原发性腹膜恶性肿瘤化疗方案的探讨

A comparison of combination chemotherapy with TP and PAC in the treatment of primary peritoneal malignancies

目的比较原发性腹膜恶性肿瘤采用不同化疗方案治疗对患者生存时间的影响.方法对1995年5月～2005年5月在本院治疗的27例原发性腹膜恶性肿瘤患者的临床病理资料进行回顾性分析.结果全部患者均施行肿瘤细胞减灭术,术后予以铂类为主的方案化疗.24例患者采用TP(紫杉醇+顺铂/卡铂)或PAC(顺铂+阿霉素+环磷酰胺)方案化疗,其中2例失访,2例尚未完成化疗;另有2例患者采用以铂类为主的其他方案化疗,1例未化疗.总结有完整化疗及随访资料的20例患者的生存情况.TP方案组13例,PAC方案组7例.20例患者初次化疗缓解率80%(完全缓解60%,部分缓解20%),无进展中位生存时间16个月(11～21个月),总体中位生存时间 42个月(22.3～61.7个月).TP方案组和PAC方案组患者的年龄、绝经状况、腹水细胞学检查、手术后残余灶大小、手术分期(沿用卵巢癌FIGO分期标准)、病理类型、化疗疗程及化疗毒副反应均无统计学差异.TP方案组患者无进展中位生存时间19个月,PAC方案组12个月,两者比较无统计学差异;TP方案组和PAC方案组患者的平均生存时间分别为69个月和28个月,两者比较,差异有统计学意义(P<0.05).结论原发性腹膜恶性肿瘤采取肿瘤细胞减灭术及铂类为主的化疗方案可改善预后,TP联合化疗可能优于PAC方案延长患者生存时间.

Objective To explore, and compare the effects of different chemotherapy regimens on the survival of patients with primary peritoneal neoplasms. Methods We retrospectively reviewed the clinical and pathological records of 27 cases of primary peritoneal neoplasm treated in Peking University People＇ s Hospital from May 1995 to May 2005. Results All patients underwent cytoreductive surgery and received a latinum - based combination chemotherapy. Twenty - four cases received paclitaxel ＋ cisplatin （riP） or cisplatin ＋ doxombicin ＋ cyclophosphamide （PAC） regimen, among whom 2 haven＇ t completed the chemother- apy and 2 were lost of follow - up. The other 2 received another platinum - based regimens and 1 didn＇ t receive chemotherapy. Among the 20 cases with detailed clinical records, 13 patients received TP and 7 received PAC chemotherapy. The primary response was 80% （ complete response 60% and partial response 20% ）. The median progression - free survival and overall survival of all patients was 16 months and 42 months respectively. The TP and PAC groups were well matched with respect to the mean age, menopause, ascitic cytology test, residual tumor size, stage, pathological types, chemotherapy courses and toxicity. The median progression- free survival for the TP and PAC groups were 19 and 12 months. No significant difference was achieved. However, patients receiving TP combination exhibited longer survival than those receiving PAC regimen （mean survival 69 vs 28 months, P 〈 0.05）, Cooclusions Cytoreductive surgery and a platinum- based combination chemotherapy may improve the prognosis of patients with primary, peritoneal malignancies. TP regimen can obtain longer survival than PAC regimen.