Sugarbaker P H
Washington Cancer Institute, Washington Hospital Center, 106 Irving Street, NW, Suite 3900, Washington, DC 20010, USA.
Tech Coloproctol. 2005 Jul;9(2):95-103. doi: 10.1007/s10151-005-0205-6. Epub 2005 Jul 8.
Peritoneal surface malignancy usually results from implantation of gastrointestinal cancer. In the past, this clinical situation was treated with palliative intent. A definitive approach to peritoneal surface malignancy involves peritonectomy procedures, visceral resections, perioperative intraperitoneal chemotherapy and knowledgeable patient selection. The quantitative prognostic indicators necessary for valid clinical judgements include the cancer histopathology (invasive vs. expansive progression), the preoperative abdominal and pelvic CT, the peritoneal cancer index and the completeness of cytoreduction score. Proper patient selection is mandatory for optimizing the results of treatment. In a series of phase II studies, appendiceal tumors with peritoneal seeding became the paradigm for success with an 85% long-term survival in selected patients. Carcinomatosis from colon cancer had an overall 5-year survival of 45% with selected patients. In all malignancies, early aggressive treatment of minimal peritoneal surface dissemination showed the greatest benefit. The definitive prognostic indicator was the complete cytoreduction. Oncologists must seek new knowledge regarding the management of peritoneal surface dissemination of cancer because a curative approach has been demonstrated in large phase II studies; in contrast all historical controls show 0% long-term survival. Additional adjuvant phase III studies with perioperative intraperitoneal chemotherapy in diseases where peritoneal surface spread occurs are indicated.
腹膜表面恶性肿瘤通常由胃肠道癌种植引起。过去，这种临床情况采用姑息性治疗。腹膜表面恶性肿瘤的确切治疗方法包括腹膜切除术、脏器切除术、围手术期腹腔内化疗以及明智的患者选择。有效临床判断所需的定量预后指标包括癌症组织病理学（浸润性进展与膨胀性进展）、术前腹部和盆腔CT、腹膜癌指数以及肿瘤细胞减灭评分的完整性。为优化治疗结果，必须进行恰当的患者选择。在一系列II期研究中，伴有腹膜播散的阑尾肿瘤成为成功范例，部分患者长期生存率达85%。结肠癌所致癌性腹膜炎患者总体5年生存率为45%。在所有恶性肿瘤中，对微小腹膜表面播散进行早期积极治疗获益最大。确切的预后指标是肿瘤细胞完全减灭。肿瘤学家必须寻求有关癌症腹膜表面播散治疗的新知识，因为在大型II期研究中已证实存在治愈性方法；相比之下，所有历史对照的长期生存率均为0%。对于发生腹膜表面播散的疾病，需开展额外的围手术期腹腔内化疗辅助III期研究。
