腹腔热灌注化疗联合系统化疗治疗恶性腹水的疗效和安全性

李先敏; 袁伟; 陈勇; 刘天舒; 崔越宏

doi:10.12025/j.issn.1008-6358.2023.20231553

腹腔热灌注化疗联合系统化疗治疗恶性腹水的疗效和安全性

Efficacy and safety of hyperthermic intraperitoneal chemotherapy combined with systemic treatment in the management of malignant ascites

摘要

摘要:
目的评价腹腔热灌注化疗（hyperthermic intraperitoneal chemotherapy，HIPEC）联合系统化疗在实体肿瘤恶性腹水（malignant ascites，MA）中的疗效及安全性。
方法回顾性分析88例于2020年7月至2022年12月在复旦大学附属中山医院肿瘤内科接受HIEPC联合系统化疗MA患者的临床资料。比较MA治疗有效与无效患者的临床病理特征。采用Kaplan-Meier法分析胃癌与非胃癌患者，应用与未应用紫杉醇（paclitaxel，PTX）患者的MA控制时间。比较治疗前后外周血免疫细胞差异。
结果随访至2023年5月31日，HIPEC联合系统化疗对MA的总体控制率为72.73%（64/88），总体中位控制时间为5.82个月。控制组与未控制组患者血清白蛋白水平、全身治疗方案、灌注次数等差异无统计学意义。胃癌患者MA控制率高于非胃癌患者（82.69%vs 58.33%，P=0.023）。Kaplan-Meier结果显示，胃癌与非胃癌患者MA控制时间差异无统计学意义（7.50个月vs 5.29个月，P=0.354）；相较于5-氟尿嘧啶（5-fluorouracil，5-FU）和顺铂（cisplatin，DDP）等非PTX类药物，PTX可明显延长MA控制时间（6.44个月vs 2.73个月，P=0.024）。治疗后CD4⁺/CD8⁺T细胞比值升高（P=0.040）。治疗后，48.86%（43/88）患者出现短暂而轻微的腹胀、腹痛，自行缓解；另有4.55%（4/88）患者因消化系统不良反应中断治疗。
结论 HIPEC联合系统化疗为MA安全且有效的治疗手段，对胃癌MA近期疗效更佳；将PTX作为HIPEC的灌注药物，可延长MA的控制时间。

Abstract:
Objective To evaluate the clinical efficacy and safety of hyperthermic intraperitoneal chemotherapy (HIPEC) combined with systemic treatment in solid tumor with malignant ascites (MA).
Methods The clinical data of 88 patients with MA who received HIPEC combined with systemic treatment in Department of Medical Oncology, Zhongshan Hospital, Fudan University from July 2020 to December 2022 were retrospectively analyzed. The control rate of MA was analyzed, and the clinicopathological characteristics of patients with effective and noneffective MA treatment were compared. The Kaplan-Meier method was used to analyze the MA control time of patients with gastric cancer and non-gastric cancer, and patients who used and did not use paclitaxel (PTX). The differences in peripheral blood immune cells before and after treatment were compared.
Results Until May 31, 2023, the overall control rate of HIPEC combined with systemic chemotherapy for MA was 72.73% (64/88), and the median control time was 5.82 months. There was no difference in serum albumin level, systemic treatment regimen and perfusion times etc. between the effective group and the noneffective group. There were differences in the short-term efficacy of MA among patients with different primary tumor, and the control rate of gastric cancer was higher than that of non-gastric cancer (82.69% vs 58.33%, P=0.023). Kaplan-Meier analysis showed that there was no difference in ascites control time between gastric cancer and non-gastric cancer patients (7.50 months vs 5.29 months, P=0.354); compared to non-PTX medicine such as 5-fluorouracil (5-FU) and cisplatin (DDP), PTX significantly prolonged the control time of ascites (6.44 months vs 2.73 months, P=0.024). After treatment, CD4⁺T/CD8⁺T rate elevated. 48.86% (43/88) patients had mild abdominal distension and abdominal pain, which could be relieved in a short time after treatment; 4.55% (4/88) patients discontinued anti-tumor treatment because of digestive adverse effects.
Conclusions HIPEC combined with systemic chemotherapy is safe and effective for MA and has a better short-term efficacy for gastric cancer, and PTX as the perfusion agent for HIPEC can prolong the control time of MA.

HTML全文

参考文献(26)

施引文献

资源附件(0)