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细胞减灭术联合腹腔热灌注化疗治疗T3~4期结直肠癌患者的临床疗效

Clinical efficacy of cytoreductive surgery combined with hyperthermic intraperitoneal chemotherapy in treatment of patients with stage T3-4 colorectal cancer

    摘要
  • 摘要:
    目的 分析细胞减灭术(CRS)联合术后腹腔热灌注化疗(HIPEC)治疗T3~4期结直肠癌伴或不伴腹膜转移患者的安全性及远期生存情况。
    方法 收集T3~4期结直肠癌伴或不伴腹膜转移患者的临床资料, 分为HIPEC组(CRS+HIPEC+术后常规化疗, n=116)和非HIPEC组(CRS+术后常规化疗, n=101)。为控制腹膜转移的混杂影响，将患者按是否发生腹膜转移再次分为无腹膜转移组(n=170)和腹膜转移组(n=47)。比较各组患者的一般资料、术后病理资料和消化道肿瘤标记物水平。
    结果 HIPEC者与非HIPEC者的腹腔感染发生情况比较，差异有统计学意义(P < 0.05)。无腹膜转移组和腹膜转移组中, HIPEC者与非HIPEC者的性别、年龄、体质量指数、肿瘤类型、病理分型、淋巴转移情况及肿瘤侵犯深度等方面比较，差异均无统计学意义(P>0.05)。HIPEC组与非HIPEC组术前及术后第1、2、3次热灌注化疗后的肿瘤标记物水平癌胚抗原(CEA)、糖类抗原199 (CA199)和甲胎蛋白(AFP)比较，差异无统计学意义(P>0.05)。HIPEC组患者灌注相关不良反应及围术期并发症的发生率与灌注时间无显著关联(P>0.05)。无腹膜转移组中, HIPEC者与非HIPEC者1、2、3年生存率比较，差异均无统计学意义(P>0.05)。HIPEC者1年生存率较非HIPEC者高，差异有统计学意义(P=0.036)。
    结论 T3~4期结直肠癌伴或不伴腹膜转移患者术后早期接受HIPEC治疗无明显不良反应，安全可行，并可有效提高患者生存率，尤其是对腹膜转移患者具有显著生存获益。

     

    Abstract:
    Objective To analyze the safety and long-term survival outcomes of cytoreductive surgery (CRS) combined with postoperative hyperthermic intraperitoneal chemotherapy (HIPEC) in patients with stage T3-4 colorectal cancer with or without peritoneal metastasis.
    Methods Clinical data from patients with stage T3-4 colorectal cancer with or without peritoneal metastasis were collected and divided into HIPEC group (CRS+HIPEC+postoperative conventional chemotherapy, n=116) and non-HIPEC group (CRS+postoperative conventional chemotherapy, n=101). To control the confounding effects of peritoneal metastasis, the study was further stratified into non-peritoneal metastasis group (n=170) and peritoneal metastasis group (n=47) based on the presence or absence of peritoneal metastasis. General patient data, postoperative pathological data and levels of gastrointestinal tumor markers were compared among the groups.
    Results A statistically significant difference was observed in the incidence of intraperitoneal infection between the HIPEC and non-HIPEC groups (P < 0.05). In both the non-peritoneal metastasis and peritoneal metastasis groups, no statistically significant differences were found in the HIPEC and non-HIPEC patients in terms of gender, age, body mass index, tumor type, pathological classification, lymph node metastasis status and depth of tumor invasion (P>0.05). No statistically significant differences were observed in the preoperative and pre-first, pre-second and pre-third HIPEC tumor marker levels carcinoembryonic antigen (CEA), carbohydrate antigen 199 (CA199) and alpha-fetoprotein (AFP) between the HIPEC and non-HIPEC groups (P>0.05). The incidence of perfusion-related adverse reactions and perioperative complications in the HIPEC group showed no significant associations with perfusion days (P>0.05). In the non-peritoneal metastasis group, no statistically significant differences were found in the 1-year, 2-year and 3-year survival rates between the HIPEC and non-HIPEC groups (P>0.05). However, the 1-year survival rate was significantly higher in the HIPEC group compared to the non-HIPEC group (P=0.036).
    Conclusion Early postoperative HIPEC treatment in patients with stage T3-4 colorectal cancer with or without peritoneal metastasis is safe and feasible, with no significant adverse reactions observed. It can effectively improve patient survival rates, particularly offering significant survival benefits for patients with peritoneal metastasis.

     

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