[Efficacy of cytoreductive surgery combined with hyperthermic intraperitoneal chemotherapy for pseudomyxoma peritonei].

Objective: To evaluate the efficacy and safety of cytoreductive surgery (CRS) combined with hyperthermic intraperitoneal chemotherapy (HIPEC) in the treatment of pseudomyxoma peritonei (PMP). Methods: In this descriptive case series study, we retrospective analyzed the records of PMP patients treated with CRS and HIPEC between January 2013 and June 2023 at Affiliated Cancer Hospital and Institute of Guangzhou Medical University. The inclusion criteria were as follows: (1) Aged 18 to 75 years and nonpregnant women. (2) Histologically confirmed diagnosis of pseudomyxoma peritonei. (3) Karnofsky Performance Scale (KPS)>70. (4) The functions of major organs such as the heart, liver, lungs, and kidneys can tolerate major surgery for long periods of time. (5) No evidence of extra-abdominal metastasis. Patients with extensive intra-abdominal adhesions or severe infectious diseases were excluded. The main outcomes were overall survival (OS) and postoperative major complications. The postoperative major complications were graded according to the National Cancer Institute Common Terminology Criteria for Adverse Events (version 5.0). We used the peritoneal cancer index (PCI) score to quantitatively assess the peritoneal metastases and the completeness of cytoreduction (CCR) score at the end of surgery (CCR-0 and CCR-1 considered to be complete CRS). Results: A total of the 186 PMP patients with a median age of 56 (interquartile range extremes (IQRE), 48-64) years were included, 65 (34.9%) males and 121 (65.1%) females. The median peritoneal cancer index (PCI) score was 28 (20-34). Appendiceal origin accounted for 91.4%. Histological types were low grade in 99 patients (53.2%), high grade in 57 patients (30.6%), and 55 patients (29.6%) received complete cytoreduction (CCR-0/1). The median operative duration was 300 (211-430) minutes for all patients. Treatment-related 30-day mortality was 2.7%; 90-day mortality 4.3%; reoperation 1.6%; and severe morbidity 43.0%. Within the entire series, anemia(27.4%), electrolyte disturbance(11.6%), and hypoalbuminemia(7.5%) were the most frequent major complications (grade 3-4). The incidences of gastrointestinal anastomotic leakage, abdominal bleeding, and abdominal infection were 2.2%, 2.2%, and 4.3%, respectively. After a median follow-up of 38.1 (95%CI:31.2-45.1) months, the 5-year OS was 50.3% (95%CI: 40.7%-59.9%) with a median survival time of 66.1 (95%CI: 43.1-89.1) months. The survival analysis showed that patients with pathological low grade, low PCI, and low CCR score had better survival with statistically significant differences (all P<0.05). Further stratified into complete and incomplete CRS subgroups, the 5-year OS of the CCR-0 and CCR-1 subgroups was 88.9% (95%CI: 68.3%-100.0%) and 77.6% (95%CI: 62.7%-92.5%), respectively; and 42.0% (95%CI: 29.5%-54.5%) in the CCR-2/3 subgroup. Conclusions: CRS and HIPEC may result in a long-term survival benefit for PMP patients with acceptable perioperative morbidity and mortality. This strategy, when complete CRS is possible, could significantly prolong survival for strictly selected patients at experienced centers.目的： 探讨细胞减灭术（CRS）联合腹腔热灌注化疗（HIPEC）治疗腹膜假黏液瘤（PMP）的安全性和有效性。 方法： 本研究为观察性研究。纳入标准：（1）年龄在18~75岁，非妊娠哺乳期女性；（2）经病理确诊为PMP患者；（3）KPS评分>70分；（4）心、肝、肺、肾等主要脏器功能可耐受长时间大手术；（5）术前没有远处转移、腹膜外转移迹象。排除术前腹腔广泛粘连、无法耐受手术者以及严重感染性疾病者。回顾性分析2013年1月到2023年6月期间在广州医科大学附属肿瘤医院接受CRS+HIPEC治疗的PMP患者临床资料。主要观察指标为总生存期（OS）。次要评价指标为手术并发症情况和严重不良事件（SAE）发生率等。并发症分级依据常见不良事件评价标准（CTCAE 5.0）。腹膜肿瘤分期采用腹膜肿瘤指数（PCI）评分系统；CRS术后进行细胞减灭程度（CCR）评分，CCR-0和CCR-1视为满意CRS。 结果： 共纳入186例PMP患者，中位年龄为56（48~64）岁，男性65例（34.9%）、女性121例（65.1%），患者中位PCI评分为28（20~34）分。中位手术时间为300（211~430）min，术中未出现明显并发症。91.4%（170/186）为阑尾来源，病理类型为低级别占53.2%（99/186）、高级别30.6%（57/186）。CCR评分显示，55例（29.6%）实现满意CRS，113例（60.8%）患者未能实现满意CRS。术后30 d病死率2.7%（5/186）、需要二次手术者占1.6%（3/186），患者90 d病死率为4.3%（8/186）。Ⅲ~Ⅳ级并发症总发生率为43.0%（80/186），其中发生率较高的主要为贫血（27.4%，51/186）、电解质紊乱（11.6%，21/181）和白蛋白降低（7.5%，14/186）等血液系统不良事件。腹部手术相关并发症主要为胃肠吻合口漏（2.2%，4/186）、腹腔出血（2.2%，4/186）、腹腔感染（4.3%，8/186）。中位随访时间为38.1（95%CI：31.2~45.1）个月。接受CRS+HIPEC治疗的PMP患者术后5年OS为50.3%（95%CI：40.7%~59.9%），中位生存时间66.1（95%CI：43.1~89.1）个月。生存分析结果显示，病理低级别、低PCI以及CCR评分满意者生存率更高（均P<0.05）。CCR-0患者的5年OS为88.9%（95%CI：68.3%~100.0%），CCR-1者为77.6%（95%CI：62.7%~92.5%），CCR-2/3者为42.0%（95%CI：29.5%~54.5%）。 结论： CRS+HIPEC在PMP中应用安全可行，生存获益高，尤其在达到满意CRS者中应用，可显著延长总生存期。.