[Efficacy and safety of different sizes drug eluting beads in the treatment of colorectal cancer liver metastasis by TACE].

Objective: To compare the efficacy and safety of different-sized drug eluting beads preloaded with irinotrcan (DEBIRI) used in transarterial chemoembolization (TACE) as second-line therapy for colorectal cancer liver metastases (CRC-LM). Methods: A retrospective analysis was conducted on 65 patients with CRC-LM who received TACE at Yantai Yuhuangding Hospital from November 2020 to November 2022. All patients had progressed after first-line therapy. After excluding 5 lost-to-follow-up cases, 30 patients treated with 100-300 μm DEBIRI (small-size group) and 30 patients treated with 300-500 μm microspheres (large-size group) were included. Short- and long-term efficacy and adverse reactions were compared between the two groups.

Univariate and multivariate Cox regression analyses were performed to identify factors influencing progression-free survival (PFS) and overall survival (OS). Results: In the small-size group, the objective response rates (ORR) at 1, 3, 6, and 12 months after treatment were 56.7%, 50.0%, 40.0%, and 30.0%, respectively, and the disease control rates (DCR) were 93.3%, 90.0%, 80.0%, and 66.7%, respectively. In the large-size group, the ORR at the same time points were 36.7%, 26.7%, 23.3%, and 16.7%, respectively, and the DCR were 86.7%, 76.7%, 76.7%, and 60.0%, respectively. None of the differences between the two groups were statistically significant (all P＞0.05). The median PFS and OS in the small-size group were 15.0 and 26.0 months, respectively, while in the large-size group they were 13.8 and 21.5 months, respectively, with no statistically significant differences between groups (all P＞0.05).

The overall incidence of adverse reactions was 76.6% in the small-size group and 70.0% in the large-size group (P=0.559). The incidence of grade ≥3 adverse reactions was 23.3% and 16.7%, respectively (P=0.519). No treatment-related deaths occurred in either group.

Multivariate Cox regression analysis showed that Child-Pugh grade, Eastern Cooperative Oncology Group (ECOG) score, and number of liver metastases were independent influencing factors for both PFS and OS. Conclusion: There was no significant difference in efficacy between 100-300 μm and 300-500 μm drug eluting beads preloaded with irinotrcanused in TACE for the treatment of CRC-LM, and both demonstrated good safety profiles. 目的： 比较不同粒径载伊立替康微球用于经导管动脉化疗栓塞术（TACE）二线治疗结直肠癌肝转移（CRC-LM）的疗效及安全性。 方法： 回顾性收集2020年11月至2022年11月于烟台毓璜顶医院接受TACE治疗的CRC-LM患者65例，均为一线治疗后进展患者，剔除失访的5例，使用100～300 μm载伊立替康微球（小粒径组）和300～500 μm载伊立替康微球（大粒径组）的患者各30例。比较两组近期远期疗效及不良反应发生情况，采用单因素和多因素Cox回归分析明确无进展生存时间（PFS）和总生存时间（OS）的影响因素。 结果： 小粒径组患者治疗后1、3、6和12个月的客观缓解率（ORR）分别为56.7%、50.0%、40.0%和30.0%，疾病控制率（DCR）分别为93.3%、90.0%、80.0%和66.7%；大粒径组患者治疗后1、3、6和12个月的ORR分别为36.7%、26.7%、23.3%和16.7%，DCR分别为86.7%、76.7%、76.7%和60.0%，两组差异均无统计学意义（均P＞0.05）。小粒径组患者的中位PFS和OS分别为15.0和26.0个月，大粒径组患者的中位PFS和OS分别为13.8和21.5个月，两组差异均无统计学意义（均P＞0.05）。小粒径组和大粒径组不良反应发生率分别为76.6%和70.0%，≥3级不良反应发生率分别为23.3%和16.7%，差异均无统计学意义（均P＞0.05）。两组均未发生治疗相关死亡。多因素Cox回归分析显示，PFS和OS的独立影响因素均为Child-Pugh分级、美国东部肿瘤协作组评分和肝转移灶数目。 结论： 使用100～300 μm和300～500 μm载伊立替康微球TACE治疗CRC-LM疗效无明显差异，且均显示出良好的安全性。.