细胞减灭术联合腹腔热灌注化疗治疗恶性腹膜间皮瘤

Application of the treatment for MPM using combined therapies of CS and HIPEC

目的:总结国内外对恶性腹膜间皮瘤(malignant peritoneal mesothelioma,MPM)综合治疗研究的现状。方法:检索Pub Med及CNKI期刊全文数据库系统,以"恶性腹膜间皮瘤、内科治疗、细胞减灭术(cytoreductive surgery,CS)和腹腔热灌注化疗(hyperthermic intraperitoneal chemotherapy,HIPEC)"等关键词检索1983年-2016年相关文献。纳入标准:MPM的CS联合HIPEC治疗;MPM的化疗;MPM的腔内化疗。根据纳入标准符合分析的文献有56篇。结果:多个报道表明联合细胞减灭术及腹腔热灌注化疗治疗MPM能显著提高患者总体生存率(overall survival,OS)及无疾病生存率(progression-free survival,PFS)。联用CS+HIPEC可提高MPM患者中位总生存期到36~92个月,5年生存率达59%。长期随访中的少数无复发患者提示MPM有潜在治愈的可能。结论:曾经一经诊断即为晚期、致死性高的MPM,现在通过积极的CS+HIPEC治疗成为一种可治的且有治愈可能的恶性肿瘤。由于MPM发病率低,大样本的多中心随机对照试验非常少,有必要积极倡导针对具体MPM开展前瞻性、大规模、多中心随机临床研究,以获得高水平循证医学证据,确定患者的选择标准、预后因素、最有效的化疗灌注方案及辅助化疗方式。

Objective： To sum up the status of the combination treatments for malignant peritoneal mesothelioma a-board. Methods：Relevant articles were searched with ＂ malignant peritoneal mesothelioma （ MPM）,medical treat-ment, cytoreductive surgery （CS） and hyperthermic intraperitoneal chemotherapy （ HIPEC） ＂ as key words in PubMed and CNKI database from 1983 to 2016. To tally 56 papers were collected and analyzed according to the in cluding crite -riaas following ： Combined therapies of CS and HIPEC for MPM, chemotherapy of MPM, the intracavitary chemothera-py of MPM. Results ： Multiple research studies demonstrated that combination of CS with HIPEC therapies significantly promoted the overall survival （OS） and progression - free survival （PFS） rates of patients with MPM. The median o-verall survival time would reach up to 36 -92 months, w hi le the five - year survival rate was as high as 5 9 % . Long - term follow - up survey from a few MPM patients without recurrence indicated that MPM has possible potential to be cured thoroughly. Conclusion： MPM,once considered as a malignant and deadly tumo r,n ow becomes a treatable and potentially treatable tumor through CS ＋ HIPEC active treatment. Due to the low incidence of MPM and rared random-ized controlled trials of large samples from multi - centers, it is necessary to carry out prospective, large - scale, multi -center randomized clinical trial against specific MPM to obtain a high level of evidence - based medicine to deter-mine the patients selection criteria,prognostic factors,the most effective chemotherapy infusion plan and adjuvant sys-temic chemotherapy.