| 基于真实世界数据的腹膜假黏液瘤诊治现状分析 |
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| 引用本文： | 张颖,李鑫宝,林育林,马茹,徐大钊,赵鑫,闫风彩,李雁. 基于真实世界数据的腹膜假黏液瘤诊治现状分析[J]. 中国肿瘤临床, 2022, 49(5): 217-223. DOI: 10.12354/j.issn.1000-8179.2022.20211037 |
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| 作者姓名： | 张颖 李鑫宝 林育林 马茹 徐大钊 赵鑫 闫风彩 李雁 |
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| 作者单位： | 1.首都医科大学附属北京世纪坛医院腹膜肿瘤外科（北京市100038） |
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| 基金项目： | 北京市优秀人才培养资助集体项目（编号：2017400003235J007）资助~~； |
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| 摘 要： | 目的 基于真实世界数据分析腹膜假黏液瘤患者的诊治现状、自然病程及预后因素。 方法 回顾性分析2009年2月至2020年7月在首都医科大学附属北京世纪坛医院就诊的具有完整自然病程的腹膜假黏液瘤患者的相关资料，包括临床病理特征、非规范化治疗情况（误诊时间、误治时间、既往抗肿瘤治疗情况）、肿瘤细胞减灭术+腹腔热灌注化疗（cytoreductive surgery+hyperthermic intraperitoneal chemotherapy，CRS+HIPEC）治疗情况[手术时间、术中输血情况、腹膜癌指数（peritoneal cancer index，PCI）评分、细胞减灭程度（completeness of cytoreduction，CC）评分、脏器切除数量、腹膜切除区域数量、严重不良事件（serious adverse event，SAE）等]、随访生存时间，随访终点为患者死亡。采用Kaplan -Meier法绘制生存曲线，组间比较采用Log-rank检验。影响5年生存的预后因素采用Cox比例风险回归模型进行单因素和多因素分析。 结果 共纳入94例患者，其中男性57例（60.6%），女性37例（39.4%）， 中位年龄54（24～76）岁，既往抗肿瘤治疗者59例（62.8%），中位误诊时间0.8（0～62.5）个月，中位误治时间15.3（0～214.8）个月。所有患者均行CRS+HIPEC治疗，中位手术时间10.1（4.8～16.5）h，中位脏器切除数2（0～8）个，中位腹膜切除区域数5（0～9）个，中位PCI评分32（3～39）分，CC评分2～3分者达80.9%（76/94），SAE发生率35.1%（33/94）。94例患者中位总生存期30.8（2.4～218.4）个月，1、2、3、5年生存率分别为96.8%、63.8%、44.7%和23.4%。分层分析显示，既往腹腔化疗（46.5 个月vs. 26.3个月）、PSS 1～3分（39.0个月 vs. 21.9个月）、低/高级别病理类型（41.5/40.9 个月vs. 20.1个月）、KPS≥80分（41.5 个月vs. 23.9个月）、无淋巴结转移（35.5 个月vs. 17.1个月）、Ki-67<50%（46.4 个月vs. 20.8个月）的患者中位生存时间延长（P<0.05）。5年生存预后分析中，单因素分析显示以下5个因素与5年生存率有关:PSS评分（P=0.021）、既往腹腔化疗（P=0.008）、病理类型（P=0.004）、淋巴结转移（P=0.008）和Ki-67表达程度（P=0.003）。多因素分析显示出以下3个影响5年生存的独立预后因素:既往腹腔化疗（HR=0.458，95%CI:0.253～0.827，P=0.010）、淋巴结转移（HR=2.879，95%CI:1.345～6.163，P=0.006）、Ki-67≥50%（HR=2.502，95%CI:1.418～4.417，P=0.002）。 结论 PMP非规范化治疗现象较普遍，误治时间长，淋巴结转移及Ki-67高表达是独立不良预后因素，CRS+HIPEC术前腹腔灌注化疗可能为PMP的治疗提供新的方向。
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| 关 键 词： | 肿瘤细胞减灭术 腹腔热灌注化疗 腹膜假黏液瘤 真实世界研究 自然病程 |
| 收稿时间： | 2021-09-15 |
Analysis of diagnosis and treatment status of pseudomyxoma peritonei based on real-world data |
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| Affiliation: | 1.Department of Peritoneal Cancer Surgery, Beijing Shijitan Hospital, Capital Medical University, Beijing 100038, China2.Department of Oncology, Daxing Teaching Hospital of Capital University of Medical Sciences, Beijing 102600, China3.Department of Pathology, Beijing Shijitan Hospital, Capital Medical University, Beijing 100038, China |
