腹腔热灌注化疗在非根治性阑尾来源低级别腹膜假黏液瘤中的应用价值

史冠军; 夏奥; 安鲁彪; 翟喜超; 马瑞卿; 卢一艳; 庞少军; 蔡莺; 王冰; 陈峰; 许洪斌

doi:10.3971/j.issn.1000-8578.2020.20.0012

腹腔热灌注化疗在非根治性阑尾来源低级别腹膜假黏液瘤中的应用价值

Therapeutic Value of Hyperthermic Intraperitoneal Chemotherapy on Non-radical Appendiceal Low-grade Pseudomyxoma Peritonei

摘要

摘要:
目的探讨腹腔热灌注化疗(HIPEC)在非根治性阑尾来源低级别腹膜假黏液瘤(PMP)中的应用价值。
方法回顾性分析300例非根治性阑尾来源低级别PMP患者的临床资料，分析其预后影响因素及HIPEC对其治疗价值。
结果 237例接受术中HIPEC治疗的患者10年生存率显著高于未接受HIPEC治疗的患者(52% vs. 26%, P < 0.001);同时接受术中及术后HIPEC治疗的患者10年生存率显著高于单纯接受术中HIPEC治疗的患者(57% vs. 44%, P=0.004)。单因素分析显示HIPEC、根治程度、减瘤前PCI > 30、减瘤后PCI > 30、CA19-9异常为预后影响因素。多因素分析结果提示未接受术中HIPEC治疗以及CA125异常为预后不良的独立危险因素。
结论对于无法达到完全减瘤的阑尾来源低级别PMP患者，姑息性减瘤术联合HIPEC治疗仍可显著改善远期预后。

Abstract:
Objective To explore the application value of hyperthermic intraperitoneal chemotherapy(HIPEC) on non-radical appendiceal low-grade pseudomyxoma peritonei(PMP).
Methods We retrospectively analyzed the clinical data of 300 patients with non-radical appendiceal-origin low-grade PMP, and the prognostic factors and therapeutic value of HIPEC.
Results The 10-year overall survival(OS) of 237 cases treated with HIPEC was significantly higher than that without HIPEC (52% vs. 26%, P < 0.001); the 10-year OS of the patients treated with intra- and post-operative HIPEC was also significantly higher than that with intraoperative HIPEC (57% vs. 44%, P=0.004). Univariate analysis showed that HIPEC, radical degree, PCI > 30 before tumor reduction, PCI > 30 after tumor reduction and CA199 abnormality were prognostic factors. Multivariate analysis showed that without HIPEC and CA125 abnormality were independent risk factors for poor prognosis.
Conclusion For appendiceal low-grade PMP patients who cannot achieve complete cytoreduction, palliative maximal cytoreductive combined with HIPEC could significantly improve the long-term prognosis.

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