内容紹介
Summary
Background and objectives: The current standard of treatment for malignant peritoneal mesothelioma(MPM)is cytoreductive surgery(CRS)plus perioperative intraperitoneal or systemic chemotherapy(comprehensive treatment), The present study was performed to clarify the prognostic factors of PMP after comprehensive treatment. Methods: Among 63 patients with MPM, male and female patients were 34 and 29. CRS was performed in 47 patients and complete cytoreduction(CC-0)was performed in 14(22%)patients. Mean numbers of resected peritoneal sectors and organs were 5.2(1-13), and 2.9(0-9), respectively. Hyperthermic intraperitoneal chemoperfusion(HIPEC)was performed in 27 patients. Grade 1/2, Grade 3, and Grade 4 complications were experienced in 5, 6, and 3 patients, respectively. One patient died of sepsis, and the mortality rate was 2.3%. Independent prognostic factors for favorable prognosis were performance of HIPEC, peritoneal cancer index(PCI)score ≤12, no distant metastasis and histologic epithelial type. Relative risk of no HIPEC, PCI score ≥13, presence of distant metastasis and non epithelial type were 7.69, 22.1, 3.6 and 3.9, respectively. Conclusions: Risk factors for death after comprehensive treatment were no HIPEC, PCI score ≥13, and non epithelial type. However, only 11(17%)patients showed PCI score ≤12. Accordingly, PCI score should be reduced≤12 before CRS by neoadjuvant chemotherapy.
要旨
背景: 腹膜中皮腫の最新の治療は包括的治療(腹膜切除+周術期化学療法)である。この研究では包括的治療後の予後因子について報告する。方法: 中皮腫63(男性34,女性29)例に対し術前化学療法後47例に腹膜切除が施行された。hyperthermic intraperitoneal chemoperfusion(HIPEC)は27例に行われた。結果: 完全切除(CC-0)は14(22%)例で平均腹膜切除領域は5.2(1～13),で平均切除臓器数は2.9(0～9)であった。術後Grade 1/2,3,4合併症は5,6,3例であった。死亡例は1例(2.3%)で腹膜炎による敗血症であった。多変量解析で良好な予後因子はHIPEC施行,peritoneal cancer index(PCI) ≤12,遠隔転移なし,組織型上皮型であった。HIPECなし,PCI ≥13,遠隔転移あり,非上皮型のrelative riskは0.13,22.1,3.6,3.9であった。結論: PCI ≥13以上の例は術前化学療法PCI ≤12にした後,CRSとHIPECを行うことで予後が改善できる可能性がある。非上皮型にはより有効な化学療法の開発が必要である。
目次
Background and objectives: The current standard of treatment for malignant peritoneal mesothelioma(MPM)is cytoreductive surgery(CRS)plus perioperative intraperitoneal or systemic chemotherapy(comprehensive treatment), The present study was performed to clarify the prognostic factors of PMP after comprehensive treatment. Methods: Among 63 patients with MPM, male and female patients were 34 and 29. CRS was performed in 47 patients and complete cytoreduction(CC-0)was performed in 14(22%)patients. Mean numbers of resected peritoneal sectors and organs were 5.2(1-13), and 2.9(0-9), respectively. Hyperthermic intraperitoneal chemoperfusion(HIPEC)was performed in 27 patients. Grade 1/2, Grade 3, and Grade 4 complications were experienced in 5, 6, and 3 patients, respectively. One patient died of sepsis, and the mortality rate was 2.3%. Independent prognostic factors for favorable prognosis were performance of HIPEC, peritoneal cancer index(PCI)score ≤12, no distant metastasis and histologic epithelial type. Relative risk of no HIPEC, PCI score ≥13, presence of distant metastasis and non epithelial type were 7.69, 22.1, 3.6 and 3.9, respectively. Conclusions: Risk factors for death after comprehensive treatment were no HIPEC, PCI score ≥13, and non epithelial type. However, only 11(17%)patients showed PCI score ≤12. Accordingly, PCI score should be reduced≤12 before CRS by neoadjuvant chemotherapy.
要旨
背景: 腹膜中皮腫の最新の治療は包括的治療(腹膜切除+周術期化学療法)である。この研究では包括的治療後の予後因子について報告する。方法: 中皮腫63(男性34,女性29)例に対し術前化学療法後47例に腹膜切除が施行された。hyperthermic intraperitoneal chemoperfusion(HIPEC)は27例に行われた。結果: 完全切除(CC-0)は14(22%)例で平均腹膜切除領域は5.2(1～13),で平均切除臓器数は2.9(0～9)であった。術後Grade 1/2,3,4合併症は5,6,3例であった。死亡例は1例(2.3%)で腹膜炎による敗血症であった。多変量解析で良好な予後因子はHIPEC施行,peritoneal cancer index(PCI) ≤12,遠隔転移なし,組織型上皮型であった。HIPECなし,PCI ≥13,遠隔転移あり,非上皮型のrelative riskは0.13,22.1,3.6,3.9であった。結論: PCI ≥13以上の例は術前化学療法PCI ≤12にした後,CRSとHIPECを行うことで予後が改善できる可能性がある。非上皮型にはより有効な化学療法の開発が必要である。