135例腹膜癌患者自然病程预后的多因素分析

Multivariate analysis of prognostic factors in the natural disease course of peritoneal carcinomatosis:135 cases

目的:分析腹膜癌患者的自然病程,探索预后相关因素。方法:收集2015年8月至2022年4月首都医科大学附属北京世纪坛医院收治的135例腹膜癌患者完整的生存数据,行单因素和多因素生存分析,筛选独立预后因素。结果:135例腹膜癌患者中位生存期为12.2个月(95%CI:10.6~13.8)。单因素生存分析发现下述10项因素影响预后:年龄(P=0.002)、卡氏评分(Karnofsky performance status,KPS)(P<0.001)、营养不良(P<0.001)、初治TNM分期(P<0.001);原发肿瘤部位(P<0.001)、既往手术(P<0.001)、既往化疗(P<0.001)、既往放疗(P=0.028)、既往中药治疗(P=0.007)、合并脑梗死(P<0.001)。多因素分析发现下述5项独立预后因素:KPS评分(HR=4.986,95%CI:2.540~9.787,P<0.001)、营养不良(HR=3.164,95%CI:1.704~5.877,P=0.001)、初治TNM分期(HR=2.632,95%CI:1.344~5.157,P=0.017)、既往手术(HR=2.110,95%CI:1.170~3.804,P=0.013)、既往中药治疗(HR=1.882,95%CI:1.043~3.396,P=0.036)为独立预后因素。结论:腹膜癌患者预后不良,改善体质状态、优化包括中药治疗在内的整合治疗技术,可能是延长生存的关键。

Objective:To analyze the natural history of patients with peritoneal carcinomatosis and to explore independent prognostic factors associated with it.Methods:From August 2015 to April 2022,independent prognostic factors were screened from the complete survival data of 135 patients of Beijing Shijitan Hospital,Capital Medical University with peritoneal carcinomatosis using univariate and multivariate analyses.Results:The median overall survival in the 135 patients with peritoneal carcinomatosis was 12.2 months(95%confidence interval[CI]:10.6–13.8).Univariate survival analysis determined 10 factors as prognostically significant:patient age(P=0.002),the Karnofsky performance status(KPS)(P<0.001),malnutrition(P<0.001),TNM stage(P<0.001),primary tumor site(P<0.001),surgery(P<0.001),chemotherapy(P<0.001),radiotherapy(P=0.028),traditional Chinese medicine(P=0.007),and cerebral infarction(P<0.001).Multivariate survival analysis identified five independent prognostic factors:the KPS(hazard ratio[HR]=4.986,95%CI:2.540–9.787,P<0.001),malnutrition(HR=3.164,95%CI:1.704–5.877,P=0.001),TNM stage(HR=2.632,95%CI:1.344–5.157,P=0.017),surgery(HR=2.110,95%CI:1.170–3.804,P=0.013),and traditional Chinese medicine(HR=1.882,95%CI:1.043–3.396,P=0.036).Conclusions:The prognosis of patients with peritoneal carcinomatosis is poor.Enhancing the performance status of patients and incorporating traditional Chinese medicine into a holistic treatment plan may be key factors in improving clinical outcomes.