倾向性评分匹配评估肿瘤细胞减灭术联合腹腔热灌注化疗治疗晚期卵巢癌的疗效

Efficacy of cytoreductive surgery combined with hyperthermic intraperitoneal chemotherapy for advanced epithelial ovarian cancer: a propensity score matching analysis

目的:探讨传统减瘤术与肿瘤细胞减灭术(cytoreductive surgery,CRS)联合术中腹腔热灌注化疗(hyperthermic intraperitoneal chemotherapy,HIPEC)治疗上皮性卵巢癌腹膜转移(peritoneal carcinomatosis of epithelial ovarian cancer,EOCPC)的疗效。方法:收集2004年5月至2019年5月186例于首都医科大学附属北京世纪坛医院行手术切除的卵巢癌患者的临床病理资料,采用倾向性评分匹配(propensity score matching,PSM)2:1匹配后,纳入133例EOCPC患者,分为行传统减瘤术80例为对照组、行CRS+HIPEC53例为研究组,并行亚组分析。比较两组中位生存期(median overall survival,mOS)。结果:研究组患者mOS显著长于对照组(87.3个月vs. 25.2个月,P=0.002),5年生存率为对照组2.5倍(46.5%vs. 18.3%,P=0.003),3、4年生存率均为对照组1.9倍(70.0%vs. 36.7%,P=0.016)。亚组分析显示,达到满意肿瘤细胞减灭研究组mOS较对照组显著延长(118.1个月vs.70.7个月,P=0.024);未达到满意肿瘤细胞减灭研究组mOS显著长于对照组(87.3个月vs. 23.1个月,P=0.028)。结论:标准化、规范化CRS+HIPEC为治疗EOCPC的必要措施,可为患者带来显著的生存获益。

Objective: To evaluate the efficacy of cytoreductive surgery(CRS) combined with hyperthermic intraperitoneal chemotherapy(HIPEC) in patients with peritoneal carcinomatosis of epithelial ovarian cancer(EOCPC). Methods: From May 2004 to May 2019, 186 patients with advanced ovarian cancer underwent surgery at Beijing Shijitan Hospital. Of them, 133 patients met the selection criteria after propensity score matching: 80 patients who had undergone CRS(control group) and 53 patients who had undergone CRS+HIPEC(study group). We performed subgroup analysis. The primary endpoints were to compare the median overall survival(m OS) between the two groups. Results:The m OS in the study group was significantly longer than that in the control group(87.3 months vs. 25.2 months, P=0.002). The 5-year survival rate in the study group was 2.5 times than that in the control group(46.5% vs. 18.3%, P=0.003), and the 3-and 4-year survival rates were both 1.9 times than those in the control group(70.0% vs. 36.7%, P=0.016). On subgroup analysis, the m OS in the study group was found to be significantly longer than that in the control group both in patients with complete CRS(118.1 months vs. 70.7 months, P=0.024) and in those with incomplete CRS(87.3 months vs. 23.1 months, P=0.028). Conclusions: Standardized CRS+HIPEC, as a necessary measure for the treatment of EOCPC, has significant survival benefits.