| 张 勇,沈志玲,李 衎,等.基于洛铂的三药腹腔热灌注化疗治疗结直肠癌/阑尾癌腹膜转移的安全性与疗效分析[J].肿瘤学杂志,2024,30(6):477-485. |
| 基于洛铂的三药腹腔热灌注化疗治疗结直肠癌/阑尾癌腹膜转移的安全性与疗效分析 |
| Safety and Efficacy of Triple-Drug Hyperthermic Intraperitoneal Chemotherapy Based on Lobaplatin in the Treatment of Patients with Peritoneal Metastasis from Appendiceal and Colorectal Cancer |
| 投稿时间：2023-12-15 |
| DOI：10.11735/j.issn.1671-170X.2024.06.B005 |
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| 中文关键词: 腹膜转移 结直肠肿瘤 阑尾肿瘤 腹腔热灌注化疗 洛铂 安全性 预后 |
| 英文关键词:peritoneal metastasis colorectal neoplasms appendiceal neoplasms hyperthermic intraperitoneal chemotherapy lobaplatin safety prognosis |
| 基金项目:中国癌症基金会北京希望马拉松专项基金（LC2020B25） |
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| 中文摘要: |
| 摘 要：［目的］ 探讨基于洛铂、奥沙利铂和雷替曲塞的三药腹腔热灌注化疗（hyperthermic intraperitoneal chemotherapy，HIPEC）方案治疗结直肠癌/阑尾癌腹膜转移患者的近期安全性与远期疗效。［方法］ 回顾性收集分析自2017年6月至2022年6月在中国医学科学院肿瘤医院和安阳市肿瘤医院行细胞减灭术（cytoreductive surgery，CRS）+HIPEC治疗的结直肠癌/阑尾癌腹膜转移患者的临床病理资料。共150例患者纳入研究，根据HIPEC化疗方案不同，将患者分为双药HIPEC组（n=78）与三药HIPEC组（n=72）。收集分析患者的临床病理特征、手术结果、化疗相关毒性指标及预后资料。［结果］ 三药HIPEC组与双药HIPEC组患者的基线临床病理资料相似，两组患者术后3～5级严重并发症发生率相似（27.8% vs 30.8%，P=0.688）。三药HIPEC组患者术后第5天平均血小板计数显著低于双药HIPEC组［（225.3±53.1）×109/L vs （289.2±72.3）×109/L，P=0.029）］。三药HIPEC组术后第3天血小板异常（13.9% vs 3.8%，P=0.029）和术后第5天谷丙转氨酶异常（20.8% vs 7.7%，P=0.020）的患者比例均显著高于双药HIPEC组。三药HIPEC组与双药HIPEC组患者的3年总生存率（48.5% vs 35.2%，P=0.298）和无病生存率（35.0% vs 21.1%，P=0.470）差异均无统计学意义。多因素Cox回归分析显示，高腹膜癌指数（HR=1.09，95%CI：1.03～1.14，P=0.005）、细胞减灭完整（completeness of cytoreduction，CC）程度评分2～3分（HR=1.93，95%CI：1.04～3.62，P=0.043）和3～5级术后严重并发症的发生（HR=2.50，95%CI：1.38～4.51，P=0.004）是结直肠癌/阑尾癌腹膜转移患者CRS+HIPEC治疗后总生存率的独立危险因素；高腹膜癌指数（HR=1.11，95%CI：1.03～1.16，P<0.001）与CC指数2～3分（HR=3.64，95%CI：1.22～5.36，P<0.001）是无病生存率的独立危险因素。［结论］ 基于洛铂的三药HIPEC方案治疗阑尾癌/结直肠癌腹膜转移安全可行，且有改善预后的趋势。虽然会对血小板和肝功能造成一定影响，但不会转化为相关并发症。 |
| 英文摘要: |
| Abstract： ［Objective］ To analyze the short-term safety and long-term efficacy of three-drug(Lobaplatin， Oxaliplatin and Raltitrexed) based hyperthermic intraperitoneal chemotherapy(HIPEC) in treatment of patients with peritoneal metastasis(PM) from appendiceal/olorectal cancer. ［Methods］ Clinicopathologic data of patients with PM of appendiceal/colorectal cancer treated with cytoreductive surgery(CRS) +HIPEC in Cancer Hospital of Chinese Academy of Medical Sciences and Anyang Cancer Hospital from June 2017 to June 2022 were retrospectively analyzed. A total of 150 patients were divided into double-drug HIPEC group(n=78) and triple-drug HIPEC group(n=72) based on different HIPEC chemotherapy regimens. The clinicopathological features， surgical results， chemotherapy-related toxicity indexes and prognosis of patients were collected and analyzed. ［Results］ There was no significant difference in clinicopathological data between triple-drug HIPEC group and double-drug HIPEC group(P>0.05). The incidence of grade 3～5 severe complications in triple-drug HIPEC group was not significantly different with that of the double-drug HIPEC group(27.8% vs 30.8%， P=0.688). The mean platelet count ［(225.3±53.1)×109/L vs(289.2±72.3)×109/L， P=0.029］ on the fifth day after surgery in the triple-drug HIPEC group was lower than that in the double-drug HIPEC group. The proportion of patients with abnormal platelet on day 3 after surgery(13.9% vs 3.8%， P=0.029) and abnormal alanine aminotransferase on day 5 after surgery(20.8% vs 7.7%， P=0.020) in triple-drug HIPEC group was higher than that in double-drug HIPEC group. There was no significant difference in 3-year overall survival(48.5% vs 35.2%， P=0.298) and disease-free survival(35.0% vs 21.1%， P=0.470) between two groups. Multivariate Cox prognostic regression analysis showed that high peritoneal carcinomatosis index(HR=1.09， 95%CI：1.03～1.14， P=0.005)， completeness of cytoreduction score 2～3(HR=1.93， 95%CI：1.04～3.62， P=0.043) and grade 3～5 postoperative complications(HR=2.50， 95%CI： 1.38～4.51， P=0.004) were independent risk factors for poor overall survival； while high peritoneal carcinomatosis index(HR=1.11， 95%CI： 1.03～1.16， P<0.001) and completeness of cytoreduction score 2～3(HR=3.64， 95%CI：1.22～5.36， P<0.001) were independent risk factors for poor disease-free survival. ［Conclusion］ The lobaplatin-based triple-drug HIPEC regimen is safe and effective for the treatment of peritoneal metastasis from appendiceal/colorectal cancer， with a tendency of prognosis improvement. |
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