细胞减灭术加腹腔热灌注化疗治疗结直肠癌腹膜转移癌病例对照研究*

摘要

目的：分析细胞减灭术（CRS）加术中腹腔热灌注化疗术（HIPEC）对结直肠癌腹膜转移癌的疗效及安全性。方法：课题设计为回顾性病例对照研究，收集结直肠癌腹膜转移癌（CRC PC）患者资料，按临床病理参数匹配原则，分为CRS组（CRS+术后全身化疗）29例，HIPEC组（CRS+HIPEC+术后全身化疗）33例。分析两组的总体生存期（OS）及严重不良事件（SAE）。结果：两组患者临床病理学特征均衡可比，术中PCI评分及器官/腹膜切除情况相似。两组中位随访时间分别为41.9个月（6.5～110.0个月）和32.0个月（10.5～95.9个月），OS分别为8.5个月（95%CI：4.9～12.1个月）和14.5个月（95%CI：11.9～17.1月）（P=0.007）。术后30天内CRS组3例发生SAE，HIPEC组9例（P=0.126）。多因素分析显示，HIPEC、CC 0～1分、术后化疗周期≥6个周期为改善生存的独立预后因素。结论：CRS+HIPEC可改善CRCPC患者生存期，SAE无显著增加，安全性可接受。%Objective:To evaluate the efficacy and safety of cytoreductive surgery (CRS) in conjunction with hyperthermic intra-peritoneal chemotherapy (HIPEC) for treating patients with peritoneal carcinomatosis (PC) from colorectal cancer (CRC). Methods:A total of 62 CRC patients with complication of PC were divided into the CRS group, namely, Group One (n=29, CRS and systemic adju-vant chemotherapy) and the CRS+HIPEC group, namely, Group Two (n=33, CRS+HIPEC). The primary end point of the study was overall survival (OS) and the secondary end point was serious adverse events (SAE). Results:Patients' clinicopathologic characteris-tics, peritoneal carcinomatosis index, and completeness of cytoreduction therapy were well balanced and comparable between the two groups. The median follow-up was 41.9 mo (6.5 mo to 110.0 mo) in Group One and 32.0 mo (10.5 mo to 95.9 mo) in Group Two. The median OS was 8.5 mo (95%CI:4.9 mo to 12.1 mo) in Group One and 14.5 mo (95%CI:11.9 mo to 17.1 mo) in Group Two (P=0.007). Within 30 days after the surgery, SAE occurred in 3 of the 29 patients in Group One, and 9 of the 33 patients in Group Two (P=0.126). Multivariate analysis revealed that HIPEC, CC0-1 score, and chemotherapy over six cycles were the independent factors for OS improvement. Conclusion:The CRS+HIPEC method improves the OS of patients with PC from CRC, suggesting an acceptable safety.