Ye Jinning, Ren Yufeng, Wei Zhewei, Peng Jianjun, Chen Chuangqi, Song Wu, Tan Min, He Yulong, Yuan Yujie
Center of Gastrointestinal Surgery, The First Affiliated Hospital, Sun Yat-Sen University, Guangzhou 510080, Guangdong Province, PR China; Center of Gastric Cancer, Sun Yat-Sen University, Guangzhou 510080, Guangdong Province, PR China.
Department of Radiation Oncology, The First Affiliated Hospital, Sun Yat-Sen University, Guangzhou 510080, Guangdong Province, PR China.
Surg Oncol. 2018 Sep;27(3):456-461. doi: 10.1016/j.suronc.2018.05.025. Epub 2018 May 28.
BACKGROUND & PURPOSE: Cytoreductive surgery (CRS) plus Hyperthermic intraperitoneal chemotherapy (HIPEC) is an effective measure for peritoneal carcinomatosis. The cisplatin (CP) applied in HIPEC carries a risk of kidney injury. This study aims to investigate CP-induced nephrotoxicity post HIPEC and to explore its risk factors.
From January 2012 to July 2013, 99 patients undergoing CRS + HIPEC were retrospectively reviewed. Patients were divided into CP and Non-CP HIPEC groups. The RIFLE classification was used to assess the severity of acute kidney injury (AKI). Renal and hepatic function, concentrations of tumor markers, and postoperative outcomes were compared between groups.
47 (47.5%) patients were in the CP HIPEC group, with 52 (52.5%) patients in the Non-CP HIPEC group. 11 (11.1%) patients developed AKI, with 10 of them from the CP HIPEC group. Two patients with CP-contained HIPEC developed acute renal failure. Plasma levels of both urea nitrogen and creatinine were significantly increased in the CP HIPEC group compared with the Non-CP HIPEC group (P < 0.01). However, postoperative pain (scaled score, 4.2 vs. 3.8; P = 0.279), length of hospital stay (18.1 vs. 20.2 days; P = 0.285), hospital costs ($1 3182 vs. $12 640; P = 0.465) and incidence of postoperative complication (25.5% vs. 17.3%; P = 0.337) were similar in both groups, with comparable 3-year overall survival observed (38.6% vs. 31.8%, P = 0.319). A multivariate analysis indicated that use of CP was an independent risk factor for AKI (P = 0.017, 95% CI: 1.277-4.155).
Application of CP during HIPEC is associated with an increased risk of nephrotoxicity, without promising long-term survival benefit.
细胞减灭术（CRS）联合腹腔热灌注化疗（HIPEC）是治疗腹膜癌病的有效措施。HIPEC中应用的顺铂（CP）存在肾损伤风险。本研究旨在探讨HIPEC后CP诱导的肾毒性并探索其危险因素。
回顾性分析2012年1月至2013年7月期间接受CRS + HIPEC的99例患者。将患者分为CP组和非CP组HIPEC组。采用RIFLE分类法评估急性肾损伤（AKI）的严重程度。比较两组患者的肾功能、肝功能、肿瘤标志物浓度及术后结局。
CP组HIPEC组有47例（47.5%）患者，非CP组HIPEC组有52例（52.5%）患者。11例（11.1%）患者发生AKI，其中10例来自CP组HIPEC组。2例接受含CP的HIPEC患者发生急性肾衰竭。与非CP组HIPEC组相比，CP组HIPEC组的血浆尿素氮和肌酐水平均显著升高（P < 0.01）。然而，两组患者的术后疼痛（量表评分，4.2对3.8；P = 0.279）、住院时间（18.1对20.2天；P = 0.285）、住院费用（13182美元对12640美元；P = 0.465）及术后并发症发生率（25.5%对17.3%；P = 0.337）相似，3年总生存率相当（38.6%对31.8%，P = 0.319）。多因素分析表明，使用CP是AKI的独立危险因素（P = 0.017，95%CI：1.277 - 4.155）。
HIPEC期间应用CP与肾毒性风险增加相关，且无长期生存获益。
