扩大姑息减瘤对阑尾源性腹膜假性黏液瘤患者远期生存的作用

Effect of Extended Surgical Resection on Long-term Survival of Appendix-derived Pseudomyxoma Peritonei

[目的]分析扩大姑息减瘤范围对改善腹膜假性黏液瘤(pseudomyxoma peritonei,PMP)患者预后的作用。[方法]回顾性分析接受肿瘤细胞减灭手术(cytoreductive surgery,CRS)治疗但仅达到姑息减瘤的阑尾来源PMP患者资料,并应用倾向评分匹配(propensity score-matching,PSM)方法平衡资料中的选择偏倚。[结果]共567例未接受达到完全性CRS的患者纳入研究,其中PSM后良好匹配患者153对。匹配后CC-2(残余肿瘤直径为2.5 mm~2.5 cm)患者5年生存率和10年生存率分别为33%和18%,与CC-3(残余肿瘤直径>2.5 cm)患者比较差异无显著性(5年生存率39%,10年生存率30%;P=0.829)。以PMP初始诊断日期计算生存期,两者间也无显著性差异(10年生存率CC-2 vs CC-3:32%vs 44%;P=0.292)。多因素分析显示,手术时间(OR=2.1,P<0.001),病理类型(OR=1.57,P=0.004)和是否接受腹腔热灌注化疗(hyperthermic intraperitoneal perfusion chemotherapy,HIPEC)(OR=2.01,P=0.002)是影响预后的独立危险因素。[结论]对无法彻底清除病灶的PMP患者,扩大切除手术范围并不能延长患者的远期生存,该部分患者实施HIPEC治疗存在生存获益可能。

[Objective]To investigate the effect of extended surgical resection on prognosis of appendix-derived pseudomyxoma peritonei(PMP).[Methods]The clinical data of patients with unresectable appendix-derived PMP who received cytoreductive surgery(CRS)but only achieved palliative tumor reduction were retrospectively analyzed.Propensity score matching(PSM)was used to balance the selection bias.[Results]A total of 567 patients received incomplete CRS were included in the study,and 153 pairs were well matched after PSM.After matching,there were no significant differences in 5-year and 10-year overall survival(OS)rates between CC-2(residual tumor diameter 2.5 mm~2.5 cm)patients and CC-3(residual tumor diameter>2.5 cm)patients,respectively(33%vs.39%and 18%vs 30%;P=0.829).There was also no significant difference in 10-year OS calculated from the date when PMP diagnosed between CC-2 and CC-3 patients(32%vs 44%,P=0.292).Multivariate analysis showed that the year when CRS performed(OR=2.1,P<0.001),pathological type(OR=1.57,P=0.004)and receiving hyperthermic intraperitoneal chemotherapy(HIPEC)(OR=2.01,P=0.002)were the independent factors influencing the prognosis of patients.[Conclusion]Extended debulking surgery does not seem to prolong the overall survival of patients with unresectable tumors.For these patients,HIPEC may be useful in selected cases.