrhage,and transient liver function injury(all P > 0.05).2.Log-rank test univariate analysis showed that the location of primary lesion(P=0.043),degree of differentiation(P=0.001),maximum diameter of metastatic lesion(P=0.006),number(P=0.021)and treatment method(P<0.001)were prognostic factors affecting CRLM;Multivariate analysis of COX suggests that the maximum diameter,number,degree of differentiation(high differentiation)and treatment methods(combined therapy,MWA)of metastases are independent influencing factors for CRLM prognosis.3.In the subgroup with a maximum diameter ?3cm,the cumulative survival rate of combined therapy is similar to that of MWA therapy,with no statistical difference(P = 0.054);The cumulative survival rate of combined therapy and MWA therapy was higher than TACE therapy,and the difference was statistically significant(P<0.001,P= 0.006);The recurrence rates of combined therapy,MWA therapy and TACE therapy were 21.1%,22.2% and 65.0%,respectively,the recurrence rates of combined therapy and therapy were similar,with no significant difference(P=0.931).Recurrence rates of combined therapy and MWA therapy were lower than TACE therapy,with significant difference(P=0.006,P = 0.008);In the maximum diameter of 3-5cmCRLM,the cumulative survival rate of combined therapy was higher than that of MWA therapy and TACE therapy,and the difference was statistically significant(P=0.019,P<0.001).The cumulative survival rate of MWA therapy was higher than TACE therapy,and the difference was statistically significant(P=0.020);The recurrence rates of combined therapy,MWA therapy and TACE therapy were 36.0%,68.2% and 94.4% respectively,the recurrence rates of combined therapy were lower than those of MWA therapy and TACE therapy respectively,and the difference was statistically significant(P=0.028,P<0.001).The recurrence rate of MWA therapy was lower than TACE therapy,and the difference was statistically significant(P=0.039).Conclusion 1.Ultrasound-guided MWA,TACE,and combination therapy all have a certain effect in CRLM,and combined therapy is more effective than MWA and TACE,with lower complications and can significantly prolong the survival of patients.2.In CRLM treatment with maximum diameter ?3cm,MWA can achieve similar efficacy to MWA combined with TACE,and the efficacy is better than TACE;Among CRLM treatments with maximum diameter of 3-5cm,MWA combined with TACE is superior to MWA and TACE alone,and MWA is superior to TACE.3.The maximum diameter,degree of differentiation(high differentiation),number and treatment methods(combined therapy and MWA therapy)of metastatic lesions are independent factors affecting the prognosis of CRLM.