摘要目的 分析CT引导125I粒子植入治疗头颈部复发转移肿瘤近期疗效的影响因素.方法 回顾性纳入2015年1月至2019年4月于河北省人民医院行125I粒子植入治疗的73例头颈部复发转移肿瘤患者[男61例、女12例,年龄(59.1±11.5)岁],植入粒子活度11.1～29.6 MBq,处方剂量80.0～145.0Gy.植入术后3个月行CT检查,参考实体瘤疗效评价标准(RECIST) 1.1评价近期疗效:有效[完全缓解(CR)和部分缓解(PR)]和无效[病情稳定(SD)和病情进展(PD)].将影响近期疗效的因素[性别、年龄、既往放疗史、卡氏功能状态(KPS)评分、病理类型、肿瘤最长径、植入方式、粒子活度、术后即刻90％大体肿瘤体积接受的剂量(D90)、术后是否行辅助化疗]先行单因素分析,将P＜0.2的变量纳入logistic回归模型;另以所有影响因素为自变量、近期疗效为因变量,构建人工神经网络(ANN);最后对logistic分析和ANN分析共有影响因素行受试者工作特征(ROC)曲线分析.结果 73例患者中,34例有效,39例无效.Logistic回归分析结果显示,肿瘤最长径、术后即刻D90、术后是否行辅助化疗对疗效有显著影响(Wald值:6.950、4.804、4.790,均P＜0.05);ANN分析结果显示,预测疗效重要性的前5位因素依次为术后即刻D90、肿瘤最长径、年龄、粒子活度和性别.ROC曲线分析结果示,肿瘤最长径、术后即刻D90是近期疗效的最佳预测因子,最佳阈值分别为5.25 cm和110.05 Gy,对应的曲线下面积(AUC)分别为0.843和0.847(均P＜0.001).结论 头颈部复发转移肿瘤125I粒子植入治疗的近期疗效主要与肿瘤最长径和术后即刻D90有关;肿瘤最长径＜5.25 cm、D90＞110.05 Gy者疗效更好.

abstractsObjective To analyze the factors influencing the short-term efficacy of CT-guided 125I seeds implantation in the treatment of recurrent and metastatic tumors in head and neck.Methods A total of 73 patients (61 males,12 females;age:(59.1±11.5) years) with head and neck tumors recurrence and metastasis treated by 125I seeds implantation in Hebei General Hospital from January 2015 to April 2019 were retrospectively enrolled.The implanted seeds activity was 11.1-29.6 MBq,and the prescription dose was 80.0-145.0 Gy.CT examination was conducted 3 months after 125I seeds implantation.According to Response Evaluation Criteria in Solid Tumors (RECIST) 1.1,short-term efficacy was classified as effective (complete remission (CR),partial remission (PR)) and ineffective (stable disease (SD),progressive disease (PD)).Univariate analysis of factors affecting short-term effect (gender,age,history of radiation therapy,Karnofsky performance status (KPS) scores,pathological type,the longest diameter of tumor,implantation patterns,seeds activity,immediate postoperative dose delivered to 90％ gross tumor volume (D90),and with adjuvant chemotherapy post-surgery or not) were conducted.Variables with P＜ 0.2 were enrolled in logistic multivariate regression analysis.In addition,artificial neural network (ANN) was constructed with all influencing factors as independent variables and short-term efficacy as dependent variables.Finally,receiver operating characteristic (ROC) curve analysis was performed for the common influencing factors in logistic regression analysis and ANN analysis.Results There were 34 with effective results and 39 with ineffective results.Logistic regression analysis indicated that the longest diameter of tumor,immediate postoperative D90,with adjuvant chemotherapy post-surgery or not had significant impacts on the shortterm efficacy (Wald values:6.950,4.804,4.790,all P＜0.05);According to results of ANN analysis,the top 5 in order of importance for short-term efficacy prediction were immediate postoperative D90,the longest diameter of tumor,age,seeds activity and gender.ROC curve analysis indicated that the longest diameter of tumor and immediate postoperative D90 were the best predictors for short-term efficacy,with the threshold of 5.25 cm and 110.05 Gy respectively,and the area under the curve (AUC) was 0.843 and 0.847 respectively (both P＜0.001).Conclusions The short-term efficacy of 125I seeds implantation in the recurrence and metastasis of head and neck tumors is mainly related to the longest diameter of tumor and immediate postoperative D90.Patients with the longest diameter of tumor ＜5.25 cm and with D90＞110.05 Gy can achieve better efficacy.