隔离热灌注化疗治疗肢体恶性黑色素瘤的临床研究

Hyperthermic isolated limb perfusion chemotherapy treatment of malignant melanoma

目的恶性黑色素瘤(malignant melanoma,MM)是临床上较为常见的高度恶性肿瘤,长期以来致残率和死亡率相当高。本研究探讨隔离热灌注化疗(hyperthermic isolated limb perfusion,HILP)技术应用于MM的治疗效果,并总结热灌注经验。方法收集2002-01-01-2016-06-30甘肃省肿瘤医院骨与软组织肿瘤科收治的93例ⅡB~Ⅲ期肢体MM患者的临床资料,根据治疗方案,将72例HILP配合手术患者纳入观察组,21例未行HILP的手术患者为对照组,术后随访观察疗效、局部复发、转移、并发症及化疗毒性反应等情况,两组5年无瘤生存率(disease free survival,DFS)及5年总生存率(overall survival,OS)比较采用χ~2检验。结果观察组完全缓解率(complete response,CR)为63.9%(46/72),部分缓解率(partial response,PR)为26.4%(19/72),总缓解率(owerall response,OR)为90.3%,局部复发率(local recurrence,LR)为11.1%(8/72),保肢率(limb salvage,LS)为95.8%(69/72)。无死亡、致残等严重并发症,Wieberdink毒性反应分级均为Ⅰ~Ⅲ级。观察组与对照组5年DFS分别为44.4%(16/36)和14.3%(3/21),差异有统计学意义,P=0.02;5年OS分别为52.8%(19/36)和19.0%(4/21),差异有统计学意义,P=0.01。结论 HILP疗效确切,毒副作用小,且安全性高,能降低LR,提高5年DFS及OS,该技术可在临床上广泛推广及应用。

OBJECTIVE Malignant melanoma（MM）is a relatively common high incidence of malignant tumors,long-term disability and mortality is quite high.This study explored the treatment effective and summarize the practice experience of hyperthermic isolated limb perfusion（HILP）application in the Limb MM.METHODS The clinical data of93 patients with stageⅡB-Ⅲ MM were collected from January 2002 to June 2016.According to the treatment method,72 patients with HILP were the observation group and 21 patients without HILP were the control group.Compared the treatment effective rate,local recurrence,metastasis and chemotherapy toxicity after operation.The 5-year disease free survival rate（DFS）and 5-year overall survival rate（OS）were statisticed with theχ~2 test between the two groups.RESULTS In the observation group,the complete response rate（CR）was 63.9%（46/72）,the partial response rate（PR）was26.4%（19/72）,the CR（OR＋PR）was 90.3%,the local recurrence rate was 11.1%（8/72）,and limb salvage rate（LS）was 95.8%（69/72）.No serious complications such as death,disability and other.Wieberdink toxicity grade was betweenⅠ-Ⅲ.The 5-year DFS was 44.4%（16/36）and 14.3%（3/21）in the observation group and control group respectively.The difference was significant statistically（P=0.02）.The 5-year OS was 52.8%（19/36）and 19.0%（4/21）respectively.The difference was statistically（P=0.01）.CONCLUSIONS HILP with exact effective,little toxicity and high security,can reduce LR and increase 5-year DFS and OS.This technique could be widely spreaded and used in clinical practice.