本文關(guān)鍵詞：腫瘤細胞減滅術(shù)聯(lián)合腹腔熱灌注化療治療結(jié)直腸癌腹膜轉(zhuǎn)移療效預(yù)后因素分析　出處：《浙江大學(xué)》2017年碩士論文　論文類型：學(xué)位論文

  更多相關(guān)文章： 腫瘤細胞減滅術(shù) 腹腔熱灌注化療 結(jié)直腸癌 腹膜轉(zhuǎn)移癌 預(yù)后因素

【摘要】：背景結(jié)直腸癌腹膜轉(zhuǎn)移,在過去往往被認為是疾病的終末期,預(yù)后通常不佳,僅僅采取姑息性治療手段聯(lián)合最佳支持治療讓患者度過生命的最后階段。但是近年來,有學(xué)者提出,腹膜轉(zhuǎn)移癌可以認為是一種在腹腔內(nèi)的局部的腫瘤而非全身系統(tǒng)性的轉(zhuǎn)移,理由是有觀察到,部分病人,即使已經(jīng)發(fā)生了腹膜轉(zhuǎn)移,但是在很長的一段時間內(nèi),腫瘤一直局限在腹腔內(nèi)而并沒有發(fā)生其他部位遠處轉(zhuǎn)移。目前,腫瘤細胞減滅術(shù)聯(lián)合腹腔熱灌注化療(CRS+HIPEC)已經(jīng)成功應(yīng)用在了結(jié)直腸癌腹膜轉(zhuǎn)移中,并顯示了良好的效果。但是患者的預(yù)后和哪些指標相關(guān)目前仍然不是十分清楚。研究目的通過對采用腫瘤細胞減滅術(shù)聯(lián)合腹腔熱灌注化療治療的晚期結(jié)直腸癌腹膜轉(zhuǎn)移患者的臨床特征、腫瘤病理、手術(shù)資料和生化指標的分析,以及患者術(shù)后隨訪資料的總結(jié),挑選出療效預(yù)后因素指標,為術(shù)前患者的選擇和風(fēng)險評估以及后續(xù)治療決策提供幫助。研究方法回顧性分析2014年1月至2016年3月在浙江大學(xué)醫(yī)學(xué)院附屬第二醫(yī)院腫瘤外科行腫瘤細胞減滅術(shù)聯(lián)合腹腔熱灌注化療的晚期結(jié)直腸癌腹膜轉(zhuǎn)移的42例患者的臨床特征、腫瘤病理、手術(shù)資料、生化指標以及術(shù)后隨訪資料。研究結(jié)果在42例結(jié)直腸癌腹膜轉(zhuǎn)移的患者中,男性17例,女性25例;年齡25-81歲,中位年齡59歲;隨訪4-35月,中位隨訪時間19.5月,失訪2例,隨訪率95.24%。全部病例死亡11例,存活31例。18項臨床資料分類量化賦值后,以總體生存率為反映預(yù)后指標,Kaplan-Meier生存分析來估計生存函數(shù),單因素分析提示:術(shù)中腹膜轉(zhuǎn)移癌指數(shù)(PCI)評分(p=0.0037),術(shù)后細胞減滅滿意度(CC)評分(p=0.0003),有無術(shù)后并發(fā)癥(p=0.027),術(shù)后住院天數(shù)(p=0.007),術(shù)前CEA(p=0.035)、術(shù)前 CA199(p=0.0078)、術(shù)前 CA125(p0.0001)、術(shù)前 CA242(p=0.0005)、術(shù)后 CA199(p=0.0006)和術(shù)后 CA242(p0.0001)為影響結(jié)直腸癌腹膜轉(zhuǎn)移患者CRS+HIPEC治療預(yù)后的相關(guān)臨床因素。COX多因素分析表明術(shù)前CEA升高(p=0.038)和CA125升高(p=0.041)是影響結(jié)直腸癌腹膜轉(zhuǎn)移CRS+HIPEC治療預(yù)后的獨立影響因素。研究結(jié)論本次小樣本回顧性研究顯示:術(shù)中PCI評分≤4,術(shù)后CC評分2,術(shù)后無并發(fā)癥,術(shù)后住院天數(shù)≤11天,術(shù)前CEA,術(shù)前CA199,術(shù)前CA125,術(shù)前CA242,術(shù)后CA199和術(shù)后CA242正常為結(jié)直腸癌腹膜患者經(jīng)CRS+HIPEC治療后預(yù)后的有益臨床因素;術(shù)前CEA升高和CA125升高是影響結(jié)直腸腹膜轉(zhuǎn)移經(jīng)CRS+HIPEC治療后預(yù)后的獨立危險因素。術(shù)前CEA升高和CA125升高的患者相比較術(shù)前該兩項指標正常的患者,經(jīng)過CRS+HIPEC相對預(yù)后不佳。臨床醫(yī)生在選擇CRS+HIPEC作為結(jié)直腸癌腹膜轉(zhuǎn)移病人的治療手段時,需要更加謹慎參考以上指標。
[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.
【學(xué)位授予單位】：浙江大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號】：R735.34

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