Division of Surgical Oncology, Department of Surgery, The University of Illinois at Chicago, Chicago, IL, USA.
Ann Surg Oncol. 2012 May;19(5):1410-5. doi: 10.1245/s10434-012-2240-7.
The prognosis of peritoneal sarcomatosis is generally poor and conventional treatments for this disease process are mostly ineffective. The use of cytoreductive surgery (CRS) with hyperthermic intraperitoneal chemotherapy (HIPEC) as an aggressive locoregional treatment option remains controversial.
We reviewed 13 patients with peritoneal sarcomatosis who underwent CRS and closed-abdomen HIPEC with cisplatin and doxorubicin between March 2007 and March 2010. None of the patients was diagnosed with GIST or uterine leiomyosarcoma. Both disease-free survival (DFS) and overall survival (OS) were evaluated. Completeness of cytoreduction (CC) and peritoneal cancer index (PCI) were assessed.
There was no operative mortality. Median follow-up was 12 (range, 4–43) months. Peritoneal disease progression occurred in six patients, distant metastases alone in none, and both in two patients. Median DFS and OS were 11 and 12 months, respectively. Completeness of cytoreduction significantly affected survival. Mean DFS and OS in those patients where a CC-0 was achieved was 27.25 ± 5.71 (median, 20) months and 35.25 ± 4.75 months (median, not reached). In contrast, patients with gross residual disease (CC ≥ 1) had a DFS of 4.25 ± 1.43 months (median, 4 months; P = 0.03) and an OS of 5.25 ± 2.36 months (median, 4 months; P = 0.02). In addition, PCI influenced survival when evaluated by univariate analysis. Using multivariate analysis, completeness of cytoreduction was the only covariate influencing overall survival (P = 0.012).
A complete cytoreduction and low PCI score appear to be important factors in considering CRS and HIPEC for patients with peritoneal sarcomatosis.
腹膜肉瘤的预后通常较差，针对这种疾病过程的传统治疗方法大多无效。使用细胞减灭术（CRS）联合高温腹腔内化疗（HIPEC）作为一种积极的局部区域治疗选择仍然存在争议。
我们回顾了 2007 年 3 月至 2010 年 3 月期间 13 名接受 CRS 和闭腹 HIPEC 联合顺铂和多柔比星治疗的腹膜肉瘤患者。这些患者均未被诊断为 GIST 或子宫平滑肌肉瘤。评估了无病生存率（DFS）和总生存率（OS）。评估了细胞减灭术的完全程度（CC）和腹膜癌症指数（PCI）。
无手术死亡。中位随访时间为 12 个月（范围 4-43 个月）。6 名患者出现腹膜疾病进展，无远处转移，2 名患者同时出现两种情况。中位 DFS 和 OS 分别为 11 个月和 12 个月。细胞减灭术的完全程度显著影响生存。在达到 CC-0 的患者中，DFS 和 OS 的平均值分别为 27.25±5.71 个月（中位数 20 个月）和 35.25±4.75 个月（中位数未达到）。相比之下，有大量残留疾病（CC≥1）的患者的 DFS 为 4.25±1.43 个月（中位数 4 个月；P=0.03），OS 为 5.25±2.36 个月（中位数 4 个月；P=0.02）。此外，通过单因素分析，PCI 影响生存。使用多因素分析，细胞减灭术的完全程度是影响总生存的唯一协变量（P=0.012）。
完全细胞减灭术和低 PCI 评分似乎是考虑对腹膜肉瘤患者进行 CRS 和 HIPEC 的重要因素。
