a Peritoneal Malignancy Institute, Basingstoke and North Hampshire Hospital , Basingstoke , UK.
b Department of General and Digestive Surgery , Valencia Oncology Institute Foundation , Valencia , Spain.
Int J Hyperthermia. 2018 Aug;34(5):578-584. doi: 10.1080/02656736.2018.1434902. Epub 2018 Feb 12.
Cytoreductive surgery (CRS) with hyperthermic intraperitoneal chemotherapy (HIPEC) benefits selected patients with peritoneal mesothelioma. We present the outcomes of this treatment strategy in a UK peritoneal malignancy national referral centre.
Observational retrospective analysis of data prospectively collected in a dedicated peritoneal malignancy database between March 1998 and January 2016.
Of 1586 patients treated for peritoneal malignancy, 76 (4.8%) underwent surgery for peritoneal mesothelioma. Median age was 49 years (range 21-73 years). 34 patients (45%) were female. Of the 76 patients, 39 (51%) had low grade histological subtypes (mostly multicystic mesothelioma), and 37 (49%) had diffuse malignant peritoneal mesothelioma (DMPM; mostly epithelioid mesothelioma). Complete cytoreduction was achieved in 52 patients (68%) and maximal tumour debulking (MTD) was performed in 20 patients (26%); the remaining 4 patients (5%) underwent a laparotomy with biopsy only. HIPEC was administered in 67 patients (88%). Median overall (OS) and disease-free survival (DFS) after CRS was 97.8 (80.2-115.4) and 58.8 (47.4-70.3) months, respectively. After complete cytoreduction, 100% overall survival was observed amongst patients with low-grade disease. Ki-67 proliferation index was significantly associated with survival outcomes after complete cytoreduction for DMPM and was an independent predictor of decreased survival.
With adequate patient selection (guided by histological classification and Ki-67 proliferation index) and complete cytoreduction with HIPEC, satisfactory outcomes can be achieved in selected patients with peritoneal mesothelioma.
细胞减灭术（CRS）联合腹腔热灌注化疗（HIPEC）使部分腹膜间皮瘤患者受益。我们在英国腹膜恶性肿瘤国家转诊中心介绍了这种治疗策略的结果。
对 1998 年 3 月至 2016 年 1 月期间在专门的腹膜恶性肿瘤数据库中前瞻性收集的数据进行观察性回顾性分析。
在 1586 例腹膜恶性肿瘤患者中，76 例（4.8%）因腹膜间皮瘤行手术治疗。中位年龄为 49 岁（范围 21-73 岁）。34 例（45%）为女性。76 例患者中，39 例（51%）为低级别组织学亚型（主要为多囊性间皮瘤），37 例（49%）为弥漫性恶性腹膜间皮瘤（DMPM；主要为上皮样间皮瘤）。52 例（68%）患者达到完全肿瘤细胞减灭术（CCR），20 例（26%）患者达到最大肿瘤减灭术（MTD）；其余 4 例（5%）患者仅行剖腹探查术和活检。67 例（88%）患者接受 HIPEC。CRS 后中位总生存期（OS）和无病生存期（DFS）分别为 97.8（80.2-115.4）和 58.8（47.4-70.3）个月。在低级别疾病患者中，完全肿瘤细胞减灭术后的总生存率为 100%。Ki-67 增殖指数与 DMPM 完全肿瘤细胞减灭术后的生存结果显著相关，是生存时间缩短的独立预测因素。
在适当的患者选择（由组织学分类和 Ki-67 增殖指数指导）和 CRS 联合 HIPEC 完全肿瘤细胞减灭术的基础上，在选定的腹膜间皮瘤患者中可以获得满意的结果。
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