Manzanedo Israel, Pereira Fernando, Pérez-Viejo Estíbalitz, Serrano Ángel, Hernández-García Miguel, Martínez-Torres Beatriz, Rihuete-Caro Cristina, Calzas Julia, Cueto Margarita
Peritoneal Carcinomatosis Unit, Department of General and Digestive Surgery, Fuenlabrada University Hospital, Fuenlabrada, Madrid, Spain -
Peritoneal Carcinomatosis Unit, Department of General and Digestive Surgery, Fuenlabrada University Hospital, Fuenlabrada, Madrid, Spain.
Minerva Ginecol. 2017 Apr;69(2):119-127. doi: 10.23736/S0026-4784.16.03959-9. Epub 2016 Jul 14.
Peritoneal dissemination is the most common route of spread of epithelial ovarian cancer (EOC). Cytoreductive surgery (CRS) followed by platinum-based systemic chemotherapy is the current standard treatment in advanced stages, with suboptimal results. The aim of this study is to analyze the outcome of advanced EOC treated with CRS plus hyperthermic intraoperative intraperitoneal chemotherapy (HIPEC) combined with systemic chemotherapy.
We analyze a cohort of women treated with CRS plus HIPEC for peritoneal carcinomatosis secondary to EOC from May 2007 to December 2014. We included both patients with peritoneal disease at first diagnosis of EOC and peritoneal recurrences after initial treatment.
We performed 61 CRS with HIPEC procedures, 31 cases as primary treatment (4 as upfront therapy and 27 after neoadjuvant chemotherapy) and 30 as secondary treatment (recurrences). Median Peritoneal Carcinomatosis Index (PCI) was 9; the cytoreduction was optimal in 92% of the procedures. Severe morbidity (Grade III-IV of Clavien-Dindo classification) was 29.5%, without mortality. Median follow-up was 23 months and median disease-free survival (DFS) was 14 months (14 in primary surgery group and 17 in recurrence group, P=0.51). Median overall survival (OS) was 57 months; in primary surgery group, OS was 96.8% at 1 year, and 55% at 5 years, and median OS was not reached; OS in recurrence group was 89.3% at 1 year and 47.1% at 5 years, and median OS was 57 months.
CRS with HIPEC is a treatment option for EOC with good results in terms of morbidity and survival, in experienced centers.
腹膜播散是上皮性卵巢癌（EOC）最常见的扩散途径。细胞减灭术（CRS）联合铂类全身化疗是晚期患者目前的标准治疗方法，但效果欠佳。本研究旨在分析CRS联合术中腹腔内热灌注化疗（HIPEC）及全身化疗治疗晚期EOC的疗效。
我们分析了2007年5月至2014年12月期间接受CRS联合HIPEC治疗EOC继发腹膜癌病的一组女性患者。纳入了初次诊断EOC时即有腹膜疾病的患者以及初始治疗后腹膜复发的患者。
我们进行了61例CRS联合HIPEC手术，31例作为初始治疗（4例作为一线治疗，27例在新辅助化疗后），30例作为二线治疗（复发患者）。腹膜癌指数（PCI）中位数为9；92%的手术达到了最佳细胞减灭效果。严重并发症（Clavien-Dindo分类III-IV级）发生率为29.5%，无死亡病例。中位随访时间为23个月，中位无病生存期（DFS）为14个月（初始手术组为14个月，复发组为17个月，P = ？0.51）。中位总生存期（OS）为57个月；在初始手术组中，1年总生存率为96.8%，5年为55%，中位OS未达到；复发组1年总生存率为89.3%，5年为47.1%，中位OS为57个月。
在有经验的中心，CRS联合HIPEC是EOC的一种治疗选择，在并发症发生率和生存率方面效果良好。
（注：原文中“P = ？0.51”这里的“？”可能是原文有误，翻译时保留了原文的样子。）
