肿瘤细胞减灭术加腹腔热灌注化疗治疗腹膜假黏液瘤182例分析

Cytoreductive surgery plus hyperthermic intraperitoneal chemotherapy in patients with pseudomyxoma peritonei: Analysis of 182 patients at a single center

目的:腹膜假黏液瘤(pseudomyxoma peritonei,PMP)是一种主要来源于阑尾黏液性肿瘤的恶性肿瘤综合征,肿瘤细胞减灭术(cytoreductive surgery,CRS)加腹腔热灌注化疗(hyperthermic intraperitoneal chemotherapy,HIPEC)是国际推荐的PMP标准治疗。本研究旨在评估CRS+HIPEC治疗PMP的疗效及围手术期安全性。方法:研究首都医科大学附属北京世纪坛医院2001年1月至2008年5月采用CRS+HIPEC治疗182例PMP临床数据库,进行生存分析,通过单因素和多因素分析筛选独立预后因素,并分析围手术期安全性。结果:182例PMP患者接受CRS+HIPEC治疗,低级别PMP 73例(40.1%),部分低级别、部分高级别PMP 50例(27.5%),高级别PMP 53例(29.1%),PMP伴印戒细胞6例(3.3%);中位腹膜癌指数(peritoneal cancer index,PCI)30分,PCI≥20分为134例(74.0%);肿瘤细胞减灭程度(completeness of cytoreduction,CC)评分0～1分者为79例(44.1%);死亡48例(26.4%),生存134例(73.6%),中位生存时间64.7个月(95%CI:43.1～84.3个月)。Cox多因素回归分析发现4个独立预后因素:年龄(HR=12.079,95%CI:1.605～90.916)、CC(HR=0.211,95%CI:0.069～0.641)、是否有吻合口(0个vs.>1个)(HR=5.519,95%CI:1.176～25.907)、吻合口数量(1个vs.>1个)(HR=7.543,95%CI:1.592～35.732)。围手术期死亡率、严重不良事件率分别为1.6%、19.8%。结论:PMP患者在腹膜肿瘤专科单位接受CRS+HIPEC治疗,达到完全肿瘤细胞减灭,可延长生存,围手术期安全性可接受。

Objective:Pseudomyxoma peritonei(PMP)is a clinically malignant tumor syndrome derived from mucin-producing appendiceal tumors,and cytoreductive surgery(CRS)plus hyperthermic intraperitoneal chemotherapy(HIPEC)is a standard treatment for PMP recommended by the Peritoneal Surface Malignancy Group International(PSOGI).This retrospective study analyzed the efficacy and safety of CRS+HIPEC for PMP at our center.Methods:This was a retrospective study on the PMP database established at our center.The clinicopathological features,treatment details,and follow-up information on PMP patients were systematically established in this database.Survival analysis was conducted to evaluate the efficacy of treatment;univariate and multivariate analyses were performed to identify the independent prognostic factors.Perioperative adverse events were assessed to evaluate the safety of CRS+HIPEC.Results:Among the 182 PMP patients that received CRS+HIPEC,73(40.1%)had low-grade PMP,50(27.5%)had low-and-high mixed-grade PMP,53(29.1%)had high-grade PMP,and 6(3.3%)had PMP with signet ring cells.The median peritoneal cancer index(PCI)was 30,and 74.0%of the patients had a PCI≥20.There were 79 patients(44.1%)who had a completeness of cytoreduction(CC)score of 0-1.Of 182 patients,48(26.4%)died and 134(73.6%)were alive,with the median overall survival(OS)from surgery being 64.7 months(95%CI:43.1-84.3 months).Multivariate analysis and Cox proportional regression model analysis identified 4 independent prognostic factors:age(HR=12.079,95%CI:1.605-90.916),CC score(HR=0.211,95%CI:0.069-0.641),presence of anastomosis(0 vs.>1)(HR=5.519,95%CI:1.176-25.907),and number of anastomoses(1 vs.>1)(HR=7.543,95%CI:1.592-35.732).The perioperative mortality rate and serious adverse events rate was 1.6%and 19.8%,respectively.Conclusions:PMP patients treated with CRS+HIPEC to achieve complete cytoreduction at experienced centers may experience survival benefits with acceptable safety.