Department of General Surgery, University of Illinois Hospital and Health Sciences System, 840 S Wood Street, Suite 376 CSN, Chicago, IL, 60612, USA.
Department of Surgical Oncology, Edward Cancer Center, Naperville, IL, USA.
Med Oncol. 2018 Apr 12;35(5):69. doi: 10.1007/s12032-018-1125-4.
The current standard of treatment for malignant peritoneal mesothelioma (MPM) is cytoreductive surgery when the disease distribution is favorable. The role of chemotherapy, as an adjunct to surgery, remains unclear. The national database of mesothelioma was used to identify MPM patients who were treated with curative intent. Patients were divided into treatment groups: (1) chemotherapy only, (2) surgery only, (3) neoadjuvant chemotherapy + surgery, and (4) surgery + adjuvant chemotherapy. A negative control group of patients who did not receive any treatment was added (group 0). Totally, 1740 patients were included. Mean age was 63.04 ± 14.58 and 60.7% were males. The patients' distribution into the treatment groups was 604, 684, 169, 55, and 228 patients in groups 0-4, respectively, with a median survival of 3.61 ± 0.37, 11.10 ± 0.73, 57.41 ± 11.91, 52.30 ± 7.20, and 55.00 ± 9.19 months. The addition of chemotherapy, in any setting, to surgery provided an improved survival at 1 year (p = 0.006). This survival benefit ceased at the 2-, 3-, and 5-year checkpoints. The multivariate analysis identified age, sarcomatoid/biphasic histologies, nodal and distant metastasis, and offering no treatment or chemotherapy only as poor prognostic factors for overall survival. No difference in overall survival was noted with the addition of chemotherapy to complete debulking regardless of the timing. Complete debulking remains the standard treatment for MPM. The addition of systemic chemotherapy provides a short-term survival improvement at 1 year only and was similar whether given in the neoadjuvant or adjuvant setting. Nevertheless, it did not add a survival benefit beyond the 1-year time point.
当前，对于疾病分布有利的恶性腹膜间皮瘤（MPM），标准治疗方法是细胞减灭术。化疗作为手术的辅助手段，其作用仍不明确。本研究使用间皮瘤国家数据库，对接受根治性治疗的 MPM 患者进行了分析。患者被分为以下治疗组：（1）单纯化疗组，（2）单纯手术组，（3）新辅助化疗+手术组，（4）手术+辅助化疗组。另外还设立了未接受任何治疗的阴性对照组（组 0）。共纳入 1740 例患者。患者平均年龄为 63.04±14.58 岁，其中 60.7%为男性。治疗组患者分布为：组 0-4 分别为 604、684、169、55 和 228 例，中位生存时间分别为 3.61±0.37、11.10±0.73、57.41±11.91、52.30±7.20 和 55.00±9.19 个月。无论化疗在何种情况下联合手术，均可提高患者 1 年生存率（p=0.006）。但在 2 年、3 年和 5 年的随访中，这种生存优势不再存在。多变量分析确定年龄、肉瘤样/双相型组织学、淋巴结和远处转移以及未接受治疗或单纯化疗是总生存的不良预后因素。无论是否完全减瘤，在完全减瘤的基础上加用化疗对总生存无影响。完全减瘤仍然是 MPM 的标准治疗方法。系统化疗仅在 1 年内可提高短期生存率，新辅助或辅助应用效果相似。但该获益无法持续至 1 年以后。
