摘要
目的:评估细胞减灭术(CRS)加腹腔热灌注化疗(HIPEC)治疗胃癌腹膜转移癌(伴/不伴恶性腹水)的疗效及安全性。方法:28例进展期胃癌腹膜转移癌患者接受CRS加HIPEC治疗,主要研究指标为生存期,次要指标为围手术期安全性及不良事件。结果:28例患者共接受30次CRS加HIPEC治疗。术中评估腹膜癌指数2-31(中位数12)。细胞减灭程度0分者11例(39.2%),1分6例(21.4%),2分8例(28.8%),3分3例(10.6%)。截至2010年5月1日,随访期5-57月(中位数24月),19例(67.9%)死亡,9例(32.1%)存活。6,12,18和24月的生存率分别为75%,50%,43%和43%。PCI≤20和>20者中位生存期分别为27.7月(95%CI,15.2-40.3月)和6.4月(95%CI,3.8-8.9月)(P=0.000)。CCR-0、CCR-1、CCR-2&3中位生存期为43.4月(95%CI,26.9-59.9月)、9.4月(95%CI,7.4-11.4月)和8.3月(95%CI,3.0-13.6月)(P=0.001)。同时性和异时性腹膜转移癌者中位生存期分别为24月(95%CI,21.6-48.4月)和12月(95%CI,6.6-19.4月)(P=0.000)。无术后30d内死亡病例,围手术期严重不良事件4例(肠梗阻2例、成人呼吸窘迫综合征1例、胆漏1例)。结论:细胞减灭术加腹腔热灌注化疗使胃癌腹膜癌患者受益,延长生存期。
Objective:To evaluate cytoreductive surgery(CRS)plus hyperthermic intraperitoneal chemotherapy(HIPEC)in the treatment of advanced gastric cancer(GC)with peritoneal carcinomatosis and/or ascites.Methods:CRS and HIPEC procedures were performed in 28GC patients with peritoneal carcinomatosis and/or malignant ascites,with survival and perioperative safety as study endpoints.Results:A total of 30CRS and HIPEC procedures were performed.Cytoreduction scores ratings were CCR-0 in 11(39.2%),CCR-1 in 6(21.4%),CCR-2in 8(28.8%),and CCR-3 in 3(10.6%)cases.19 patients(67.9%)were dead and 9 patients(32.1%)survived, and the 6-,12-,18-and 24-month survival rates were 75%,50%,43%,and 43%,respectively.The median survivals of patients with peritoneal carcinomatosis index(PCI)≤20 and PCI20 were 27.7months(95%CI=15.2-40.3 months)and 6.4 months(95%CI=3.8-8.9 months) (P=0.000)respectively.The estimated median survival for patients with CCR-0,CCR-1 and CCR-23were 43.4months(95%CI=26.9-59.9 months),9.5months(95%CI=6.4-12.6 months),and 7.5months(95% CI=3.0-13.6 months)respectively(P=0.001,CCR0vs CCR1-3).The median survivals of patients with synchronous and metachronous peritoneal carci-nomatosis were 24 months(95%CI=21.6-48.4months)and 12 months(95%CI=6.6-19.4 months)respectively(P=0.000).No perioperative death but 4(14.3%)serious adverse events occurred.Conclusion:CRS plus HIPEC could offer survival advantage for selected GC patients with peritoneal carcinomatosis and ascites,with acceptable safety profile.
出处
《武汉大学学报(医学版)》
CAS
北大核心
2010年第5期635-639,共5页
Medical Journal of Wuhan University
基金
全国优秀博士学位论文作者专项资金资助项目(编号:200464)
关键词
胃癌
腹膜转移癌
细胞减灭术
腹腔热灌注化疗
Gastric Cancer
Peritoneal Carcinomatosis
Cytoreductive Surgery
Hyperthermic Intraperitoneal Chemotherapy