恶性腹膜间皮瘤100例临床病理特征及预后分析

Clinicopathological characteristics and prognostic analysis of patients with malignant peritoneal mesothelioma:100 cases

目的:探讨恶性腹膜间皮瘤(malignant peritoneal mesothelioma,MPM)临床病理特点及预后,寻找影响预后独立指标。方法:收集首都医科大学附属北京世纪坛医院2013年1月至2021年12月手术的100例MPM病例,研究石棉接触、CA125、腹水、腹膜癌指数(peritoneal cancer index,PCI)评分、完全细胞减灭(completeness of cytoreduction,CC)评分、TNM分期、组织学分型、脉管瘤栓、神经侵犯、Ki-67指数,收集随访资料。采用Kaplan-Meier法计算患者生存率;生存预后模型进行单因素和多因素分析,研究独立影响MPM预后的临床病理学因素。结果:本研究男性48例(48%),女性52例(52%),中位年龄54(24~72)岁,有石棉接触史患者19例(19%),腹水患者90例(90%),CA125≥35 U/mL 58例(59%),PCI评分≥25分56例(56%)、CC评分为0~1分49例(49%)、2~3分51例(51%)。上皮样型79例(79%),非上皮样型21例(21%),Ⅰ期患者10例(10%)、Ⅱ期和Ⅲ期患者均为45例(45%)。单因素分析发现影响患者生存主要指标:石棉接触、PCI评分、CA125、组织学类型、Ki-67指数、TNM分期。多因素分析显示,有石棉接触史患者死亡风险是无接触史患者的2.3倍(95%CI:0.233~0.806,P=0.008),PCI评分≥25分患者的死亡风险是<25分患者的2.9倍(95%CI:0.200~0.612,P<0.001),Ki-67指数>10%患者死亡风险是指数≤10%患者的5.90倍(95%CI:0.072~0.401,P<0.001)。上皮样型与非上皮样型MPM的Ki-67指数呈显著性差异(P=0.001)。结论:石棉接触史、PCI评分和Ki-67指数是MPM的独立预后因子。

Objective:To investigate the clinicopathological features of malignant peritoneal mesothelioma(MPM)in correlation with prognosis and independent prognostic factors.Methods:One hundred MPM specimens were collected at Beijing Shijitan Hospital,Capital Medical University,from January 2013 to December 2021.Asbestos exposure,CA125,ascites,peritoneal cancer index(PCI)score,complete cell reduction(CC)score,tumor–node–metastasis(TNM)staging,histological type,vascular tumor thrombus,nerve invasion and Ki-67 proliferation index were studied.Clinical follow-up data were reviewed to correlate with pathological prognostic factors using a Kaplan–Meier estimator and Cox proportional hazards regression model for both univariate and multivariate analyses.Results:The study participants comprised 48 males and 52 females.The median age was 54(24-72)years.There were 19 patients with asbestos exposure history(19%),90 patients with ascites(90%),58 patients with CA125≥35 U/mL(59%),56 patients with PCI scores of≥25(56%),49 patients with CC scores of 0-1(49%),and 51 patients with CC scores of 2-3(51%).There were 79 cases of epithelioid type(79%)and 21 cases of non-epithelioid type(21%)MPM.There were 10 patients(10%)with stageⅠdisease,and 45 patients(45%)had stagesⅡorⅢdisease,respectively.Univariate analysis revealed that the survival-related parameters included asbestos exposure,PCI score,CA125,histological type,Ki-67 proliferation index,and TNM stage.Multivariate analysis results revealed that the risk of death in patients with asbestos exposure history was 2.3 times higher than that in patients with no asbestos exposure history(95%confidence interval[CI]:0.233-0.806,P=0.008),the risk of death in patients with PCI scores of≥25 was 2.9 times higher than that in patients with scores of<25(95%CI:0.200-0.612,P<0.001),and the risk of death in patients with Ki-67>10%was 5.9 times higher than that in patients with Ki-67≤10%(95%CI:0.072-0.401,P<0.001).There was significant difference in Ki-67 index between epithelioid and non-epithelioid MPM.