肿瘤细胞减灭术联合腹腔热灌注化疗治疗晚期卵巢癌效果观察

Efficacy observation of cytoreductive surgery combined with hyperthermic intraperitoneal chemotherapy for advanced ovarian cancer

目的评估肿瘤细胞减灭术(CRS)联合腹腔热灌注化疗(HIPEC)作为首选方案治疗晚期卵巢癌的临床疗效和安全性。方法回顾性分析2007年12月至2019年11月首都医科大学附属北京世纪坛医院收治的国际妇产科协会(FIGO)ⅢC~Ⅳ期卵巢癌、以CRS+HIPEC作为首选治疗方案并具有完整临床资料的患者。采用Kaplan-Meier法分析生存情况,Cox回归模型分析预后因素,主要终点为中位总生存(mOS)时间和中位无进展生存(mPFS),次要终点为围术期安全性。结果100例晚期卵巢癌患者入组,中位随访时间18.4个月,生存75例(75.0%),死亡25例(25.0%),mOS时间为87.6个月(95%CI 72.1~103.1个月),1、2、3、4、5年生存率分别为94.1%、77.2%、68.2%、64.2%和64.2%。单因素分析显示,年龄≤58岁(P=0.023)、Karnofsky评分≥80分(P=0.026)、腹腔积液量≤1000 ml(P=0.041)、腹膜癌指数(PCI)评分<19分(P=0.044)和肿瘤细胞减灭程度(CC)评分0~1分(P=0.001)者预后较好。多因素分析显示,CC评分0~1分为独立预后因素,CC评分2~3分者死亡风险为CC评分0~1分者的3.2倍(HR=3.2,95%CI 1.4~7.6,P=0.008);CC评分0~1分者mPFS时间为23.3个月(95%CI 0~50.7个月)。围术期Ⅲ~Ⅳ级不良事件发生率和死亡率分别为4.0%(4/100)和2.0%(2/100)。结论CRS+HIPEC可有效延长晚期卵巢癌患者生存期,且安全性较好。

Objective To evaluate the clinical efficacy and safety of cytoreductive surgery plus hyperthermic intraperitoneal chemotherapy(CRS+HIPEC)for patients with advanced ovarian cancer as the first-line surgical treatment.Methods The ovarian cancer patients with completed clinical data diagnosed as stageⅢC-Ⅳaccording to Federation International of Gynecology and Obstetrics(FIGO)who underwent CRS+HIPEC as the first-line treatment from December 2007 to November 2019 in Beijing Shijitan Hospital were retrospectively analyzed.Survival status was analyzed by using Kaplan-Meier method,and prognostic factors were analyzed by using Cox multivariate regression model.The primary endpoints were median overall survival(mOS)time and median progress-free survival(mPFS)time,and the secondary endpoint was safety in perioperative period.Results Of 100 patients with advanced ovarian cancer,the median follow-up time was 18.4 months,and 75(75.0%)patients were alive and 25(25.0%)patients died,of which the mOS time was 87.6 months(95%CI 72.1-103.1 months),and 1-,2-,3-,4-and 5-year survival rate was 94.1%,77.2%,68.2%,64.2%and 64.2%,respectively.Univariate analysis showed that the patients with age≤58 years old(P=0.023),Karnofsky≥80 scores(P=0.026),ascites≤1000 ml(P=0.041),peritoneal carcinomatosis index(PCI)score<19(P=0.044)and completeness of cytoreduction(CC)score 0-1(P=0.001)had better prognosis.Multivariate analysis showed that CC score 0-1 was independent prognostic factor,the mortality risk of resectable patients with CC score 2-3 was 3.2 times higher than that in patients with CC score 0-1(HR=3.2,95%CI 1.4-7.6,P=0.008),and mPFS time was 23.3 months(95%CI 0-50.7 months)for patients with CC score 0-1.GradeⅢ-Ⅳadverse event rate during perioperative period and mortality rate was 4.0%(4/100)and 2.0%(2/100),respectively.Conclusion CRS+HIPEC could improve the survival of advanced ovarian cancer patients with good safety.