Milovanov V, Sardi A, Aydin N, Nieroda C, Sittig M, Nunez M, Gushchin V
Department of Surgical Oncology, Mercy Medical Center, 227 St Paul Place, Baltimore, MD 21202-2001, USA.
Eur J Surg Oncol. 2015 Jul;41(7):881-5. doi: 10.1016/j.ejso.2015.02.016. Epub 2015 Apr 13.
Patients with PMCA commonly undergo surgery before CRS/HIPEC. We evaluated the role of extensive surgical treatment before CRS/HIPEC in terms of overall survival (OS).
105 patients with PMCA who underwent a CRS/HIPEC procedure were identified from a prospective database. Patients were divided into two groups based on Prior Surgery Score (PSS): PSS ≤ 1 limited surgery group (LSG), PSS >1 extensive surgery group (ESG). Survival of lymph node (LN) negative and positive patients was analyzed separately.
40 patients were in LSG and 65 in ESG. Mean time from diagnosis to CRS/HIPEC was 6 and 17 months for LSG and ESG, respectively (p = 0.004). Groups were well balanced in peritoneal cancer index, complete cytoreduction rate, and LN status. One, 3, and 5-year OS among LN negative patients was 95, 83, and 75% for the LSG (n = 22) group and 87, 55, and 32% for the ESG (n = 35), group respectively (p = 0.026). One, 3, and 5-year OS among LN positive patients was 69, 50, and 17% for the LSG (n = 18) group and 80, 21, and 14% for the ESG (n = 30), group respectively (p = 0.613). For all patients 1, 3, and 5-year OS was 84, 65, and 54% for the LSG (n = 40) group and 86, 43, and 26% for the ESG (n = 65) group, respectively (p = 0.029).
Extensive surgical treatment before CRS/HIPEC is associated with delay of CRS/HIPEC and poorer OS overall, especially among LN negative patients. We recommend early referral of PMCA patients to a peritoneal surface malignancy center.
原发性腹膜癌（PMCA）患者通常在进行细胞减灭术联合腹腔热灌注化疗（CRS/HIPEC）之前接受手术。我们从总生存期（OS）方面评估了CRS/HIPEC之前广泛手术治疗的作用。
从一个前瞻性数据库中确定了105例行CRS/HIPEC手术的PMCA患者。根据既往手术评分（PSS）将患者分为两组：PSS≤1的有限手术组（LSG），PSS>1的广泛手术组（ESG）。分别分析淋巴结（LN）阴性和阳性患者的生存期。
LSG组40例，ESG组65例。LSG组和ESG组从诊断到CRS/HIPEC的平均时间分别为6个月和17个月（p = 0.004）。两组在腹膜癌指数、完全细胞减灭率和LN状态方面平衡良好。LSG组（n = 22）LN阴性患者的1年、3年和5年总生存率分别为95%、83%和75%，ESG组（n = 35）分别为87%、55%和32%（p = 0.026）。LSG组（n = 18）LN阳性患者的1年、3年和5年总生存率分别为69%、50%和17%，ESG组（n = 30）分别为80%、21%和14%（p = 0.613）。所有患者中，LSG组（n = 40）的1年、3年和5年总生存率分别为84%、65%和54%，ESG组（n = 65）分别为86%、43%和26%（p = 0.029）。
CRS/HIPEC之前的广泛手术治疗与CRS/HIPEC延迟及总体较差的总生存期相关，尤其是在LN阴性患者中。我们建议将PMCA患者尽早转诊至腹膜表面恶性肿瘤中心。
