腹腔内热灌注化疗治疗复发性上皮性卵巢癌。
Hyperthermic intraperitoneal chemotherapy for recurrent epithelial ovarian cancer.
机构信息
Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan; Chang Gung University College of Medicine, Taoyuan, Taiwan; Gynecologic Cancer Research Center, Chang Gung Memorial Hospital, Taoyuan, Taiwan; Institute of Biomedical Engineering, International Intercollegiate Ph.D. Program, National Tsing Hua University, Hsinchu, Taiwan; Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital at Keelung, Keelung, Taiwan.
Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan; Chang Gung University College of Medicine, Taoyuan, Taiwan; Gynecologic Cancer Research Center, Chang Gung Memorial Hospital, Taoyuan, Taiwan.
出版信息
Biomed J. 2022 Oct;45(5):821-827. doi: 10.1016/j.bj.2021.10.003. Epub 2021 Oct 14.
BACKGROUND
To investigate outcomes and morbidity of patients undergoing secondary cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) in recurrent ovarian cancer.
MATERIALS AND METHODS
Between April 2014 and January 2019, a total of 51 recurrent ovarian cancer patients receiving secondary CRS and HIPEC were retrospectively reviewed.
RESULTS
Among the 51 patients, median peritoneal cancer index score was 13 (range 3-34), and completeness of cytoreduction (CC) score of 0/1 was achieved in 41 patients (78.8%). Regimen of HIPEC included cisplatin and paclitaxel in 39 (75%) cases. The median follow-up duration of survivors was 20.2 months. Sixteen (30.8%) patients remained free of recurrence after HIPEC. The median progression-free survival (PFS) and overall survival (OS) were 11.8 months and 34.5 months respectively. Multivariate analysis showed previous chemotherapy <2 lines (HR 0.24, 0.11-0.52; p = 0.001), chemotherapy-free interval ≥6 months (HR 0.19, 0.09-0.37; p < 0.001) and CA125 < 35 U/mL before HIPEC (HR 0.133, 0.021-0.0832; p = 0.031) were good prognostic factors for PFS. CC0/1 was not significant in multivariate analysis. The most common grade 3/4 toxicity was anemia (17.3%), pleural effusion (11.5%) and renal insufficiency (5.7%). Patients with age ≥50, peritoneal carcinomatosis index (PCI) ≥ 11, operation time ≥10 h and diaphragm surgery had significantly higher incidence of pleural effusion.
CONCLUSIONS
The current study showed adding HIPEC to secondary CRS might prolong PFS especially in patients with previous chemotherapy <2 lines, chemotherapy-free interval ≥6 months and CA125 < 35 U/mL before HIPEC.
背景
研究复发性卵巢癌患者接受二次细胞减灭术（CRS）和腹腔内热灌注化疗（HIPEC）的结果和发病率。
材料与方法
2014 年 4 月至 2019 年 1 月，回顾性分析了 51 例接受二次 CRS 和 HIPEC 的复发性卵巢癌患者。
结果
在 51 例患者中，中位腹膜癌指数（PCI）评分为 13 分（范围 3-34 分），41 例（78.8%）患者达到完全细胞减灭术（CC）评分 0/1。HIPEC 方案包括顺铂和紫杉醇 39 例（75%）。生存者的中位随访时间为 20.2 个月。HIPEC 后 16 例（30.8%）患者无复发。中位无进展生存期（PFS）和总生存期（OS）分别为 11.8 个月和 34.5 个月。多因素分析显示，HIPEC 前化疗线数<2 线（HR 0.24，0.11-0.52；p=0.001）、化疗无间隔时间≥6 个月（HR 0.19，0.09-0.37；p<0.001）和 HIPEC 前 CA125<35 U/mL（HR 0.133，0.021-0.0832；p=0.031）是 PFS 的良好预后因素。多因素分析中 CC0/1 无统计学意义。最常见的 3/4 级毒性为贫血（17.3%）、胸腔积液（11.5%）和肾功能不全（5.7%）。年龄≥50 岁、PCI≥11、手术时间≥10 小时和膈肌手术的患者胸腔积液发生率显著较高。
结论
本研究表明，在 HIPEC 辅助二次 CRS 后，特别是在 HIPEC 前化疗线数<2 线、化疗无间隔时间≥6 个月和 CA125<35 U/mL 的患者中，可能延长 PFS。
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