一项关于接受细胞减灭术和腹腔内热灌注化疗的子宫肉瘤腹膜转移瘤的多机构研究。

Multi-institutional study of peritoneal sarcomatosis from uterine sarcoma treated with cytoreductive surgery and hyperthermic intraperitoneal chemotherapy.

作者信息

Sardi Armando, Sipok Arkadii, Baratti Dario, Deraco Marcello, Sugarbaker Paul, Salti George, Yonemura Yutaka, Sammartino Paolo, Glehen Olivier, Bakrin Naoual, Díaz-Montes Teresa P, Gushchin Vadim

机构信息

Department of Surgical Oncology, Institute for Cancer Care at Mercy Medical Center, 227 St. Paul Place, Baltimore, MD, 21202, USA.

Fondazione IRCCS Istituto Nazionale Dei Tumori di Milano, Department of Surgery, Peritoneal Surface Malignancies Program, Via Venezian, 1, Milano, MI Cap 20133, Italy.

出版信息

Eur J Surg Oncol. 2017 Nov;43(11):2170-2177. doi: 10.1016/j.ejso.2017.08.011. Epub 2017 Sep 7.

DOI:10.1016/j.ejso.2017.08.011

PMID:28967566

Abstract

OBJECTIVE

Uterine sarcoma (US) is a rare tumor representing 1% of female genital tract malignancies. Peritoneal sarcomatosis (PS) after US, diminishes median overall survival (OS) and progression-free survival (PFS) with cytoreductive surgery (CRS) alone, with or without systemic chemotherapy is <1 year and 6 months, respectively. A multi-institutional review of PS from US was conducted to evaluate CRS and hyperthermic intraperitoneal chemotherapy (HIPEC) and effects on survival outcomes.

METHODS

A retrospective review of 36 patients from 7 specialized international centers was performed. Selection criteria included PS of uterine origin with CRS/HIPEC treatment. Clinical data were analyzed. OS and PFS were estimated with Kaplan-Meier method.

RESULTS

Thirty-six patients underwent a total 38 HIPEC procedures performed from 2005 to 2014; 35 previous treatment and 1 primary treatment. Twenty-nine (81%) LMS patients, 3 (8%) endometrial stromal sarcoma (ESS), 3 (8%) adeneosarcoma (AS), and 1 (3%) categorized as other. Median PCI was 16 (range: 2-39), 10 patients had PCI ≥20. Thirty-four patients (94%) had complete cytoreduction (CC 0-1), 19 patients recurred. CRS/HIPEC OS at 1, 3, and 5-years was 75%, 53%, and 32% respectively, with median OS of 37 months (CI 95%: 20-54). PFS in 32 patients with CC at 1, 3, and 5-years was 67%, 32% and 32%, respectively with median PFS of 18.9 months (CI 95%: 6.7-31).

CONCLUSIONS

CRS/HIPEC is a promising treatment modality for patients with PS. Histological subtype may influence survival. A global prospective registry of patients to further assess the efficacy of CRS/HIPEC is needed.

摘要

目的

子宫肉瘤（US）是一种罕见肿瘤，占女性生殖道恶性肿瘤的1%。US发生腹膜肉瘤病（PS）后，单纯细胞减灭术（CRS）（无论是否联合全身化疗）会缩短中位总生存期（OS）和无进展生存期（PFS），其OS和PFS分别小于1年和6个月。开展了一项针对US所致PS的多机构研究，以评估CRS和热灌注化疗（HIPEC）及其对生存结局的影响。

方法

对来自7个国际专业中心的36例患者进行回顾性研究。选择标准包括子宫源性PS并接受CRS/HIPEC治疗。分析临床数据。采用Kaplan-Meier法估计OS和PFS。

结果

2005年至2014年，36例患者共接受了38次HIPEC治疗；35例为既往治疗，1例为初次治疗。29例（81%）为平滑肌肉瘤（LMS）患者，3例（8%）为子宫内膜间质肉瘤（ESS），3例（8%）为腺肉瘤（AS），1例（3%）归类为其他。中位腹膜癌指数（PCI）为16（范围：2 - 39），10例患者PCI≥20。34例患者（94%）实现了完全细胞减灭（CC 0 - 1），19例患者复发。CRS/HIPEC治疗后的1年、3年和5年OS分别为75%、53%和32%，中位OS为37个月（95%CI：20 - 54）。32例实现CC的患者的1年、3年和5年PFS分别为67%、32%和32%，中位PFS为18.9个月（95%CI：6.7 - 31）。