Department of Peritoneal Cancer Surgery, Beijing Shijitan Hospital, Capital Medical University, Beijing, China.
Department of Surgical Oncology, Beijing Tsinghua Changgung Hospital, Tsinghua University, Beijing, China.
Ann Surg Oncol. 2024 Feb;31(2):1058-1068. doi: 10.1245/s10434-023-14470-8. Epub 2023 Oct 22.
We aimed to evaluate the safety and efficacy of hyperthermic intraoperative thoraco-abdominal chemotherapy (HITAC) and cytoreductive surgery (CRS) for peritoneal carcinomatosis (PC) patients who underwent diaphragm resection.
PC patients who underwent CRS with diaphragm resection were selected from a prospectively established database and were divided into hyperthermic intraperitoneal chemotherapy (HIPEC) and HITAC groups. The clinicopathological characteristics, treatment-related variables, perioperative adverse events (AEs), and survival outcomes were compared between the two groups.
Of 1168 CRS + HIPEC/HITACs, 102 patients were enrolled-61 HITAC patients and 41 HIPEC patients. In the HITAC and HIPEC groups, the incidence of grade III-V AEs was 29.5% versus 34.1% (p = 0.621). The pleural progression rates were 13.2 versus 18.9% (p = 0.462) and the median overall survival (OS) was 50.5 versus 52.7 months (p = 0.958). Median time to progression (TTP) in thoracic disease was not reached. There was no significant difference in perioperative AEs, TTP, and OS for total patients and the completeness of cytoreduction (CC) score subgroups (p > 0.05). Age ≥ 60 years (hazard ratio [HR] 4.162, p = 0.026) was an independent risk factor influencing pleural progression, and primary malignant peritoneal mesothelioma (MPM; HR 2.749, p = 0.016) and the presence of two or more serious AEs (SAEs; HR 7.294, p = 0.001) were independent risk factors influencing OS.
HITAC can be performed in carefully selected PC patients who underwent diaphragm resection, with no worsening of the safety profile and a possible benefit for pleural progression. In those patients, age ≥ 60 years is associated with a shorter TTP of thoracic disease, while primary MPM and two or more perioperative SAEs are associated with worse OS.
我们旨在评估高热腹腔内化疗（HITAC）联合细胞减灭术（CRS）治疗接受膈肌切除术的腹膜癌患者的安全性和疗效。
从一个前瞻性建立的数据库中选择接受 CRS 联合膈肌切除术的腹膜癌患者，并将其分为腹腔内热灌注化疗（HIPEC）组和 HITAC 组。比较两组患者的临床病理特征、治疗相关变量、围手术期不良事件（AEs）和生存结局。
在 1168 例 CRS+HIPEC/HITAC 中，纳入了 102 例患者，包括 61 例 HITAC 患者和 41 例 HIPEC 患者。在 HITAC 和 HIPEC 组中，III-V 级 AEs 的发生率分别为 29.5%和 34.1%（p=0.621）。胸腔进展率分别为 13.2%和 18.9%（p=0.462），中位总生存期（OS）分别为 50.5 个月和 52.7 个月（p=0.958）。胸部疾病的中位无进展生存期（TTP）尚未达到。在总患者和完全减瘤（CC）评分亚组中，围手术期 AEs、TTP 和 OS 无显著差异（p>0.05）。年龄≥60 岁（危险比[HR] 4.162，p=0.026）是影响胸腔进展的独立危险因素，而原发性恶性腹膜间皮瘤（MPM；HR 2.749，p=0.016）和存在 2 个或更多严重 AEs（SAEs；HR 7.294，p=0.001）是影响 OS 的独立危险因素。
HITAC 可用于仔细选择接受膈肌切除术的腹膜癌患者，且不会增加安全性，同时可能对胸腔进展有益。在这些患者中，年龄≥60 岁与胸腔疾病的 TTP 更短相关，而原发性 MPM 和 2 个或更多围手术期 SAE 与更差的 OS 相关。
