恶性腹膜间皮瘤患者预后影响因素研究

Investigation of the Prognostic Factors in Malignant Peritoneal Mesothelioma

目的探讨恶性腹膜间皮瘤(MPeM)组织病理学特点及常用临床指标对预后的影响。方法选取沧州市中心医院2012—2015年收治的首次确诊的72例MPeM患者,分析性别、年龄、体质指数(BMI)、病理分型、TNM分期、美国东部肿瘤协作组体能状况(ECOG)评分、Charlson合并症指数(CCI)及腹膜癌病指数(PCI)及其对预后的影响。结果 MPeM患者的临床特征缺乏特异性,以腹胀为主要临床表现,其次为腹痛。TNM分期:Ⅰ~Ⅱ期52例,Ⅲ~Ⅳ期20例。病理大体分型:弥漫型68例,局限型4例。病理组织学分型:上皮型69例,肉瘤型3例。42例接受了腹腔化疗。不同组织学分型、TNM分期、ECOG评分、PCI及化疗情况患者累积生存曲线比较,差异有统计学意义(P<0.05)。Cox回归模型分析显示,TNM分期(HR=2.105,P=0.015)、ECOG评分(HR=1.930,P=0.038)、化疗(HR=0.457,P=0.005)是MPeM患者预后的独立影响因素。结论 MPeM疾病分期越早、患者体能状态越好,对预后越有利,早期检查及诊断对提高生存率有重要意义。

Objective To investigate the effect of histopathology and common clinical indices on the prognosis of patients with malignant peritoneal mesothelioma（MPeM）.Methods This study consisted of 72 cases diagnosed with MPeM in Cangzhou Central Hospital from 2012 to 2015.Patient data including gender,age,BMI,pathological type,TNM stage,Eastern Cooperative Oncology Group（ECOG） score,Charlsoncomorbidity index（CCI） and peritoneal carcinoma index（PCI） were obtained,and the associations between these indices and patients prognosis were analyzed.Results MPeM lacks specific clinical manifestations.In this cohort,bloat was a common symptom followed by abdominal pain.Fifty-two cases had stage Ⅰ-Ⅱ and 20 cases had stage Ⅲ-Ⅳ disease.Sixty-eight cases had diffuse MPeM and four cases had localized MPeM.With regard to pathological type,69 cases had epithelial carcinoma and 3 cases had sarcomatoid mesothelioma.Forty-two patients received intra-peritoneal chemotherapy.Histopathological type,TNM stage,ECOG score,PCI and whether undergoing chemotherapy were significantly associated with cumulative survival（P〈0.05）.Cox regression analysis showed that TNM stage [hazard ratio（HR）=2.105,P=0.015],ECOG score（HR=1.930,P=0.038）,and chemotherapy（HR=0.457,P=0.005） were independent prognostic factors for MPeM.Conclusion MPeM patients in the earlier stages with better performance status have a better prognosis.Early examination and diagnosis are of great significance for improving the survival of MPeM patients.