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| Abstract: | Objective To analyze diagnosis and treatment status, natural history, and prognostic factors of patients with pseudomyxoma peritonei (PMP) based on real-world data. Methods Real-world data of patients with PMP with a complete natural history, including clinicopathological characteristics, non-standardized treatment (time of misdiagnosis, time of mistreatment, previous anti-tumor treatment), cytoreductive surgery + hyperthermic intraperitoneal chemotherapy (CRS+HIPEC) treatment [operation time, intraoperative blood transfusion, peritoneal cancer index (PCI) score, completeness of cytoreduction (CC) score, number of organs removed, number of peritoneal resection areas, serious adverse events (SAEs)], and follow-up until patient death, were retrospectively analyzed at Beijing Shijitan Hospital, Capital Medical University, from February 2009 to July 2020. The Kaplan-Meier method was used to draw survival curves, and the Log-rank test was used to compare between groups. Prognostic factors affecting survival were analyzed using univariate and multivariate analyses with a Cox proportional hazards regression model. Results : Overall, 94 patients were included, among whom 57 (60.6%) were male and 37(39.4%) were female; the median age of the patients was 54 (24–76) years. Fifty-nine (62.8%) patients previously received antitumor therapy. The median misdiagnosis time was 0.8 (0–62.5) months, and the median time of mistreatment was 15.3 (0–214.8) months. All patients received CRS+HIPEC treatment. The median operation time was 10.1 (4.8–16.5) hours, the mean number of organ resection was 2 (0–8), and the number of median peritonectomy was 5 (0–9). The PCI score was 32 (3–39) points, the CC score was 2–3 in 80.9% (76/94) of patients, and the SAE incidence rate was 35.1% (33/94). The median overall survival of 94 patients was 30.8 (2.4–218.4) months, and the 1-, 2-, 3-, and 5-year survival rates were 96.8%, 63.8%, 44.7%, and 23.4%, respectively. Stratified analysis showed that the median survival time of patients with previous intraperitoneal chemotherapy (46.5 months vs. 26.3 months), PSS 1–3 points (39.0 months vs. 21.9 months), low-/high-grade pathology (41.5/40.9 months vs. 20.1 months), KPS ≥80 (41.5 months vs. 23.9 months), no lymph node metastasis (35.5 months vs. 17.1 months), or Ki-67<50% (46.4 months vs. 20.8 months) was prolonged (P<0.05). Univariate analysis showed that the following five factors were related to 5-year survival rates: PSS score (P=0.021), previous intraperitoneal chemotherapy (P=0.008), pathological type (P=0.004), lymph node metastasis (P=0.008), and Ki-67 expression (P=0.003). Multivariate analysis revealed that the following three independent prognostic factors affected 5-year survival rates: previous intraperitoneal chemotherapy (HR=0.458, 95%CI: 0.253–0.827, P=0.010), lymph node metastasis (HR=2.879, 95%CI: 1.345–6.163, P=0.006), and Ki-67≥50% (HR=2.502, 95%CI: 1.418–4.417, P=0.002). Conclusions : Non-standardized treatment of PMP is common and long-standing in the real world. However, preoperative intraperitoneal infusion chemotherapy may provide a new treatment direction for PMP. |
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