十年单中心经验：细胞减灭术（CRS）和腹腔热灌注化疗（HIPEC）治疗原发性弥漫性恶性腹膜间皮瘤（DMPM）。

Ten-year single-center experience with treatment of primary diffuse malignant peritoneal mesothelioma (DMPM) by cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC).

机构信息

Department of General and Visceral Surgery, Hospital Barmherzige Brüder, Regensburg, Germany.

Tumor Center-Institute for Quality Management and Health Services Research, University of Regensburg, Regensburg, Germany.

出版信息

Langenbecks Arch Surg. 2022 Nov;407(7):3057-3067. doi: 10.1007/s00423-022-02594-6. Epub 2022 Jun 23.

DOI:10.1007/s00423-022-02594-6

PMID:35732846

Abstract

PURPOSE

This single-center study evaluated cytoreductive surgery (CRS) combined with hyperthermic intraperitoneal chemotherapy (HIPEC) for diffuse malignant peritoneal mesothelioma (DMPM).

METHODS

Prospectively collected data from a single institution data registry was retrospectively investigated. Eighty-four patients with primary malignant peritoneal mesothelioma underwent CRS and HIPEC with cisplatin and doxorubicin either for 60 min or 90 min of duration from 2011 to 2021. The primary endpoint was overall survival. The secondary endpoint was the evaluation of prognostic factors for overall survival. The tertiary endpoint was to assess the effect of neoadjuvant chemotherapy on survival.

RESULTS

The median follow-up was 5.0 years (95%-CI 4.6-5.5). The median age was 59.2 years (IQR: 47-66). Eighty-two patients (97.6%) had epithelioid tumors. The median peritoneal cancer index was 18.0 (IQR: 13-27). Sixty-six patients (78.6%) had complete or near-complete cytoreduction (CCR 0 or CCR 1). Seventy patients (83.3%) received HIPEC for 60 min and 14 patients (16.7%) received it for 90 min. Twenty-two patients (26.2%) had grade 3 to 4 complications. Acute kidney injury (AKI) stage I-III occurred in 30 (35.7%) patients. Three patients (3.6%) died perioperatively. The overall median survival was 38.4 months (95%-CI 23.6-54.3), and the 5-year survival rate was 42%. Survival was independently associated with age, female gender, and thrombocytosis. Preoperative chemotherapy did not emerge as an adverse prognostic factor.

CONCLUSION

In well-selected patients with DMPM, prolonged survival is achievable with CRS and HIPEC in specialized centers.

摘要

目的

本单中心研究评估了细胞减灭术（CRS）联合腹腔内热灌注化疗（HIPEC）治疗弥漫性恶性腹膜间皮瘤（DMPM）的效果。

方法

回顾性分析了 2011 年至 2021 年期间，在一家单中心数据登记处前瞻性收集的数据。84 例原发性恶性腹膜间皮瘤患者接受了 CRS 和 HIPEC 治疗，使用顺铂和多柔比星，持续时间分别为 60 分钟和 90 分钟。主要终点是总生存期。次要终点是评估总生存期的预后因素。 tertiary 终点是评估新辅助化疗对生存的影响。

结果

中位随访时间为 5.0 年（95%CI 4.6-5.5）。中位年龄为 59.2 岁（IQR：47-66）。82 例（97.6%）患者为上皮样肿瘤。腹膜癌指数中位数为 18.0（IQR：13-27）。66 例（78.6%）患者达到完全或接近完全肿瘤细胞减灭术（CCR 0 或 CCR 1）。70 例（83.3%）患者接受了 60 分钟 HIPEC 治疗，14 例（16.7%）患者接受了 90 分钟 HIPEC 治疗。22 例（26.2%）患者发生 3 级至 4 级并发症。30 例（35.7%）患者发生 AKI Ⅰ-Ⅲ期。3 例（3.6%）患者围手术期死亡。总中位生存期为 38.4 个月（95%CI 23.6-54.3），5 年生存率为 42%。生存与年龄、女性和血小板增多独立相关。术前化疗未成为不良预后因素。