摘要
目的探讨肿瘤细胞减灭术(CRS)+腹腔热灌注化疗(HIPEC)治疗结直肠癌腹膜癌(CRC PC)的疗效和安全性。方法收集2015年1月至2018年6月于首都医科大学附属北京世纪坛医院接受CRS+HIPEC综合诊治的CRC PC患者的临床资料。生存分析采用Kaplan-Meier法,并行Log rank检验,单因素和多因素分析采用Cox回归模型。结果90例CRC PC患者接受CRS+HIPEC治疗,年龄13~81岁,中位年龄53岁,男51例,女39例。全组患者中位生存时间为21.9个月(95%CI为15.7~28.1个月),1、2、3、5年生存率分别为77.8%、48.6%、21.1%和5.5%。严重不良事件发生率为8.9%(8/90),围手术期死亡率为2.2%(2/90)。单因素分析显示,年龄(P=0.040)、原发肿瘤部位(P=0.020)、术前糖类抗原125(CA125)水平(P<0.001)、腹膜癌指数(P<0.001)、肿瘤细胞减灭程度(P<0.001)、腹水量(P=0.012)、术后辅助化疗周期(P<0.001)与总生存有关。多因素分析显示,术前CA125水平(P=0.033)、肿瘤细胞减灭完全(P=0.014)、术后辅助化疗周期数(P=0.002)为总生存独立预后影响因素。结论CRS+HIPEC可延长部分CRC PC患者的生存时间,严格患者筛选和彻底的CRS是该治疗策略成功的关键。
Objective To evaluate the safety and efficacy of cytoreductive surgery plus hyperthermic intraperitoneal chemotherapy(CRS+HIPEC)in patients with peritoneal carcinomatosis from colorectal carcinoma(CRC PC).Methods The clinical and follow-up data of 90 consecutive CRC PC patients underwent CRS+HIPEC in Beijing Shijitan Hospital from January 2015 to June 2018 were collected.Kaplan-Meier method and parallel Log rank test were used for survival analysis.Cox regression model was used for univariate and multivariate analysis.Results A total of 90 CRC PC patients underwent CRS+HIPEC,the median age was 53 years(rage:13 to 81 years),and 51 cases were male,while other 39 were female.The median overall survival(mOS)was 21.9 months(95%CI:15.7,28.1).The 1-,2-,3-,and 5-year survival rates were 77.8%,48.6%,21.1%,and 5.5%,respectively.The incidence rate of serious adverse event(SAE)was 8.9%(8/90).The mortality rate of perioperative period was 2.2%(2/90).Univariate analysis showed the age(P=0.040),primary tumor site(P=0.020),preoperative carbohydrate antigen 125(CA125)level(P<0.001),peritoneal cancer index(PCI)(P<0.001),completeness of cytoreduction(CC)(P<0.001),ascites(P=0.012)and postoperative adjuvant chemotherapy(P<0.001)were significantly associated with the OS.Multivariate Cox-analysis identified preoperative CA125 level(P=0.033),CC of 0 to 1(P=0.014),and adjuvant chemotherapy postoperative(P=0.002)were independent prognostic factor for OS.Conclusions CRS+HIPEC can improve survival for CRC PC patients with acceptable morbidity and mortality.Stringent patient selection and complete CRS are two key factors for better survival.
作者
安松林
张凯
姬忠贺
李鑫宝
于洋
张彦斌
刘刚
李兵
闫国军
李雁
An Songlin;Zhang Kai;Ji Zhonghe;Li Xinbao;Yu Yang;Zhang Yanbin;Liu Gang;Li Bing;Yan Guojun;Li Yan(Department of Peritoneal Cancer Surgery,Beijing Shijitan Hospital,Capital Medical University,Beijing 100038,China)
出处
《中华肿瘤杂志》
CAS
CSCD
北大核心
2021年第12期1298-1303,共6页
Chinese Journal of Oncology
基金
首都临床特色应用研究与成果推广项目(Z161100000516077)
北京市登峰人才培养计划(DFL20180701)
北京市优秀人才培养资助集体项目(2017400003235J007)
首都医科大学附属北京世纪坛医院青年基金项目(2018-q26)。
关键词
结直肠肿瘤
腹膜癌
肿瘤细胞减灭术
腹腔热灌注化疗
Colorectal neoplasms
Peritoneal carcinomatosis
Cytoreductive surgery
Hyperthermic intraperitoneal chemotherapy