Clinical efficacy of intraoperative spraying of methotrexate-loaded tumor cell-derived microparticles for reducing postoperative local recurrence risk of digestive system malignancies
SUI Xiao-jun,LI Yan,SUN Xiang-yu
Abstract:
Objective To investigate the safety of intraoperative topical spraying of methotrexate-loaded tumor cell-derived microparticles (MTX-TMPs) in radical surgery for digestive system malignancies and to explore their potential value in clearing residual local lesions and reducing the risk of local recurrence. Methods A retrospective study was conducted using clinical and follow-up data from patients who received intraoperative topical spraying of MTX-TMPs between April 2022 and March 2023(MTX-TMPs group, n=28), and those who did not receive MTX-TMPs between April 2021 and March 2022(control group, n=46). General conditions, liver and kidney function, postoperative complications, and survival outcomes were compared between the two groups. Results Preoperative and postoperative levels of direct bilirubin and alanine aminotransferase were significantly lower in the MTX-TMPs group than in the control group (P <0.05), while postoperative hemoglobin level was higher in the MTX-TMPs group (P <0.05). No statistically significant differences were observed in renal function between the two groups (P >0.05). Intraoperative blood loss, operative time, postoperative complication rate, and postoperative hospital stay were comparable between the two groups (P >0.05). Survival analysis showed that the median overall survival and recurrence-free survival were significantly longer in the MTX-TMPs group than in the control group (P <0.05). However, after adjusting for TNM stage using multivariate Cox proportional hazards regression model, the group variable was not an independent prognostic factor for overall survival (HR=0.383, 95%CI 0.127-1.159, P =0.09) or recurrence-free survival (HR=0.445, 95%CI 0.153-1.297, P =0.138), suggesting that the survival differences might be influenced by baseline imbalances. Conclusion Topical application of MTX-TMPs in the surgical field demonstrates favorable safety, with no adverse effects on liver or kidney function, and no increase in intraoperative blood loss, operative time, or postoperative complications. The treatment also shows potential efficacy in reducing the risk of local recurrence.
