基于洛铂的三药腹腔热灌注化疗治疗结直肠癌/阑尾癌腹膜转移的安全性与疗效分析  

Safety and Efficacy of Triple-Drug Hyperthermic Intraperitoneal Chemotherapy Based on Lobaplatin in the Treatment of Patients with Peritoneal Metastasis from Appendiceal and Colorectal Cancer

作　　者：张勇[1] 沈志玲 李衎 武亚超 曹凯 陈秀清 韩晓东 黄天臣[1] ZHANG Yong;SHEN Zhiling;LI Kan;WU Yachao;CAO Kai;CHEN Xiuqing;HAN Xiaodong;HUANG Tianchen(Anyang Cancer Hospital,Anyang 455001,China;National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital,Chinese Academy of Medical Sciences and Peking Union Medical College,Beijing 100021,China)

机构地区：[1]安阳市肿瘤医院,河南安阳455001 [2]国家癌症中心/国家肿瘤临床医学研究中心/中国医学科学院北京协和医学院肿瘤医院,北京100021

出　　处：《肿瘤学杂志》2024年第6期477-485,共9页Journal of Chinese Oncology

基　　金：中国癌症基金会北京希望马拉松专项基金(LC2020B25)。

摘　　要：[目的]探讨基于洛铂、奥沙利铂和雷替曲塞的三药腹腔热灌注化疗(hyperthermic intraperitoneal chemotherapy,HIPEC)方案治疗结直肠癌/阑尾癌腹膜转移患者的近期安全性与远期疗效。[方法]回顾性收集分析自2017年6月至2022年6月在中国医学科学院肿瘤医院和安阳市肿瘤医院行细胞减灭术(cytoreductive surgery,CRS)+HIPEC治疗的结直肠癌/阑尾癌腹膜转移患者的临床病理资料。共150例患者纳入研究,根据HIPEC化疗方案不同,将患者分为双药HIPEC组(n=78)与三药HIPEC组(n=72)。收集分析患者的临床病理特征、手术结果、化疗相关毒性指标及预后资料。[结果]三药HIPEC组与双药HIPEC组患者的基线临床病理资料相似,两组患者术后3~5级严重并发症发生率相似(27.8%vs 30.8%,P=0.688)。三药HIPEC组患者术后第5天平均血小板计数显著低于双药HIPEC组[(225.3±53.1)×10^(9)/L vs (289.2±72.3)×10^(9)/L,(P=0.029)]。三药HIPEC组术后第3天血小板异常(13.9%vs 3.8%,P=0.029)和术后第5天谷丙转氨酶异常(20.8%vs 7.7%,P=0.020)的患者比例均显著高于双药HIPEC组。三药HIPEC组与双药HIPEC组患者的3年总生存率(48.5%vs 35.2%,P=0.298)和无病生存率(35.0%vs 21.1%,P=0.470)差异均无统计学意义。多因素Cox回归分析显示,高腹膜癌指数(HR=1.09,95%CI:1.03~1.14,P=0.005)、细胞减灭完整(completeness of cytoreduction,CC)程度评分2~3分(HR=1.93,95%CI:1.04~3.62,P=0.043)和3~5级术后严重并发症的发生(HR=2.50,95%CI:1.38~4.51,P=0.004)是结直肠癌/阑尾癌腹膜转移患者CRS+HIPEC治疗后总生存率的独立危险因素;高腹膜癌指数(HR=1.11,95%CI:1.03~1.16,P<0.001)与CC指数2~3分(HR=3.64,95%CI:1.22~5.36,P<0.001)是无病生存率的独立危险因素。[结论]基于洛铂的三药HIPEC方案治疗阑尾癌/结直肠癌腹膜转移安全可行,且有改善预后的趋势。虽然会对血小板和肝功能造成一定影响,但不会转化为相关并发症。[Objective]To analyze the short-term safety and long-term efficacy of three-drug(Lobaplatin,Oxaliplatin and Raltitrexed)based hyperthermic intraperitoneal chemotherapy(HIPEC)in treatment of patients with peritoneal metastasis(PM)from appendiceal/olorectal cancer.[Methods]Clinicopathologic data of patients with PM of appen-diceal/colorectal cancer treated with cytoreductive surgery(CRS)+HIPEC in Cancer Hospital of Chinese Academy of Medical Sciences and Anyang Cancer Hospital from June 2017 to June 2022 were retrospectively analyzed.A total of 150 patients were divided into double-drug HIPEC group(n=78)and triple-drug HIPEC group(n=72)based on different HIPEC chemotherapy regimens.The clinicopathological features,surgical results,chemotherapy-related toxicity in-dexes and prognosis of patients were collected and analyzed.[Results]There was no significant difference in clinico-pathological data between triple-drug HIPEC group and double-drug HIPEC group(P>0.05).The incidence of grade 3~5 severe complications in triple-drug HIPEC group was not significantly different with that of the double-drug HIPEC group(27.8%vs 30.8%,P=0.688).The mean platelet count[(225.3±53.1)×10^(9)/L vs(289.2±72.3)×10^(9)/L,P=0.029]on the fifth day after surgery in the triple-drug HIPEC group was lower than that in the double-drug HIPEC group.The proportion of patients with abnormal platelet on day 3 after surgery(13.9%vs 3.8%,P=0.029)and abnormal alanine aminotransferase on day 5 after surgery(20.8%vs 7.7%,P=0.020)in triple-drug HIPEC group was higher than that in double-drug HIPEC group.There was no significant difference in 3-year overall survival(48.5%vs 35.2%,P=0.298)and disease-free survival(35.0%vs 21.1%,P=0.470)between two groups.Multivariate Cox prognostic regression analy-sis showed that high peritoneal carcinomatosis index(HR=1.09,95%CI:1.03~1.14,P=0.005),completeness of cy-toreduction score 2~3(HR=1.93,95%CI:1.04~3.62,P=0.043)and grade 3~5 postoperative complications(HR=2.50,95%CI:1.38~4.51,P=0.004)were independent risk facto

关 键 词：结直肠癌 阑尾癌 热灌注化疗 疗效分析 

分 类 号：R735.35[医药卫生—肿瘤] R735.36[医药卫生—临床医学] R735.37