Zhang Ying, Zhao Xin, Gao Chao, Lin Lin-Yu, Li Yan
Department of Peritoneal Cancer Surgery, Beijing Shijitan Hospital, Capital Medical University, Beijing 100038, China.
World J Gastrointest Surg. 2023 Jun 27;15(6):1149-1158. doi: 10.4240/wjgs.v15.i6.1149.
Pseudomyxoma peritonei (PMP) is a rare peritoneal malignant tumor syndrome. Cytoreductive surgery combined with hyperthermic intraperitoneal chemotherapy is its standard treatment. However, there are few studies and insufficient evidence regarding systemic chemotherapy of advanced PMP. Regimens for colorectal cancer are often used clinically, but there is no uniform standard for late-stage treatment.
To determine if bevacizumab combined with cyclophosphamide and oxaliplatin (Bev+CTX+OXA) is effective for treatment of advanced PMP. The primary study endpoint was progression-free survival (PFS).
Retrospective analysis was conducted on the clinical data of patients with advanced PMP who received Bev+CTX+OXA regimen (bevacizumab 7.5 mg/kg ivgtt d1, oxaliplatin 130 mg/m ivgtt d1 and cyclophosphamide 500 mg/m ivgtt d1, q3w) in our center from December 2015 to December 2020. Objective response rate (ORR), disease control rate (DCR) and incidence of adverse events were evaluated. PFS was followed up. Kaplan-Meier method was used to draw survival curve, and log-rank test was used for comparison between groups. Multivariate Cox proportional hazards regression model was used to analyze the independent influencing factors of PFS.
A total of 32 patients were enrolled. After 2 cycles, the ORR and DCR were 3.1% and 93.7%, respectively. The median follow-up time was 7.5 mo. During the follow-up period, 14 patients (43.8%) had disease progression, and the median PFS was 8.9 mo. Stratified analysis showed that the PFS of patients with a preoperative increase in CA125 (8.9 2.1, = 0.022) and a completeness of cytoreduction score of 2-3 (8.9 5.0, = 0.043) was significantly longer than that of the control group. Multivariate analysis showed that a preoperative increase in CA125 was an independent prognostic factor for PFS (HR = 0.245, 95%CI: 0.066-0.904, = 0.035).
Our retrospective assessment confirmed that the Bev+CTX+OXA regimen is effective in second- or posterior-line treatment of advanced PMP and that adverse reactions can be tolerated. A preoperative increase in CA125 is an independent prognostic factor of PFS.
腹膜假黏液瘤（PMP）是一种罕见的腹膜恶性肿瘤综合征。细胞减灭术联合腹腔内热灌注化疗是其标准治疗方法。然而，关于晚期PMP全身化疗的研究较少且证据不足。临床上常采用结直肠癌的治疗方案，但晚期治疗尚无统一标准。
确定贝伐单抗联合环磷酰胺和奥沙利铂（Bev+CTX+OXA）治疗晚期PMP是否有效。主要研究终点为无进展生存期（PFS）。
回顾性分析2015年12月至2020年12月在本中心接受Bev+CTX+OXA方案（贝伐单抗7.5mg/kg静脉滴注d1，奥沙利铂130mg/m²静脉滴注d1，环磷酰胺500mg/m²静脉滴注d1，每3周重复）治疗的晚期PMP患者的临床资料。评估客观缓解率（ORR）、疾病控制率（DCR）和不良事件发生率。随访PFS。采用Kaplan-Meier法绘制生存曲线，采用log-rank检验进行组间比较。采用多因素Cox比例风险回归模型分析PFS的独立影响因素。
共纳入32例患者。2个周期后，ORR和DCR分别为3.1%和93.7%。中位随访时间为7.5个月。随访期间，14例患者（43.8%）疾病进展，中位PFS为8.9个月。分层分析显示，术前CA125升高（8.9±2.1，P=0.022）和细胞减灭术评分2-3分（8.9±5.0，P=0.043）的患者PFS明显长于对照组。多因素分析显示，术前CA125升高是PFS的独立预后因素（HR=0.245，95%CI：0.066-0.904，P=0.035）。
我们的回顾性评估证实，Bev+CTX+OXA方案在晚期PMP的二线或后线治疗中有效，且不良反应可耐受。术前CA125升高是PFS的独立预后因素。
