新TNM分期及血清CA125对恶性腹膜间皮瘤的预后价值

Prognostic value of new TNM staging and serum CA125 in malignant peritoneal mesothelioma

目的探讨新肿瘤-淋巴结-远处转移(TNM)分期系统及血清CA125水平与恶性腹膜间皮瘤(MPeM)预后的关系。方法收集沧州市中心医院2005年1月至2016年6月收治的经病理及免疫组织化学确诊的74例MPeM患者的临床资料。根据CT-腹膜癌指数(PCI)结果将腹膜肿瘤负荷分为T1(PCI 1~10)、T2(PCI 11~20)、T3(PCI 21~30)、T4(PCI 31~39)4组,联合腹腔淋巴结转移、腹膜外转移形成一个新TNM分期系统,同时检测血清CA125水平。回顾性分析MPeM患者的中位生存期以及新TNM分期系统、血清CA125水平对其预后的影响。结果74例MPeM患者中,男性25例(33.8%),女性49例(66.2%);全身化疗8例,腹腔热灌注化疗8例,联合化疗1例。T1组10例,T2组22例,T3组27例,T4组15例;12例有淋巴结转移;10例有腹膜外转移。T1、T2、T3、T4的中位生存期分别为12、10、6、3个月。49例患者测定血清CA125水平,阳性组38例(77.6%),中位生存期为6个月;阴性组11例(22.4%),中位生存期为11个月。68例(91.9%)患者死亡,中位生存期为8个月。单因素分析显示,不同CT-PCI、血清CA125水平以及有无淋巴结、腹膜外转移患者的生存期差异均有统计学意义(P<0.05)。多因素分析显示,CT-PCI是影响MPeM预后的独立危险因素(HR=2.203,95%CI:1.475~3.289)。结论新TNM分期系统及血清CA125水平对MPeM患者的预后有重要意义,早期发现、诊断及综合治疗可提高MPeM患者的生存期。

Objective To explore the relationship between the new Tumor-Node-Metastasis(TNM)staging system and the serum CA125 level with the prognosis of malignant peritoneal mesothelioma(MPeM).Methods The clinical data of 74 patients with MPeM diagnosed by pathology and immunohistochemistry were collected from January 2005 to June 2016 in Cangzhou Central Hospital.According to the results of CT-peritoneal carcinoma index(PCI),the tumor load was divided into T1(PCI 1-10),T2(PCI 11-20),T3(PCI 21-30)and T4(PCI 31-39),combined with lymph node metastasis and extraperitoneal metastasis,a new TNM staging system was established.And serum CA125 level was measured in the same time.The median survival time of patients with MPeM,the effect of the new TNM staging system,and serum CA125 levels on their prognosis were retrospectively analyzed.Results Among the 74 patients with MPeM,25(33.8%)cases were males and 49(66.2%)cases were females.There were 8 cases with systemic chemotherapy,8 cases with heated intraperitoneal chemotherapy,and 1 case with combination chemotherapy.10 cases were T1,22 cases were T2,27 cases were T3,15 cases were T4,12 cases had lymph node metastasis and 10 cases had distant metastasis.The median survival time of T1,T2,T3 and T4 were 12,10,6 and 3 months respectively.There were 38(77.6%)cases with high serum CA125 in all 49 cases who have been tested for CA125.The median survival time of positive group and negative group were 6 months and 11 months respectively.68(91.9%)patients had died by the end of collecting data.The median survival time was 8 months.Univariate analysis showed that there were significant differences in survival time between patients with different CT-PCI stages,serum CA125 levels,and with or without lymph node and extraperitoneal metastasis(P<0.05).Multivariate analysis showed that CT-PCI was independent risk factors for the prognosis of MPeM(HR=2.203,95%CI:1.475-3.289).Conclusion The new TNM staging system and serum CA125 are important for the prognosis of patients with MPeM.Early detection,early diagnosis and comprehensive treatment can improve the survival time of patients with MPeM.