Cao Baoshan, Liu Yan'e, Yin Wencheng, Li Qian, Liang Li
Department of Medical Oncology and Radiation Sickness, Peking University Third Hospital, Beijing 100191, China.
Zhongguo Fei Ai Za Zhi. 2019 Mar 20;22(3):143-150. doi: 10.3779/j.issn.1009-3419.2019.03.04.
Peritoneal carcinomatosis is a rare clinical event in lung cancer and the prognosis is very poor. There are limited data on what factors predict peritoneal progression and affect the outcome. The aim of this study is to investigate investigate the factors associated with peritoneal carcinomatosis.
The patients with non-small cell lung cancer (NSCLC) from the Department of Medical Oncology and Radiation Sickness, Peking University Third Hospital were eligible for retrospective analysis between August 2010 and August 2018. Clinical factors such as age, gender, histology, pleural effusion and gene mutations with epidermal growth factor receptor/anaplastic lymphoma kinase/ROS proto-oncogene 1 receptor tyrosine kinase (EGFR/ALK/ROS1) were analyzed. Overall survival (OS) was calculated by the Kaplan-Meier method.
1.44% (12/836) patients in this study developed peritoneal carcinomatosis and 12 patients with adenocarcinoma had metachronous NSCLC diagnosis and PC. Malignant pleural effusion rates at baseline and at PC diagnosis were separately 50% (6/12) and 100.0% (12/12). Among the 12 patients, 9 patients harbored EGFR/ALK/ROS1 mutation. The outcome of patients with EGFR/ALK/ROS1 mutation was significantly better than that of patients without EGFR/ALK/ROS1 mutation, the mOS1 and mOS2 were separately 26.0 months and 6.0 months versus 10.0 months and 1.5 months (P<0.05). The mOS2 of patients with aggressive treatment after PC diagnosis was 6.0 months, significantly better than 1.0 month of patients with best supportive care (P<0.05). The mOS2 of the patients with angiogenesis inhibitors based-treatment after PC diagnosis was 8.5 months, significantly longer than that of patients with other treatments (P<0.05).
Adenocarcinoma and malignant pleural effusion are highly associated with peritoneal carcinomatosis in patients with advanced NSCLC. Aggressive treatment for lung cancer with PC is encouraged when possible. More patients with PC may benefit from the treatment strategies with angiogenesis inhibitors. Further prospective trials are urgently needed.
腹膜癌病在肺癌中是一种罕见的临床事件，预后很差。关于哪些因素可预测腹膜进展并影响预后的数据有限。本研究的目的是调查与腹膜癌病相关的因素。
对2010年8月至2018年8月期间北京大学第三医院肿瘤内科和放射病科的非小细胞肺癌（NSCLC）患者进行回顾性分析。分析了年龄、性别、组织学、胸腔积液以及表皮生长因子受体/间变性淋巴瘤激酶/ROS原癌基因1受体酪氨酸激酶（EGFR/ALK/ROS1）等基因突变等临床因素。总生存期（OS）采用Kaplan-Meier法计算。
本研究中1.44%（12/836）的患者发生了腹膜癌病，12例腺癌患者为异时性NSCLC诊断并伴有腹膜癌病。基线时和腹膜癌病诊断时的恶性胸腔积液发生率分别为50%（6/12）和100.0%（12/12）。在这12例患者中，9例存在EGFR/ALK/ROS1突变。EGFR/ALK/ROS1突变患者的预后明显优于无EGFR/ALK/ROS1突变的患者，mOS1和mOS2分别为26.0个月和6.0个月，而无突变患者分别为10.0个月和1.5个月（P<0.05）。腹膜癌病诊断后接受积极治疗的患者mOS2为6.0个月，明显优于接受最佳支持治疗患者的1.0个月（P<0.05）。腹膜癌病诊断后接受抗血管生成抑制剂治疗的患者mOS2为8.5个月，明显长于接受其他治疗的患者（P<0.05）。
腺癌和恶性胸腔积液与晚期NSCLC患者的腹膜癌病高度相关。鼓励对伴有腹膜癌病的肺癌患者尽可能进行积极治疗。更多伴有腹膜癌病的患者可能从抗血管生成抑制剂治疗策略中获益。迫切需要进一步的前瞻性试验。
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