肿瘤细胞减灭术联合腹腔热灌注化疗治疗结直肠癌腹膜癌的疗效  

The effect of cytoreductive surgery plus hyperthermic intraperitoneal chemotherapy on peritoneal carcinomatosis from colorectal cancer

作　　者：安松林 张凯 姬忠贺 李鑫宝 于洋 张彦斌 刘刚 李兵 闫国军 李雁 An Songlin;Zhang Kai;Ji Zhonghe;Li Xinbao;Yu Yang;Zhang Yanbin;Liu Gang;Li Bing;Yan Guojun;Li Yan(Department of Peritoneal Cancer Surgery,Beijing Shijitan Hospital,Capital Medical University,Beijing 100038,China)

机构地区：[1]首都医科大学附属北京世纪坛医院腹膜肿瘤外科,100038

出　　处：《中华肿瘤杂志》2021年第12期1298-1303,共6页Chinese Journal of Oncology

基　　金：首都临床特色应用研究与成果推广项目(Z161100000516077);北京市登峰人才培养计划(DFL20180701);北京市优秀人才培养资助集体项目(2017400003235J007);首都医科大学附属北京世纪坛医院青年基金项目(2018-q26)。

摘　　要：目的探讨肿瘤细胞减灭术(CRS)+腹腔热灌注化疗(HIPEC)治疗结直肠癌腹膜癌(CRC PC)的疗效和安全性。方法收集2015年1月至2018年6月于首都医科大学附属北京世纪坛医院接受CRS+HIPEC综合诊治的CRC PC患者的临床资料。生存分析采用Kaplan-Meier法,并行Log rank检验,单因素和多因素分析采用Cox回归模型。结果90例CRC PC患者接受CRS+HIPEC治疗,年龄13~81岁,中位年龄53岁,男51例,女39例。全组患者中位生存时间为21.9个月(95%CI为15.7~28.1个月),1、2、3、5年生存率分别为77.8%、48.6%、21.1%和5.5%。严重不良事件发生率为8.9%(8/90),围手术期死亡率为2.2%(2/90)。单因素分析显示,年龄(P=0.040)、原发肿瘤部位(P=0.020)、术前糖类抗原125(CA125)水平(P<0.001)、腹膜癌指数(P<0.001)、肿瘤细胞减灭程度(P<0.001)、腹水量(P=0.012)、术后辅助化疗周期(P<0.001)与总生存有关。多因素分析显示,术前CA125水平(P=0.033)、肿瘤细胞减灭完全(P=0.014)、术后辅助化疗周期数(P=0.002)为总生存独立预后影响因素。结论CRS+HIPEC可延长部分CRC PC患者的生存时间,严格患者筛选和彻底的CRS是该治疗策略成功的关键。Objective To evaluate the safety and efficacy of cytoreductive surgery plus hyperthermic intraperitoneal chemotherapy(CRS+HIPEC)in patients with peritoneal carcinomatosis from colorectal carcinoma(CRC PC).Methods The clinical and follow-up data of 90 consecutive CRC PC patients underwent CRS+HIPEC in Beijing Shijitan Hospital from January 2015 to June 2018 were collected.Kaplan-Meier method and parallel Log rank test were used for survival analysis.Cox regression model was used for univariate and multivariate analysis.Results A total of 90 CRC PC patients underwent CRS+HIPEC,the median age was 53 years(rage:13 to 81 years),and 51 cases were male,while other 39 were female.The median overall survival(mOS)was 21.9 months(95%CI:15.7,28.1).The 1-,2-,3-,and 5-year survival rates were 77.8%,48.6%,21.1%,and 5.5%,respectively.The incidence rate of serious adverse event(SAE)was 8.9%(8/90).The mortality rate of perioperative period was 2.2%(2/90).Univariate analysis showed the age(P=0.040),primary tumor site(P=0.020),preoperative carbohydrate antigen 125(CA125)level(P<0.001),peritoneal cancer index(PCI)(P<0.001),completeness of cytoreduction(CC)(P<0.001),ascites(P=0.012)and postoperative adjuvant chemotherapy(P<0.001)were significantly associated with the OS.Multivariate Cox-analysis identified preoperative CA125 level(P=0.033),CC of 0 to 1(P=0.014),and adjuvant chemotherapy postoperative(P=0.002)were independent prognostic factor for OS.Conclusions CRS+HIPEC can improve survival for CRC PC patients with acceptable morbidity and mortality.Stringent patient selection and complete CRS are two key factors for better survival.

关 键 词：结直肠肿瘤 腹膜癌 肿瘤细胞减灭术 腹腔热灌注化疗 

分 类 号：R735.34[医药卫生—肿瘤] R735.5[医药卫生—临床医学]