肿瘤细胞减灭术联合腹腔热灌注化疗治疗120例中晚期卵巢癌的疗效观察

Curative effect of cytoreductive surgery combined with hyperthermic intraperitoneal chemotherapy in treatment of advanced ovarian cancer 120 cases

目的探讨ⅢC~Ⅳ期卵巢癌经肿瘤细胞减灭术(cytoreductive surgery,CRS)联合术后顺铂腹腔热灌注化疗(hyperthermic intraperiton eal chemotherapy,HIPEC)的疗效和安全性。方法回顾分析河南省人民医院2013年1月—2017年3月有完整随访资料的ⅢC~Ⅳ期卵巢癌患者120例,其中热灌注组(CRS+HIPEC)60例,术后接受腹腔热灌注化疗联合全身静脉化疗方案。对照组(CRS)60例,术后仅采用全身静脉化疗方案,分析两组无疾病进展时间(PFS)、腹水控制情况及安全性。结果热灌注组与对照组中位PFS分别为25.0个月(95%CI:19.24~30.76个月)和19.0个月(95%CI:14.54~23.43个月),差异有统计学意义(P=0.03);热灌注组与对照组腹水缓解率分别为87.5%与58.3%,差异有统计学意义(P=0.01);治疗过程中热灌注组发生9例严重不良反应(SAE),对照组6例(P=0.55),差异无统计学意义(P>0.05)。多因素分析显示,CRS+HIPEC、减瘤程度(CCR)、术后化疗周期数、FIGO分期是影响PFS的因素。结论肿瘤细胞减灭术联合腹腔热灌注化疗可延长中晚期卵巢癌无疾病进展时间,治疗卵巢癌恶性腹水有效率高且未显著增加严重不良事件。

Objective To evaluate the efficacy and safety of cytoreductive surgery（CRS） combined with intraperitoneal hyperthermic perfusion chemotherapy（HIPEC） with cisplatin for treating patients with stage Ⅲc-Ⅳ ovarian cancer.Methods A total of 120 patients in stage ⅢC-Ⅳ ovarian cancer with complete follow-up data were enrolled in this study.Sixty patients underwent hyperthermic intraperitoneal chemotherapy combined with systemic intravenous chemotherapy.60 patients underwent systemic intravenous chemotherapy,progression-free survival time and safety were analyzed between two groups.Results The median PFS of the perfusion group and the intravenous group were 25.0 months（95%CI： 19.24-30.76 months） and 19.0 months（95% CI： 14.54-23.43 months）,the difference was statistically significant（P = 0.029）.The effective rate of controlling malignant ascites in the perfusion group and the intravenous group was87.5% and 58.3%,respectively.The difference was statistically significant（P = 0.013）.In the perfusion group,there were 9 cases of severe adverse reactions（SAE） and 6 cases in the intravenous group,the difference was not statistically significant（P = 0.552）.Univariate analysis identified four affecting factors on PFS： CRS ＋ HIPEC,completeness of CRS,cycles of adjuvant chemotherapy,and FIGO staging.Conclusion The CRS ＋ HIPEC method can prolong the median progression-free survival time of advanced ovarian cancer,and is an effective and safe palliative treatment modality to control the malignant ascites and no serious adverse events are significantly increased.