肿瘤细胞减灭术联合腹腔热灌注化疗治疗结直肠癌腹膜转移疗效预后因素分析

发布时间：2017-12-26 18:26

本文关键词：肿瘤细胞减灭术联合腹腔热灌注化疗治疗结直肠癌腹膜转移疗效预后因素分析　出处：《浙江大学》2017年硕士论文　论文类型：学位论文

【摘要】：背景结直肠癌腹膜转移,在过去往往被认为是疾病的终末期,预后通常不佳,仅仅采取姑息性治疗手段联合最佳支持治疗让患者度过生命的最后阶段。但是近年来,有学者提出,腹膜转移癌可以认为是一种在腹腔内的局部的肿瘤而非全身系统性的转移,理由是有观察到,部分病人,即使已经发生了腹膜转移,但是在很长的一段时间内,肿瘤一直局限在腹腔内而并没有发生其他部位远处转移。目前,肿瘤细胞减灭术联合腹腔热灌注化疗(CRS+HIPEC)已经成功应用在了结直肠癌腹膜转移中,并显示了良好的效果。但是患者的预后和哪些指标相关目前仍然不是十分清楚。研究目的通过对采用肿瘤细胞减灭术联合腹腔热灌注化疗治疗的晚期结直肠癌腹膜转移患者的临床特征、肿瘤病理、手术资料和生化指标的分析,以及患者术后随访资料的总结,挑选出疗效预后因素指标,为术前患者的选择和风险评估以及后续治疗决策提供帮助。研究方法回顾性分析2014年1月至2016年3月在浙江大学医学院附属第二医院肿瘤外科行肿瘤细胞减灭术联合腹腔热灌注化疗的晚期结直肠癌腹膜转移的42例患者的临床特征、肿瘤病理、手术资料、生化指标以及术后随访资料。研究结果在42例结直肠癌腹膜转移的患者中,男性17例,女性25例;年龄25-81岁,中位年龄59岁;随访4-35月,中位随访时间19.5月,失访2例,随访率95.24%。全部病例死亡11例,存活31例。18项临床资料分类量化赋值后,以总体生存率为反映预后指标,Kaplan-Meier生存分析来估计生存函数,单因素分析提示:术中腹膜转移癌指数(PCI)评分(p=0.0037),术后细胞减灭满意度(CC)评分(p=0.0003),有无术后并发症(p=0.027),术后住院天数(p=0.007),术前CEA(p=0.035)、术前 CA199(p=0.0078)、术前 CA125(p0.0001)、术前 CA242(p=0.0005)、术后 CA199(p=0.0006)和术后 CA242(p0.0001)为影响结直肠癌腹膜转移患者CRS+HIPEC治疗预后的相关临床因素。COX多因素分析表明术前CEA升高(p=0.038)和CA125升高(p=0.041)是影响结直肠癌腹膜转移CRS+HIPEC治疗预后的独立影响因素。研究结论本次小样本回顾性研究显示:术中PCI评分≤4,术后CC评分2,术后无并发症,术后住院天数≤11天,术前CEA,术前CA199,术前CA125,术前CA242,术后CA199和术后CA242正常为结直肠癌腹膜患者经CRS+HIPEC治疗后预后的有益临床因素;术前CEA升高和CA125升高是影响结直肠腹膜转移经CRS+HIPEC治疗后预后的独立危险因素。术前CEA升高和CA125升高的患者相比较术前该两项指标正常的患者,经过CRS+HIPEC相对预后不佳。临床医生在选择CRS+HIPEC作为结直肠癌腹膜转移病人的治疗手段时,需要更加谨慎参考以上指标。
[Abstract]:Background: peritoneal metastasis of colorectal cancer is often regarded as the end stage of disease in the past. The prognosis is usually poor. Only palliative treatment combined with the best supportive treatment can let patients pass the last stage of life. But in recent years, some scholars have suggested that can be considered as a tumor in the abdominal cavity of the local and non metastasis of systemic peritoneal metastatic carcinoma, reasons are observed, some patients, even had peritoneal metastasis, but in a very long period of time, a direct limit in the intraperitoneal tumor which did not happen in other parts of distant metastasis. At present, tumor cell subtraction combined with intraperitoneal perfusion chemotherapy (CRS+HIPEC) has been successfully applied to the peritoneal metastasis of rectal cancer and has shown good results. But the outcome of the patient and what indicators are still not very clear. The purpose of the study through the analysis of cytoreductive surgery combined with intraperitoneal hyperthermic perfusion chemotherapy in the treatment of advanced colorectal cancer with tumor cells by peritoneal metastasis, clinical features, pathology, surgery and biochemical parameters, and summarize the postoperative follow-up data, selected indicators to provide help for the prognosis, selection and risk assessment of patients. Before and subsequent treatment decisions. Study on the method of analysis of clinical features, from January 2014 to March 2016 in the Second Affiliated Hospital of Zhejiang University Medical College cancer surgery underwent cytoreductive surgery combined with intraperitoneal hyperthermic perfusion chemotherapy for advanced colon in 42 cases of rectal cancer patients with peritoneal metastasis of tumor pathology, surgical data, biochemical indicators and postoperative follow-up data review. Results in 42 patients with peritoneal metastasis of colorectal cancer, there were 17 males and 25 females. The median age was 59 years old, and the median age was 59 years. The median follow-up time was 4-35 months. The median follow-up time was 19.5 months, and 2 cases were lost. The follow-up rate was 95.24%. All cases died in 11 cases, and 31 cases survived. 18 classification of quantitative clinical data after the assignment, to reflect the overall survival rate was Kaplan-Meier prognostic index, survival analysis to estimate the function of survival, the single factor analysis showed that the cancer index of peritoneal metastasis surgery (PCI) score (p=0.0037), postoperative cytoreductive satisfaction (CC) score (p=0.0003), there is no postoperative complications (p=0.027), postoperative hospital stay (p=0.007), preoperative CEA (p=0.035), preoperative CA199 (p=0.0078), CA125 (P0.0001) before surgery, preoperative and postoperative CA242 (p=0.0005) CA199 (p=0.0006) and CA242 after operation (P0.0001). Clinical factors associated with peritoneal metastasis of colorectal cancer in patients treated with CRS+HIPEC the prognosis is. COX multivariate analysis showed that pre operation CEA increase (p=0.038) and elevated CA125 (p=0.041) were independent factors affecting the prognosis of colorectal carcinoma peritoneal metastasis CRS+HIPEC treatment. The research conclusion of this small retrospective study showed: intraoperative PCI score of 4 or less, the postoperative CC score of 2, no postoperative complications, postoperative hospital stay less than 11 days, preoperative CEA, preoperative CA199, preoperative CA125, preoperative CA242, postoperative CA199 and postoperative CA242 patients with normal. The beneficial clinical prognostic factors of peritoneal cancer after CRS+HIPEC treatment; preoperative CEA increased and the rise of CA125 is influenced by independent prognostic factors after CRS+HIPEC treatment of colorectal peritoneal metastasis. Patients with normal CEA and CA125 increase before operation were compared with the two patients with normal indexes before operation, and the relative prognosis was poor after CRS+HIPEC. Clinicians need to be more careful with the above indicators when choosing CRS+HIPEC as a means of treatment for patients with colorectal cancer peritoneum metastasis.
【学位授予单位】：浙江大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R735.34

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