Objective: To evaluate the safety and efficacy of cytoreductive surgery plus hyperthermic intraperitoneal chemotherapy (CRS+ HIPEC) in patients with peritoneal carcinomatosis from colorectal carcinoma (CRC PC). Methods: The clinical and follow-up data of 90 consecutive CRC PC patients underwent CRS+ HIPEC in Beijing Shijitan Hospital from January 2015 to June 2018 were collected. Kaplan-Meier method and parallel Log rank test were used for survival analysis. Cox regression model was used for univariate and multivariate analysis. Results: A total of 90 CRC PC patients underwent CRS+ HIPEC, the median age was 53 years (rage: 13 to 81 years), and 51 cases were male, while other 39 were female. The median overall survival (mOS) was 21.9 months (95%CI: 15.7, 28.1). The 1-, 2-, 3-, and 5-year survival rates were 77.8%, 48.6%, 21.1%, and 5.5%, respectively. The incidence rate of serious adverse event (SAE) was 8.9% (8/90). The mortality rate of perioperative period was 2.2% (2/90). Univariate analysis showed the age (P=0.040), primary tumor site (P=0.020), preoperative carbohydrate antigen 125 (CA125) level (P<0.001), peritoneal cancer index (PCI) (P<0.001), completeness of cytoreduction (CC) (P<0.001), ascites (P=0.012) and postoperative adjuvant chemotherapy (P<0.001) were significantly associated with the OS. Multivariate Cox-analysis identified preoperative CA125 level(P=0.033), CC of 0 to 1 (P=0.014), and adjuvant chemotherapy postoperative (P=0.002) were independent prognostic factor for OS. Conclusions: CRS+ HIPEC can improve survival for CRC PC patients with acceptable morbidity and mortality. Stringent patient selection and complete CRS are two key factors for better survival.
目的： 探讨肿瘤细胞减灭术(CRS)+腹腔热灌注化疗(HIPEC)治疗结直肠癌腹膜癌(CRC PC)的疗效和安全性。 方法： 收集2015年1月至2018年6月于首都医科大学附属北京世纪坛医院接受CRS+HIPEC综合诊治的CRC PC患者的临床资料。生存分析采用Kaplan-Meier法，并行Log rank检验，单因素和多因素分析采用Cox回归模型。 结果： 90例CRC PC患者接受CRS+HIPEC治疗，年龄13~81岁，中位年龄53岁，男51例，女39例。全组患者中位生存时间为21.9个月(95% CI为15.7~28.1个月)，1、2、3、5年生存率分别为77.8%、48.6%、21.1%和5.5%。严重不良事件发生率为8.9%(8/90)，围手术期死亡率为2.2%(2/90)。单因素分析显示，年龄(P＝0.040)、原发肿瘤部位(P＝0.020)、术前糖类抗原125(CA125)水平(P<0.001)、腹膜癌指数(P<0.001)、肿瘤细胞减灭程度(P<0.001)、腹水量(P＝0.012)、术后辅助化疗周期(P<0.001)与总生存有关。多因素分析显示，术前CA125水平(P＝0.033)、肿瘤细胞减灭完全(P＝0.014)、术后辅助化疗周期数(P＝0.002)为总生存独立预后影响因素。 结论： CRS+HIPEC可延长部分CRC PC患者的生存时间，严格患者筛选和彻底的CRS是该治疗策略成功的关键。.
Keywords: Colorectal neoplasms; Cytoreductive surgery; Hyperthermic intraperitoneal chemotherapy; Peritoneal carcinomatosis.