恶性腹膜间皮瘤25例临床分析

Clinical Analysis of 25 Cases of Malignant Peritoneal Mesothelioma

目的探讨恶性腹膜间皮瘤的临床病理特点、治疗及预后。方法回顾性分析1993至2017年在北京协和医院确诊的25例恶性腹膜间皮瘤患者的临床资料。结果 25例患者中位年龄50岁,均经病理确诊,均为上皮型(100%)。弥漫型24例(96%)、局限型1例(4%)。行肿瘤细胞减灭术6例(24%),腹腔灌注化疗12例(48%),全身化疗24例(96%)。全部患者的中位生存期26个月,1年生存率74.2%,5年生存率16.7%。减瘤手术或腹腔灌注化疗与静脉化疗联合,较单纯静脉化疗或腹腔化疗有生存优势(P=0.046,P=0.005)。多因素分析显示,减瘤手术(P=0.018)是独立预后因子(风险比=6.889;95%CI=1.386~34.247)。结论腹膜间皮瘤临床表现多样,接受减瘤手术的患者生存延长,除培美曲塞外的部分化疗药物及靶向治疗有一定的应用前景,接受减瘤手术是独立预后因素。

Objective To investigate the clinicopathological features,treatment,and prognosis of patients with malignant peritoneal mesothelioma(MPM).Method Clinical data of 25 MPM patients admitted to Peking Union Medical College Hospital from 1993 to 2017 were retrospectively analyzed.Results The mean age of these 25 patients with pathologically confirmed MPM(epithelioid subtype)was 50 years.The tumors were diffuse in 24 patients(96%)and localized in 1 patient(4%).Cytoreductive surgery was performed in 6 patients(24%),intraperitoneal chemotherapy in 12 patients(48%),and systemic chemotherapy in 24 patients(96%).The median overall survival was 26 months,with 1-year survival rate of 74.2%and 5-year survival rate of 16.7%.Cytoreductive surgery or intraperitoneal chemotherapy combined with systemic chemotherapy showed a significant survival advantage over intraperitoneal or intravenous chemotherapy alone(P=0.046,P=0.005).Cytoreductive surgery(P=0.018)showed statistical significance by multivariate analysis as a predictive factor in survival(hazard rate=6.889;95%CI=1.386-34.247).Conclusions MPM has its diverse clinical manifestations.Patients after cytoreductive surgery have longer survival time.Chemotherapy drugs(except for pemetrexed)and targeted therapy may be promising treatments.Cytoreductive surgery is an independent prognostic factor.