接受细胞减灭术和术中腹腔内热化疗的结直肠癌腹膜转移患者的生存预后因素：单中心经验
Survival prognostic factors in patients with colorectal peritoneal carcinomatosis treated with cytoreductive surgery and intraoperative hyperthermic intraperitoneal chemotherapy: a single institution experience.
作者信息
Nikolic Srdjan, Dzodic Radan, Zegarac Milan, Djurisic Igor, Gavrilovic Dusica, Vojinovic Vera, Kocic Milan, Santrac Nada, Radlovic Petar, Radosavljevic Davorin, Pupic Gordana, Martinovic Aleksandar
机构信息
Surgical Oncology Clinic, Institute for Oncology and Radiology of Serbia, Belgrade; 2School of Medicine, University of Belgrade, Belgrade, Serbia.
出版信息
J BUON. 2014 Jan-Mar;19(1):66-74.
PURPOSE
The aim of this research was to examine overall (OS) and disease-free survival (DFS) in patients with colorectal peritoneal carcinomatosis (CRC-PC), treated with cytoreductive surgery (CRS) and intraoperative hyperthermic intraperitoneal chemotherapy (HIPEC), as well as to analyse factors of prognostic significance.
METHODS
We included 61 patients with pathological/and computerized tomography (CT) confirmation of CRC-PC, treated with CRS+HIPEC from 2005 to 2012. Peritoneal Cancer Index (PCI) score was used for quantitative assessment of the CRC-PC extent. We performed CRS following the Sugarbaker's principles in all patients with PCI ≤20 and only in 3/61 (4.92%) patients with PCI >20. HIPEC (oxaliplatin 410 mg/m(2) in 2000mL isotonic solution and 41?C) was performed using RanD Performer® HT perfusion system during 30-60 min. Cox proportional hazard regression was used to determine significant factors for OS and DFS.
RESULTS
The follow-up ranged from 1 to 83 months (median 22). Median OS was 51 months (95% confidence interval/ CI 22+). Median DFS for patients without residual disease (57/61, 93.44%) was 23 months (95% CI 16+). One-, 2- and 6-year OS (DFS) were 78.6% (68.3%), 58.7% (46.7%) and 50.5% (38.1%), respectively. By the end of the study, 55.74% of the patients were still alive. Cox multivariate analysis indicated PCI score as a parameter of highly prognostic significance for patients treated with CRS+HIPEC (p<0.001). Patients with PCI (13 (vs PCI ≥13) had significantly longer OS and DFS (p<0.001), also confirmed for PCI subcategories (PCI <7 vs 7≤ PCI <13 vs PCI ≥13). All patients with PCI <7 are still alive.
CONCLUSION
Our study indicates that CRS+HIPEC significantly improves the survival of CRC-PC patients. This treatment modality should be considered as the most suitable in well-selected patients with this disease.
目的
本研究旨在探讨接受细胞减灭术（CRS）及术中腹腔热灌注化疗（HIPEC）治疗的结直肠癌腹膜转移（CRC-PC）患者的总生存期（OS）和无病生存期（DFS），并分析具有预后意义的因素。
方法
我们纳入了61例经病理及计算机断层扫描（CT）确诊为CRC-PC的患者，这些患者在2005年至2012年期间接受了CRS+HIPEC治疗。采用腹膜癌指数（PCI）评分对CRC-PC的范围进行定量评估。对于所有PCI≤20的患者以及仅3/61例（4.92%）PCI>20的患者，我们按照Sugarbaker原则进行CRS。使用RanD Performer® HT灌注系统在30-60分钟内进行HIPEC（在2000mL等渗溶液中使用410mg/m²奥沙利铂，温度为41°C）。采用Cox比例风险回归分析来确定OS和DFS的显著因素。
结果
随访时间为1至83个月（中位数为22个月）。中位OS为51个月（95%置信区间/CI 22+）。无残留疾病患者（57/61，93.44%）的中位DFS为23个月（95%CI 16+）。1年、2年和6年的OS（DFS）分别为78.6%（68.3%）、58.7%（46.7%）和50.5%（38.1%）。到研究结束时，55.74%的患者仍然存活。Cox多因素分析表明，PCI评分是接受CRS+HIPEC治疗患者具有高度预后意义的参数（p<0.001）。PCI<13（vs PCI≥13）的患者OS和DFS显著更长（p<0.001），PCI亚组（PCI<7 vs 7≤PCI<13 vs PCI≥13）也得到证实。所有PCI<7的患者仍然存活。
结论
我们的研究表明，CRS+HIPEC显著提高了CRC-PC患者的生存率。这种治疗方式应被视为最适合精心挑选的此类疾病患者。
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