阑尾源性腹膜黏液性癌（PMCA）患者在减瘤手术和热灌注腹腔化疗（CRS/HIPEC）前进行全身化疗（SC）。
Systemic chemotherapy (SC) before cytoreductive surgery and hyperthermic intraperitoneal chemotherapy (CRS/HIPEC) in patients with peritoneal mucinous carcinomatosis of appendiceal origin (PMCA).
作者信息
Milovanov V, Sardi A, Ledakis P, Aydin N, Nieroda C, Sittig M, Nunez M, Gushchin V
机构信息
Department of Surgical Oncology, Mercy Medical Center, 227 St Paul Place, Baltimore, MD 21202-2001, USA.
出版信息
Eur J Surg Oncol. 2015 May;41(5):707-12. doi: 10.1016/j.ejso.2015.01.005. Epub 2015 Jan 17.
BACKGROUND
The role of SC before CRS/HIPEC for patients with PMCA is unclear. This study explores the effect of SC prior to CRS/HIPEC on overall survival (OS) in patients with PMCA.
METHODS
72 patients with recently diagnosed PMCA who underwent CRS/HIPEC were identified from a prospective database. Thirty patients had SC before CRS/HIPEC (Group 1) and 42 did not (Group 2). Patients who were referred to our center after multiple lines of SC were excluded from this analysis. OS was estimated.
RESULTS
Median follow-up was 3.2 years. Groups were similar regarding lymph node positivity, postoperative SC and rate of complete cytoreduction. Twenty-four (80%) patients in Group 1 and 21 (50%) in Group 2 had high grade histology (HG) (p = 0.01). OS from CRS/HIPEC at 1, 2, and 3 years was 93, 68, 51% in Group 1 and 82, 64, 60% in Group 2, respectively (p = 0.74). Among HG patients 3-year survival was 36% in the SC group vs. 35% in the group without SC (p = 0.67). The 3-year OS for patients with low grade (LG) tumors was 100% in the SC group vs. 79% in the group with no prior SC (p = 0.26). Among patients with signet ring cell (SRC) histology, 1, 2 and 3-year survival was 94, 67 and 22% in the SC group vs. 43, 14, 14% in the group with no SC, respectively (p = 0.028). There were only 6 patients with LG PMCA who received prior SC.
CONCLUSIONS
Preoperative SC could improve the prognosis of patients with high-grade PMCA with SRC histology.
背景
对于原发性腹膜癌（PMCA）患者，细胞减灭术（SC）在细胞减灭术联合腹腔热灌注化疗（CRS/HIPEC）之前的作用尚不清楚。本研究探讨了CRS/HIPEC之前进行SC对PMCA患者总生存期（OS）的影响。
方法
从一个前瞻性数据库中识别出72例近期诊断为PMCA并接受CRS/HIPEC的患者。30例患者在CRS/HIPEC之前进行了SC（第1组），42例未进行（第2组）。经过多线SC后转诊至我们中心的患者被排除在本分析之外。对总生存期进行了评估。
结果
中位随访时间为3.2年。两组在淋巴结阳性、术后SC和完全细胞减灭率方面相似。第1组24例（80%）患者和第2组21例（50%）患者为高级别组织学（HG）（p = 0.01）。第1组CRS/HIPEC后1年、2年和3年的总生存率分别为93%、68%、51%，第2组分别为82%、64%、60%（p = 0.74）。在HG患者中，SC组3年生存率为36%，未进行SC组为35%（p = 0.67）。低级别（LG）肿瘤患者中，SC组3年总生存率为100%，未进行SC组为79%（p = 0.26）。在印戒细胞（SRC）组织学患者中，SC组1年、2年和3年生存率分别为94%、67%、22%，未进行SC组分别为43%、14%、14%（p = 0.028）。仅有6例LG PMCA患者接受过SC。
结论
术前SC可改善高级别PMCA伴SRC组织学患者的预后。
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