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JAMA Surg:腹腔内温热化疗可提高腹膜假黏液瘤患者术后生存率

2021-02-02 MedSci原创 MedSci原创

对于腹膜假黏液瘤患者,在肿瘤细胞减灭术后进行腹腔内温热化疗可显著提高患者生存率

腹膜假黏液瘤(PMP)是发生在腹腔壁层、大网膜及肠壁浆膜面的低度恶性黏液性肿瘤,发病率较低,主要表现为腹围进行性增加伴腹胀,手术治疗为主,很少转移,但难以治愈、易复发,复发者预后不佳。腹腔内温热化疗(HIPEC)在控制胃癌术后腹腔内游离癌细胞播散方面有一定效果。近日研究人员考察了HIPEC对腹膜假性粘液瘤患者预后的影响。
 
研究分析了PSOGI队列数据,包括1924例阑尾黏液囊肿性PMP患者,患者在肿瘤细胞减灭术(CRS)基础上,随机接受HIPEC治疗或对照, HIPEC组治疗方案包括奥沙利铂-氟尿嘧啶-亚叶酸、顺铂-丝裂霉素、丝裂霉素-奥沙利铂。研究的主要终点包括总生存率、严重并发症、二次手术以及30天和90天死亡率。
 
1924名患者参与研究,其中男性占51.8%,平均年龄56岁,376名患者仅接受CRS治疗,1548名患者接受CRS-HIPEC联合治疗。仅接受CRS治疗患者的年龄较大(平均年龄:60 vs 54岁),淋巴结受累较少(14例[3.7%] vs 119例[7.7%]),先前接受过术前全身化疗的比例较高(198例[52.7%]vs 529例[34.2%]),肿瘤组织学分类高度的比例较高(179 例[47.6%]vs492 例[31.8%])。除丝裂霉素治疗方案外,HIPEC不会增加手术风险,但术后并发症风险更高(HR=1.99)。在所有亚群中,HIPEC治疗后的总体存活率显著提高(校正危险比[HRs],0.60-0.68)。CRS-HIPEC组5年加权总生存率分别为57.8%,而CRS单独治疗组为46.2%(加权HR:0.65),其中HIPEC方案采用奥沙利铂-氟尿嘧啶-亚叶酸(HR:0.42)和顺铂-丝裂霉素方案(HR:0.57)的效果最为显著。
 
研究认为,对于腹膜假黏液瘤患者,在肿瘤细胞减灭术后进行腹腔内温热化疗可显著提高患者生存率
 
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  2. [GetPortalCommentsPageByObjectIdResponse(id=2034603, encodeId=2bd620346039b, content=<a href='/topic/show?id=51b38558ef1' target=_blank style='color:#2F92EE;'>#腹腔内#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=82, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=85587, encryptionId=51b38558ef1, topicName=腹腔内)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=a885259, createdName=yourmama, createdTime=Mon Aug 16 09:10:33 CST 2021, time=2021-08-16, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1985536, encodeId=421419855361e, content=<a href='/topic/show?id=1cc485646dc' target=_blank style='color:#2F92EE;'>#腹膜假黏液瘤#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=81, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=85646, encryptionId=1cc485646dc, topicName=腹膜假黏液瘤)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=82ba2500166, createdName=ms1467340776200723, createdTime=Sun Oct 17 00:10:33 CST 2021, time=2021-10-17, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1933188, encodeId=b1ae193318843, content=<a href='/topic/show?id=4c371032459b' target=_blank style='color:#2F92EE;'>#黏液瘤#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=97, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=103245, encryptionId=4c371032459b, topicName=黏液瘤)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=ed25376, createdName=gdsun, createdTime=Fri Jun 18 02:10:33 CST 2021, time=2021-06-18, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1256810, encodeId=1319125681071, content=<a href='/topic/show?id=43706900963' target=_blank style='color:#2F92EE;'>#生存率#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=0, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=69009, encryptionId=43706900963, topicName=生存率)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=6a6043, createdName=guoyibin, createdTime=Thu Feb 04 10:10:33 CST 2021, time=2021-02-04, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1623858, encodeId=f113162385853, content=<a href='/topic/show?id=16ba8564526' target=_blank style='color:#2F92EE;'>#腹膜#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=71, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=85645, encryptionId=16ba8564526, topicName=腹膜)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=93e220615097, createdName=xuyong530, createdTime=Thu Feb 04 10:10:33 CST 2021, time=2021-02-04, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1036431, encodeId=ee78103643153, content=顶刊就是顶刊,谢谢梅斯带来这么高水平的研究报道,我们科里同事经常看梅斯,分享梅斯上的信息, beContent=null, objectType=article, channel=null, level=null, likeNumber=129, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=f0620, createdName=旺医, createdTime=Tue Feb 02 22:10:33 CST 2021, time=2021-02-02, status=1, ipAttribution=)]
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    2021-06-18 gdsun
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    2021-02-04 guoyibin
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    2021-02-04 xuyong530
  6. [GetPortalCommentsPageByObjectIdResponse(id=2034603, encodeId=2bd620346039b, content=<a href='/topic/show?id=51b38558ef1' target=_blank style='color:#2F92EE;'>#腹腔内#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=82, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=85587, encryptionId=51b38558ef1, topicName=腹腔内)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=a885259, createdName=yourmama, createdTime=Mon Aug 16 09:10:33 CST 2021, time=2021-08-16, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1985536, encodeId=421419855361e, content=<a href='/topic/show?id=1cc485646dc' target=_blank style='color:#2F92EE;'>#腹膜假黏液瘤#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=81, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=85646, encryptionId=1cc485646dc, topicName=腹膜假黏液瘤)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=82ba2500166, createdName=ms1467340776200723, createdTime=Sun Oct 17 00:10:33 CST 2021, time=2021-10-17, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1933188, encodeId=b1ae193318843, content=<a href='/topic/show?id=4c371032459b' target=_blank style='color:#2F92EE;'>#黏液瘤#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=97, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=103245, encryptionId=4c371032459b, topicName=黏液瘤)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=ed25376, createdName=gdsun, createdTime=Fri Jun 18 02:10:33 CST 2021, time=2021-06-18, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1256810, encodeId=1319125681071, content=<a href='/topic/show?id=43706900963' target=_blank style='color:#2F92EE;'>#生存率#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=0, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=69009, encryptionId=43706900963, topicName=生存率)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=6a6043, createdName=guoyibin, createdTime=Thu Feb 04 10:10:33 CST 2021, time=2021-02-04, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1623858, encodeId=f113162385853, content=<a href='/topic/show?id=16ba8564526' target=_blank style='color:#2F92EE;'>#腹膜#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=71, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=85645, encryptionId=16ba8564526, topicName=腹膜)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=93e220615097, createdName=xuyong530, createdTime=Thu Feb 04 10:10:33 CST 2021, time=2021-02-04, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1036431, encodeId=ee78103643153, content=顶刊就是顶刊,谢谢梅斯带来这么高水平的研究报道,我们科里同事经常看梅斯,分享梅斯上的信息, beContent=null, objectType=article, channel=null, level=null, likeNumber=129, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=f0620, createdName=旺医, createdTime=Tue Feb 02 22:10:33 CST 2021, time=2021-02-02, status=1, ipAttribution=)]
    2021-02-02 旺医

    顶刊就是顶刊,谢谢梅斯带来这么高水平的研究报道,我们科里同事经常看梅斯,分享梅斯上的信息

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