女性恶性腹膜间皮瘤52例预后因素分析  

An analysis of the prognostic factors in 52 cases of female malignant peritoneal mesothelioma

作　　者：马建婷[1] 傅云雀[1] 杨春林[1] 苏雪锋[1] MA Jianting;FU Yunque;YANG Chunlin;SU Xuefeng(Department of Obstetrics and Gynecology,the People's Hospital of Yuyao City in Zhejiang Province,Yuyao315400,China)

机构地区：[1]浙江省余姚市人民医院妇产科,浙江余姚315400

出　　处：《中国现代医生》2020年第23期75-79,共5页China Modern Doctor

基　　金：浙江省宁波市医学科技计划项目(2013A27)。

摘　　要：目的探讨女性恶性腹膜间皮瘤(Malignant peritonealmesothelioma,MPM)的预后影响因素。方法收集2012年1月~2017年12月在本地区诊治的52例女性MPM患者的临床资料,进行回顾分析,采用Kaplan-Meier生存曲线、Log-rank法和Cox回归模型进行单因素和多因素生存分析。结果单因素分析显示:上皮型、肉瘤型中位生存期(median survival time,MST)分别为12个月、5个月,12个月的累积生存率分别为45.7%、0%,差异有统计学意义(P=0.005);增殖细胞相关核抗原Ki67≤10%患者MST长于Ki67>10%患者(15个月vs.11个月),12个月的累积生存率分别为60.0%、28.1%,差异有统计学意义(P=0.036);肾母细胞瘤蛋白-1(Wilms tumor1,WT-1)阳性、阴性者MST分别为12个月、6个月,12个月的累积生存率分别为42.9%、0%;差异无统计学意义(P=0.089);腹膜活检(或附件切除)+紫杉醇+铂类灌注、腹膜活检(或附件切除)+培美曲塞+铂类灌注、减瘤+紫杉醇+铂类灌注、减瘤+培美曲塞+铂类灌注不同疗法MST分别为6个月、11个月、12个月、24个月,12个月累积生存率分别为0%、35.7%、45.5%、73.3%,以减瘤+培美曲塞+铂类生存时间最长,差异有统计学意义(P=0.000)。多因素分析中年龄、Ki67与生存时间无关(P>0.05),病理类型、TNM分期、治疗方案是MPM的预后独立影响因素(P<0.05)。结论MPM患者的预后与其病理亚型、临床期别、减瘤手术、后续化疗使用培美曲塞相关,彻底的减瘤手术及术后培美曲塞的治疗对延长生存期有重要意义。Objective To explore the prognostic factors of female malignant peritoneal mesothelioma(MPM).Methods The clinical data of 52 cases of female MPM diagnosed and treated in this area from January 2012 to December 2017 were collected and retrospectively analyzed.Kaplan-Meier survival curve,log-rank method and Cox regression model were used to carry out single-factor and multi-factor survival analysis.Results Single-factor analysis showed that the median survival time(MST)of epithelial type and sarcoma type was 12 months and 5 months respectively,and the cumulative survival rates of 12 months were 45.7%and 0%respectively,with statistically significant differences(P=0.005).The MST of the patients with proliferating cell-associated nuclear antigen Ki67≤10%was longer than that of the patients with Ki67>10%(15 months vs.11 months),and the cumulative survival rates of 12 months were 60.0%and 28.1%respectively,with statistically significant differences(P=0.036).The MST of those with positive expression of Wilms tumor protein(WT-1)was 12 months,while that of those with negative expression was 6 months,and the cumulative survival rates of 12 months were 42.9%and 0%respectively,with no statistically significant difference(P=0.089).The MST of the therapies of peritoneal biopsy or adnexal resection+paclitaxel+platinum perfusion,peritoneal biopsy(or adnexal resection)+pemetrexed+platinum perfusion,cytoreduction+paclitaxel+platinum perfusion,cytoreduction+pemetrexed+platinum perfusion was 6 months,11 months,12 months and 24 months respectively,and the cumulative survival rates of 12 months were 0%,35.7%,45.5%and 73.3%respectively,withthe survival time of cytoreduction+pemetrexed+platinum perfusion being the longest,and the differences were statistically significant(P=0.000).In the multi-factor analysis,age and Ki67 were not related to survival time(P>0.05),and pathological type,TNM stage and treatment plan were independent prognostic factors of MPM(P<0.05).Conclusion The prognosis of the patients with MPM is related to their pat

关 键 词：女性恶性腹膜间皮瘤 预后 病理亚型 减瘤手术 培美曲塞 

分 类 号：R735.5[医药卫生—肿瘤]