腹膜癌指数对接受细胞减灭术和腹腔热灌注化疗治疗的黏液性腹膜恶性肿瘤患者生存的预测价值：单中心经验。
Predictive value of peritoneal cancer index for survival in patients with mucinous peritoneal malignancies treated with cytoreductive surgery and hyperthermic intraperitoneal chemotherapy: a single centre experience.
机构信息
a Department of General, Visceral, and Transplantation Surgery and Department of General, Visceral, Vascular, and Thoracic Surgery, Campus Virchow and Mitte, Charité , Universitätsmedizin Berlin , Berlin , Germany.
b Institute of Pathology, Campus Mitte, Charité , Universitätsmedizin Berlin , Berlin , Germany.
出版信息
Int J Hyperthermia. 2018 Aug;34(5):512-517. doi: 10.1080/02656736.2017.1351627. Epub 2017 Jul 26.
OBJECTIVES
This study investigated the correlation between the peritoneal carcinomatosis index (PCI) and patient outcome depending on the tumour type.
BACKGROUND
Peritoneal surface malignancy (PSM) treatment depends on tumour type. Mucinous PSM (m-PSM) is associated with a better prognosis than non-mucinous PSM (nm-PSM). The PCI's predictive ability has not yet been evaluated.
METHODS
We analysed 123 patients with PSM treated with cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) between 2008 and 2015. The m-PSM group (n = 75) included patients with appendiceal cancer (n = 15), colorectal cancer (n = 21), or low-grade appendiceal mucinous neoplasm (n = 39); the nm-PSM group (n = 48) included patients with gastric (n = 18) or colorectal (n = 30) cancer. The PCI's predictive ability was evaluated by multiple Cox-proportional hazard regression analysis and Kaplan-Meier curves.
RESULTS
The 5-year survival and PCI were higher in m-PSM patients (67.0%; 20.5 ± 12.1) than in nm-PSM patients (32.6%; p = 0.013; 8.9 ± 6.0; p < 0.001). Colorectal nm-PSM patients with PCI ≥16 had a worse 2-year survival (25.0%) vs. patients with PCI <16 (79.1%; log rank = 0.009), but no significant effect was observed in patients with m-PSM (66.7% vs. 68.1%; p = 0.935). Underlying disease (HR 5.666-16.240), BMI (HR 1.109), and PCI (HR 1.068) significantly influenced overall survival in all patients.
CONCLUSIONS
PCI is prognostic in nm-PSM, but not in m-PSM. CRS and HIPEC may benefit not only patients with low PCI, but also those with high PCI and m-PSM.
目的
本研究旨在探讨腹膜癌转移指数（peritoneal carcinomatosis index，PCI）与肿瘤类型相关的患者预后之间的关系。
背景
腹膜表面恶性肿瘤（peritoneal surface malignancy，PSM）的治疗取决于肿瘤类型。黏液性腹膜表面恶性肿瘤（mucinous PSM，m-PSM）的预后优于非黏液性腹膜表面恶性肿瘤（non-mucinous PSM，nm-PSM）。目前尚未评估 PCI 的预测能力。
方法
我们分析了 2008 年至 2015 年间接受细胞减灭术（cytoreductive surgery，CRS）和腹腔内热灌注化疗（hyperthermic intraperitoneal chemotherapy，HIPEC）治疗的 123 例 PSM 患者。m-PSM 组（n=75）包括阑尾癌（appendiceal cancer，n=15）、结直肠癌（colorectal cancer，n=21）或低级别阑尾黏液性肿瘤（low-grade appendiceal mucinous neoplasm，n=39）患者；nm-PSM 组（n=48）包括胃癌（gastric cancer，n=18）或结直肠癌（colorectal cancer，n=30）患者。采用多 Cox 比例风险回归分析和 Kaplan-Meier 曲线评估 PCI 的预测能力。
结果
m-PSM 患者的 5 年生存率和 PCI 均高于 nm-PSM 患者（67.0%，20.5±12.1 vs. 32.6%，p=0.013；8.9±6.0 vs. 7.9±6.0，p<0.001）。结直肠 nm-PSM 患者 PCI≥16 时 2 年生存率较差（25.0% vs. PCI<16 患者的 79.1%，log rank=0.009），但 m-PSM 患者无显著差异（66.7% vs. 68.1%，p=0.935）。基础疾病（HR 5.666-16.240）、BMI（HR 1.109）和 PCI（HR 1.068）均显著影响所有患者的总生存率。
结论
PCI 对 nm-PSM 具有预后意义，但对 m-PSM 无预后意义。CRS 和 HIPEC 不仅可能使低 PCI 患者受益，也可能使高 PCI 和 m-PSM 患者受益。
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