肿瘤细胞减灭术联合腹腔热灌注治疗恶性腹膜间皮瘤的并发症及危险因素分析  

Analysis of risk factors and complications of cytoreductive surgery combined with hyperthermic intraperitoneal chemotherapy for malignant peritoneal mesothelioma

作　　者：杨智冉 苏延冬 杨锐 吴合亮 李雁 Zhiran Yang;Yandong Su;Rui Yang;Heliang Wu;Yan Li(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,北京市100038

出　　处：《中国肿瘤临床》2023年第13期661-666,共6页Chinese Journal of Clinical Oncology

基　　金：国家自然科学基金面上项目(编号:82073376);北京市医院管理局“登峰”人才培养计划(编号:DFL20180701)资助。

摘　　要：目的:分析肿瘤细胞减灭术(cytoreductive surgery,CRS)联合腹腔热灌注化疗(hyperthermic intraperitoneal chemotherapy,HIPEC)治疗恶性腹膜间皮瘤(malignant peritoneal mesothelioma,MPM)的并发症及其影响因素,预防严重不良事件(serious adverse events,SAEs)发生。方法:收集2015年4月至2022年11月在首都医科大学附属北京世纪坛医院行CRS+HIPEC治疗的154例MPM患者临床病理资料,统计术后并发症发生情况,分析影响SAEs的危险因素。结果:共计154例MPM患者接受CRS+HIPEC治疗,1级不良事件10例(8.8%),2级41例(36.3%),3级53例(46.9%),4级7例(6.2%),5级2例(1.8%)。需要进行抢救的SAEs发生率为5.8%(9/154),围手术期死亡率1.3%(2/154)。单因素分析表明,腹膜癌指数(peritoneal cancer index,PCI)(P=0.036)、肿瘤细胞减灭程度(completeness of cytoreduction,CC)(P=0.004)、腹膜剥除区域数量(P=0.035)及术前CA125水平(P=0.025)为影响SAEs发生的预后因素。多因素分析显示,腹膜剥除区域数量(OR=0.360,P=0.024)、CC评分(OR=0.325,P=0.003)是影响SAEs发生的独立危险因素。结论:在提高疗效实现完全CRS同时,合理把握肿瘤细胞减灭程度,可能是目前减少并发症,尤其是降低SAEs发生率、提高手术安全性的关键。Objective:To analyze complications of malignant peritoneal mesothelioma(MPM)treated with cytoreductive surgery(CRS)and hyperthermic intraperitoneal chemotherapy(HIPEC),and identify the associated risk factors to prevent serious adverse events(SAEs).Method:Clinicopathological information from 154 patients with MPM,who underwent treatment with CRS+HIPEC,enrolled in Beijing Shijitan Hospital,Capital Medical University from April 2015 to November 2022 was retrospectively analyzed.The incidence of postoperative complications was statistically analyzed,and risk factors affecting SAEs were evaluated.Results:Among 154 MPM patients,adverse events occurred as follows:grade 1,n=10(8.8%);grade 2,n=41(36.3%);grade 3,n=53(46.9%);grade 4,n=7(6.2%);and grade 5,n=2(1.8%).No adverse events were reported in 41 patients.The rate of SAEs requiring rescue was 5.8%(9/154),and the perioperative mortality rate was 1.3%(2/154).Univariate analysis revealed that peritoneal cancer index(PCI)(P=0.036),completeness of cytoreduction(CC)(P=0.004),number of peritoneal exfoliated areas(P=0.035),and preoperative CA125 level(P=0.025)were prognostic factors.Multivariate analysis revealed that the number of peritoneal exuded areas(odds ratio[OR]=0.360,P=0.024)and CC score(OR=0.325,P=0.003)were independent risk factors.Conclusions:To improve the therapeutic effect of achieving complete CRS,a reasonable grasp of the extent of CRS may be an important factor in reducing complications,especially the incidence of SAEs,and improving surgical safety.

关 键 词：肿瘤细胞减灭术 腹腔热灌注化疗 恶性腹膜间皮瘤 严重不良事件 

分 类 号：R735.5[医药卫生—肿瘤]