Department of Surgical Oncology, Tsinghua University Affiliated Beijing Tsinghua Changgung Hospital, Beijing, 102218, China; Department of Peritoneal Cancer Surgery, Beijing Shijitan Hospital, Capital Medical University, Beijing, 100038, China.
Department of Peritoneal Cancer Surgery, Beijing Shijitan Hospital, Capital Medical University, Beijing, 100038, China.
Eur J Surg Oncol. 2024 Nov;50(11):108692. doi: 10.1016/j.ejso.2024.108692. Epub 2024 Sep 14.
The comprehensive treatment strategy, mainly cytoreductive surgery (CRS) plus hyperthermic intraperitoneal chemotherapy (HIPEC), combined with systemic and intraperitoneal chemotherapy, is the standard treatment for malignant peritoneal mesothelioma (MPM), which can significantly prolong the survival of patients. The aim of this study is to investigate the clinical significance of postoperative normothermic intraperitoneal chemotherapy (NIPEC) in MPM patients.
Data of 152 MPM patients who underwent CRS + HIPEC and postoperative intravenous chemotherapy were retrospectively analyzed. Patients were divided into the Non-NIPEC group and the NIPEC group according to whether they received NIPEC after surgery. The baseline characteristics of the two groups were compared, and the survival outcome was analyzed in subgroups according to completeness of cytoreduction (CC) score. Multivariate survival analysis was used to determine the independent prognostic factors.
In CC 0-1 and CC 2-3 subgroups, there was no significant difference in baseline characteristics between Non-NIPEC and NIPEC groups. Survival analysis showed that for CC 0-1 patients, there was no significant difference in overall survival (OS) between Non-NIPEC and NIPEC groups (P = 0.503). However, for CC 2-3 patients, the median OS of the NIPEC group was significantly longer than that of the Non-NIPEC group (24.5 vs. 10.3 months, P = 0.005). Pathological type, preoperative thrombosis and postoperative NIPEC (HR = 0.423, 95%CI: 0.228-0.786, P = 0.006) were independent prognostic factors for CC 2-3 patients.
For MPM patients receiving CRS + HIPEC, postoperative intraperitoneal combined with intravenous chemotherapy may improve the survival of CC 2-3 patients, but CC 0-1 patients do not seem to derive the same benefit.
以细胞减灭术（CRS）加腹腔内热灌注化疗（HIPEC）为主的综合治疗策略，结合全身和腹腔内化疗，是恶性腹膜间皮瘤（MPM）的标准治疗方法，可显著延长患者的生存时间。本研究旨在探讨 MPM 患者术后常温腹腔内化疗（NIPEC）的临床意义。
回顾性分析 152 例接受 CRS+HIPEC 及术后静脉化疗的 MPM 患者资料。根据术后是否行 NIPEC 将患者分为非 NIPEC 组和 NIPEC 组。比较两组患者的基线特征，并根据细胞减灭术（CC）评分的完整性进行亚组生存分析。采用多因素生存分析确定独立预后因素。
在 CC 0-1 和 CC 2-3 亚组中，非 NIPEC 组和 NIPEC 组的基线特征无显著差异。生存分析显示，对于 CC 0-1 患者，非 NIPEC 组和 NIPEC 组的总生存期（OS）无显著差异（P=0.503）。然而，对于 CC 2-3 患者，NIPEC 组的中位 OS 明显长于非 NIPEC 组（24.5 个月比 10.3 个月，P=0.005）。病理类型、术前血栓形成和术后 NIPEC（HR=0.423，95%CI：0.228-0.786，P=0.006）是 CC 2-3 患者的独立预后因素。
对于接受 CRS+HIPEC 治疗的 MPM 患者，术后腹腔内联合静脉化疗可能改善 CC 2-3 患者的生存，但 CC 0-1 患者似乎未从中获益。
