腹腔内热化疗在子宫内膜癌腹膜转移患者细胞减灭术后的应用。下一个前沿领域？

Intraperitoneal hyperthermic chemotherapy after cytoreduction in patients with peritoneal metastases from endometrial cancer. The next frontier?

机构信息

Hospital Clínico Universitario Virgen de la Arrixaca-Instituto Murciano de Investigación Biosanitaria (IMIB), Servicio de Cirugía General y del Aparato Digestivo, Spain.

Hospital de Sant Joan Despí Moisès Broggi, Servicio de Cirugía General y del Aparato Digestivo, Spain.

出版信息

Surg Oncol. 2020 Jun;33:19-23. doi: 10.1016/j.suronc.2019.12.002. Epub 2019 Dec 31.

DOI:10.1016/j.suronc.2019.12.002

PMID:32561085

Abstract

BACKGROUND

Endometrial cancer is the most common malignancy of the female genital tract. For cancers detected at an advanced stage or intraperitoneal relapse, the prognosis is poor. Optimal cytoreductive surgery (CRS) is the most accepted treatment; however, patients with advanced intraperitoneal disease might benefit from hyperthermic intraoperative peritoneal chemotherapy (HIPEC). The aim of this study was to analyze recurrence-free survival (RFS) after CRS and HIPEC in a large series of patients with peritoneal metastases from endometrial cancer.

METHODS

Patients with a diagnosis of endometrial cancer with primary or recurrent peritoneal dissemination were included. All patients underwent CRS plus HIPEC. Data were prospectively collected in the Spanish Group of Peritoneal Oncological Surgery (GECOP) database.

RESULTS

Forty-three patients with endometrial cancer and peritoneal metastasis were included. Fifteen patients (35%) were diagnosed with G3 endometrioid carcinomas and 28 (65%) with other non-endometroid histologies. A completeness of cytoreduction score of CC-0 was achieved in 41 patients (95%). RFS at 5 years was 23%, being factors related to worse RFS: treatment with preoperative chemotherapy (p = 0.027), resection of more than three peritoneal areas (p = 0.010), cytoreduction of the upper abdominal space (p = 0.023), HIPEC treatment with paclitaxel (p = 0.013), and the presence of metastatic lymph nodes (p = 0.029).

CONCLUSIONS

Better RFS rates after CRS and HIPEC were observed for patients with the following characteristics: cytoreductive surgery without preoperative chemotherapy, complete surgery performed with limited surgical maneuvers, treated with cisplatin, and no lymph node metastases.

SYNOPSIS

Endometrial cancer has a poor prognosis when diagnosed at advance stage. Patients with intraperitoneal metastases from endometrial cancer may benefit from CRS plus HIPEC with improvement in the recurrence-free survival results.

摘要

背景

子宫内膜癌是女性生殖道最常见的恶性肿瘤。对于晚期或腹腔内复发的癌症，预后较差。最佳的细胞减灭术（CRS）是最被接受的治疗方法；然而，患有晚期腹腔内疾病的患者可能受益于术中高热腹膜化疗（HIPEC）。本研究的目的是分析大量子宫内膜癌腹膜转移患者接受 CRS 和 HIPEC 后的无复发生存（RFS）。

方法

纳入诊断为原发性或复发性腹膜播散的子宫内膜癌患者。所有患者均接受 CRS 加 HIPEC。数据前瞻性地收集于西班牙腹膜肿瘤外科组（GECOP）数据库中。

结果

共纳入 43 例子宫内膜癌合并腹膜转移患者。15 例（35%）患者诊断为 G3 子宫内膜样癌，28 例（65%）为其他非子宫内膜样组织学类型。41 例（95%）患者达到完全细胞减灭评分 CC-0。5 年 RFS 为 23%，与较差的 RFS 相关的因素包括：术前化疗（p=0.027）、切除超过三个腹膜区域（p=0.010）、上腹部空间的细胞减灭（p=0.023）、紫杉醇 HIPEC 治疗（p=0.013）和存在转移性淋巴结（p=0.029）。