肿瘤细胞减灭术联合腹腔热灌注化疗治疗胃癌腹膜转移的远期疗效  

Long-term efficacy of cytoreductive surgery combined with hyperthermic intraperitoneal chemotherapy for peritoneal carcinomatosis from gastric cancer

作　　者：彭茜 李仕卿 武海涛[1,2] 王舒艺 杨肖军[1] 黄超群[1] 熊斌[1,2] PENG Qian;LI Shi-qing;WU Hai-tao;WANG Shu-yi;YANG Xiao-jun;HUANG Chao-qun;XIONG Bin(Department of Gastrointestinal Surgery,Zhongnan Hospital of Wuhan University,Wuhan,Hubei 430071,China;不详)

机构地区：[1]武汉大学中南医院胃肠外科,湖北武汉430071 [2]肿瘤生物学行为湖北省重点实验室湖北省肿瘤临床研究中心,湖北武汉430071

出　　处：《中国临床研究》2020年第11期1449-1453,共5页Chinese Journal of Clinical Research

基　　金：湖北省卫生健康委科研项目(WJ2019H012)。

摘　　要：目的分析肿瘤细胞减灭术(CRS)联合腹腔热灌注化疗(HIPEC)对比单纯系统化疗(SC)治疗胃癌腹膜转移(PCGC)的远期疗效,以找到治疗PCGC效果更佳的方法及其受益对象。方法回顾性分析2014年1月至2017年12月至武汉大学中南医院就诊的PCGC患者96例的临床资料,根据治疗方法分为CRS+HIPEC+SC组和单纯SC组。2年内每3个月随访1次,2年后每6个月随访1次,最近1次随访时间为2019年5月31日,观察并比较两组患者的总生存期(OS)。结果CRS+HIPEC+SC组患者56例,单纯SC组患者40例。Kaplan-Meier分析显示,CRS+HIPEC+SC组患者中位OS是19.7(95%CI:15.8~23.6)个月,单纯SC组患者中位OS为8.0(95%CI:5.9~10.1)个月,组间差异有统计学意义(P<0.01)。Cox多因素分析显示,腹膜转移癌指数(PCI)评分>20分、未实现完全性CRS、化疗周期数<6个周期为影响CRS联合HIPEC治疗患者预后的独立危险因素(P<0.05,P<0.01)。在CRS+HIPEC+SC组中,未实现完全性CRS或PCI评分>20分的患者与单纯SC组患者比较中位OS差异无统计学意义(P>0.05);CRS+HIPEC联合<6周期SC的患者中位OS(10.0个月)较单纯SC组患者仍有生存优势(P<0.01)。结论与单纯SC相比,CRS+HIPEC能显著延长PCGC患者的生存期,其受益患者群为PCI评分≤20分,能实现完全性CRS的患者,联合≥6周期的SC能增加生存受益。Objective To analyze the long-term clinical efficacy of tumor cytoreductive surgery(CRS)combined hyperthermic intraperitoneal chemotherapy(HIPEC)versus alone systemic chemotherapy(SC)for peritoneal carcinomatosis from gastric cancer(PCGC)to find a better treatment regimen for patients who were suitable for it.Methods A retrospective study was conducted on 96 patients diagnosed with PCGC in Zhongnan Hospital of Wuhan University between January 2014 and December 2017.The patients were divided into CRS+HIPEC+SC group(n=56)and SC alone group(n=40)according to the treatment regimens and were followed up every 3 months within two years and every 6 months after two years.The latest follow-up was on May 31,2019.The overall survival time(OS)was observed and compared between two groups.Results Kaplan-Meier analysis showed that the median OS in CRS+HIPEC+SC group was significant higher than that in SC alone group[19.7(95%CI:15.8-23.6)months vs 8.0(95%CI:5.9-10.1)months,P<0.01].Multivariate Cox regression analysis indicated that peritoneal carcinomatosis index(PCI)>20,incomplete CRS and of systemic chemotherapy<6 cycles were the independent risk factors affecting the prognosis of patients treated with CRS combined with HIPEC(P<0.05,P<0.01).There was no significant difference in the median OS between the patients without complete CRS or PCI>20 in CRS+HIPEC+SC group and the patients in SC alone group(P>0.05).The median OS of patients with less than 6 cycles of SC in CRS+HIPEC+SC group was 10.0 months,which was significantly higher than that in SC alone group(P<0.01).Conclusions Compared with SC alone,CRS+HIPEC could significantly prolong the survival of PCGC patients and the benefit group is patients with PCI≤20 points and CRS completed;while combined with≥6 cycles of SC can increase the survival benefit.

关 键 词：胃癌 腹膜转移癌 肿瘤细胞减灭术 腹腔热灌注化疗 系统化疗 腹膜转移癌指数 生存 

分 类 号：R735.2[医药卫生—肿瘤]