细胞减灭术联合腹腔热灌注化疗治疗恶性腹膜间皮瘤20例分析

  目的  探讨肿瘤细胞减灭术（cytoreductive surgery，CRS）联合腹腔热灌注化疗（hyperthermic intraperitoneal chemotherapy，HIPEC）治疗恶性腹膜间皮瘤（malignant peritoneal mesothelioma，MPM）的围手术期安全性及其疗效。  方法  回顾性分析2015年1月至2020年6月于航天中心医院接受治疗的20例MPM患者的临床病理资料，评价CRS+HIPEC治疗模式安全性，通过单因素及多因素统计分析研究影响患者生存的预后因素。  结果  20例患者中男性8例，女性12例，男女比例为:1:1.5。病理结果均为MPM，病理分型为上皮型。接受CRS+HIPEC治疗后总体1、2、3年生存率分别为73.9%、58.2%和43.6%，其中肿瘤细胞减灭程度（completeness of cytoreduction，CC）达到0/1的患者3年生存率为75%。单因素分析结果显示，性别（P=0.295），CA125异常（P=0.256），既往手术（P=0.460）以及静脉化疗（P=0.283）未见对总生存有显著影响。而年龄 > 60岁（P=0.037），CC-2/3（P=0.027），腹膜癌指数（peritoneal cancer index，PCI）≥20分（P=0.014）为预后不良的危险因素。  结论  MPM是一种罕见疾病，早期诊断困难，传统治疗预后差，静脉化疗无法有效改善预后。尽早行CRS+HIPEC综合治疗安全可靠，可以明显延长患者生存。 

Treatment of 20 cases of malignant peritoneal mesothelioma by cytoreductive surgery combined with hyperthermic perioperative chemotherapy

Objective:To explore the perioperative safety and efficacy of cytoreductive surgery(CRS)combined with hyperthermic intraperitoneal chemotherapy(HIPEC)for the treatment of malignant peritoneal mesothelioma(MPM).Methods:The clinical and survival data of 20 patients with MPM treated in Aerospace Center Hospital from January 2015 to Jun 2020 were analyzed retrospectively.The safety of the CRS+HIPEC was evaluated,and prognostic factors were determined by univariate and multivariate analyses.Results:There were 20 patients enrolled in this study,including 8 men and 12 women(sex ratio:1:1.5).In all cases,the pathology was MPM and they were classified to be of the epithelial type.After CRS+HIPEC,the 1-,2-,and 3-year overall survival rates were 73.9%,58.2%,and 43.6%,respectively,and the 3-year survival rate of patients with complete cytoreduction(CC-0/1)was 75%.Sex(P=0.295),abnormal CA125 levels(P=0.256),history of surgery(P=0.460),and intravenous chemotherapy(P=0.283)had no significant effect on overall survival.Age over 60 years(P=0.037),incomplete cytoreduction(CC-2/3)(P=0.027),and a peritoneal cancer index(PCI)≥20(P=0.014)were risk factors for poor prognosis.Conclusions:MPM is a rare disease that is difficult to diagnose early and has a poor prognosis after traditional treatment.Intravenous chemotherapy does not confer any survival benefit in this patient population.The comprehensive treatment strategy involving CRS combined with HIPEC should be used in experienced centers as it is safe,reliable,and can significantly prolong overall survival.