Macrì Antonio, Accarpio Fabio, Arcoraci Vincenzo, Casella Francesco, De Cian Franco, De Iaco Pierandrea, Orsenigo Elena, Roviello Franco, Scambia Giovanni, Saladino Edoardo, Galati Marica
Department of Human Pathology, University of Messina, Via Consolare Valeria, 98125, Messina, Italy.
Cytoreductive Surgery and HIPEC Unit - Department of Surgery "Pietro Valdoni", University "Sapienza" of Rome, Rome, Italy.
Pleura Peritoneum. 2020 Dec 4;6(1):21-30. doi: 10.1515/pp-2020-0139. eCollection 2021 Mar.
The aim of this retrospective study is to assess the incidence of morbidity and mortality related to cytoreductive surgery (CRS) plus hyperthermic intraperitoneal chemotherapy (HIPEC) and to evaluate their predictors, in patients with peritoneal metastasis of ovarian origin.
A retrospective multicenter study was carried out investigating results from eight Italian institutions. A total of 276 patients met inclusion criteria. Predictors of morbidity and mortality were evaluated with univariate and multivariate analysis.
Overall morbidity was 71.4%, and severe complications occurred in 23.9% of the sample; 60-day mortality was 4.3%. According to univariate logistic regression models, grade 3-4 morbidity was related to Peritoneal Cancer Index (PCI) (OR 1.06; 95% CI 1.02-1.09; p<0.001), number of intraoperative blood transfusions (OR 1.21; 95% CI 1.10-1.34; p<0.001), Completeness of Cytoreduction (CC) score (OR 1.68; 95% CI 1.16-2.44; p=0.006) and number of anastomoses (OR 1.32; 95% CI 1.00-1.73; p=0.046). However, at the multivariate logistic regression analysis, only the number of intraoperative blood transfusions (OR 1.17; 95% CI 1.5-1.30; p=0.004) and PCI (OR 1.04; 95% CI 1.01-1.08; p=0.010) resulted as key predictors of severe morbidity. Furthermore, using multivariate logistic regression model, ECOG score (OR 2.45; 95% CI 1.21-4.93; p=0.012) and the number of severe complications (OR 2.16; 95% CI 1.03-4.52; p=0.042) were recorded as predictors of exitus within 60 days.
The combination of CRS and HIPEC for treating peritoneal metastasis of ovarian origin has acceptable morbidity and mortality and, therefore, it can be considered as an option in selected patients.
本回顾性研究旨在评估细胞减灭术（CRS）联合腹腔热灌注化疗（HIPEC）相关的发病率和死亡率，并评估其在卵巢源性腹膜转移患者中的预测因素。
开展一项回顾性多中心研究，调查来自八个意大利机构的结果。共有276例患者符合纳入标准。采用单因素和多因素分析评估发病率和死亡率的预测因素。
总体发病率为71.4%，23.9%的样本出现严重并发症；60天死亡率为4.3%。根据单因素逻辑回归模型，3-4级发病率与腹膜癌指数（PCI）（比值比1.06；95%置信区间1.02-1.09；p<0.001）、术中输血次数（比值比1.21；95%置信区间1.10-1.34；p<0.001）、细胞减灭术完整性（CC）评分（比值比1.68；95%置信区间1.16-2.44；p=0.006）和吻合口数量（比值比1.32；95%置信区间1.00-1.73；p=0.046）相关。然而，在多因素逻辑回归分析中，只有术中输血次数（比值比1.17；95%置信区间1.5-1.30；p=0.004）和PCI（比值比1.04；95%置信区间1.01-1.08；p=0.010）是严重发病率的关键预测因素。此外，使用多因素逻辑回归模型，东部肿瘤协作组（ECOG）评分（比值比2.45；95%置信区间1.21-4.93；p=0.012）和严重并发症数量（比值比2.16；95%置信区间1.03-4.52；p=0.042）被记录为60天内死亡的预测因素。
CRS联合HIPEC治疗卵巢源性腹膜转移的发病率和死亡率可接受，因此，在选定患者中可将其视为一种选择。
