Dodson Rebecca M, McQuellon Richard P, Mogal Harveshp D, Duckworth Katharine E, Russell Gregory B, Votanopoulos Konstantinos I, Shen Perry, Levine Edward A
Department of Surgical Oncology, Wake Forest Baptist Health, Winston-Salem, NC, USA.
Department of Medical Oncology, Wake Forest Baptist Health, Winston-Salem, NC, USA.
Ann Surg Oncol. 2016 Dec;23(Suppl 5):772-783. doi: 10.1245/s10434-016-5547-y. Epub 2016 Sep 8.
Cytoreductive surgery (CS) with hyperthermic intraperitoneal chemotherapy (HIPEC) for peritoneal metastases can alleviate symptoms and prolong survival at the expense of morbidity and quality of life (QoL). This study aimed to monitor QoL and outcomes before and after HIPEC.
A prospective QoL trial of patients who underwent HIPEC for peritoneal metastases from 2000 to 2015 was conducted. The patients completed the Medical Outcomes Study 36-Item Short-Form Health Survey (SF-36), the Functional Assessment of Cancer Therapy + Colon Subscale (FACT-C), the Brief Pain Inventory, the Center for Epidemiologic Studies Depression scale, and the Eastern Cooperative Oncology Group (ECOG) performance status at baseline, then 3, 6, 12, and 24 months after HIPEC. The trial outcome index (TOI) was analyzed. Proportional hazards modeled the effect of baseline QoL on survival.
The 598 patients (53.8 % female) in the study had a mean age of 53.3 years. The overall 1-year survival rate was 76.8 %, and the median survival period was 2.9 years. The findings showed a minor morbidity rate of 29.3 %, a major morbidity rate of 21.7 %, and a 30-day mortality rate of 3.5 %. The BPI (p < 0.0001) and worst pain (p = 0.004) increased at 3 months but returned to baseline at 6 months. After CS + HIPEC, FACT-C emotional well-being, SF-36 mental component score, and emotional health improved (all p < 0.001). Higher baseline FACT-General (hazard ratio [HR], 0.92; 95 % confidence interval [CI], 0.09-0.96), FACT-C (HR, 0.73; 95 % CI 0.65-0.83), physical well-being (HR, 0.71; 95 % CI 0.64-0.78), TOI (HR, 0.87; 95 % CI 0.84-0.91), and SF-36 vitality (HR, 0.88; 95 % CI 0.83-0.92) were associated with improved survival (all p < 0.001). Higher baseline BPI (HR, 1.1; 95 % CI 1.05-1.14; p < 0.0001), worst pain (HR, 1.06; 95 % CI 1.01-1.10; p = 0.01), and ECOG (HR, 1.74; 95 % CI 1.50-2.01; p < 0.0001) were associated with worse survival.
Although HIPEC is associated with morbidity and detriments to QoL, recovery with good overall QoL typically occurs at or before 6 months. Baseline QoL is associated with morbidity, mortality, and survival after HIPEC.
细胞减灭术（CS）联合热灌注化疗（HIPEC）治疗腹膜转移瘤可缓解症状、延长生存期，但会以增加发病率和影响生活质量（QoL）为代价。本研究旨在监测HIPEC前后的生活质量和治疗结果。
对2000年至2015年接受HIPEC治疗腹膜转移瘤的患者进行一项前瞻性生活质量试验。患者在基线时、HIPEC后3个月、6个月、12个月和24个月完成医学结局研究简明健康调查问卷（SF - 36）、癌症治疗功能评估+结肠子量表（FACT - C）、简明疼痛量表、流行病学研究中心抑郁量表以及东部肿瘤协作组（ECOG）体能状态评估。对试验结局指数（TOI）进行分析。采用比例风险模型评估基线生活质量对生存的影响。
研究中的598例患者（53.8%为女性）平均年龄为53.3岁。总体1年生存率为76.8%，中位生存期为2.9年。结果显示轻微发病率为29.3%，严重发病率为21.7%，30天死亡率为3.5%。简明疼痛量表（p < 0.0001）和最严重疼痛程度（p = 0.004）在3个月时升高，但在6个月时恢复至基线水平。CS + HIPEC后，FACT - C的情感健康状况、SF - 36心理成分评分和情绪健康状况均有所改善（均p < 0.001）。较高的基线FACT - 通用量表（风险比[HR]，0.92；95%置信区间[CI]，0.09 - 0.96）、FACT - C（HR，0.73；95% CI 0.65 - 0.83）、身体健康状况（HR，0.71；95% CI 0.64 - 0.78）、TOI（HR，0.87；95% CI 0.84 - 0.91）以及SF - 36活力评分（HR，0.88；95% CI 0.83 - 0.92）与生存期改善相关（均p < 0.001）。较高的基线简明疼痛量表（HR，1.1；95% CI 1.05 - 1.14；p < 0.0001）、最严重疼痛程度（HR，1.06；95% CI 1.01 - 1.10；p = 0.01）以及ECOG评分（HR，1.74；95% CI 1.50 - 2.01；p < 0.0001）与生存期较差相关。
尽管HIPEC会增加发病率并损害生活质量，但通常在6个月或6个月之前可实现总体生活质量良好的恢复。基线生活质量与HIPEC后的发病率、死亡率和生存期相关。
