论文部分内容阅读
目的探讨原发性腹膜恶性肿瘤的临床治疗方案及预后相关因素。方法对1995年5月—2004年4月在北京大学人民医院治疗的24例原发性腹膜恶性肿瘤患者的临床病理资料进行回顾性分析。结果24例患者中,腹膜浆液性乳头状腺癌15例(中、高分化9例,低分化6例),腹膜混合型上皮性癌6例,腹膜恶性苗勒管混合瘤3例。全部患者均施行肿瘤细胞减灭术,其中满意的肿瘤细胞减灭术(残留灶直径<2cm)3例,不满意的肿瘤细胞减灭术(残留灶直径≥2cm)21例。术后给予以铂类为主的联合化疗,其中13例行紫杉醇+顺铂或卡铂(TP)方案化疗,9例行顺铂+阿霉素+环磷酰胺(PAC)方案化疗。初次化疗缓解率为80%,其中完全缓解率为55%,部分缓解率为25%。患者的中位数生存时间为42个月(22～62个月),其中腹膜浆液性乳头状腺癌、恶性苗勒管混合瘤、混合型上皮性癌患者的中位数生存时间分别为44、13和19个月,前两者比较,差异有统计学意义(P<0.05),而后者分别与前两者比较,差异均无统计学意义(P>0.05);接受TP和PAC方案化疗患者的平均生存时间分别为75、28个月,两者比较,差异有统计学意义(P<0.05)。结论原发性腹膜恶性肿瘤的治疗,应尽量首选恰当的肿瘤细胞减灭术,基本术式为双侧附件及大网膜切除术,过分强调减瘤的彻底性可能不利于患者的预后;术后应给予以铂类为主的联合化疗,TP方案可能优于PAC方案。病理类型及化疗方案是预后的影响因素。
Objective To investigate the clinical treatment of primary peritoneal malignant tumor and prognostic factors. Methods The clinical and pathological data of 24 patients with primary peritoneal malignancy treated at Peking University People’s Hospital from May 1995 to April 2004 were analyzed retrospectively. Results Among the 24 patients, there were 15 cases of peritoneal serous papillary adenocarcinoma (9 cases of moderate and high differentiated, 6 cases of poorly differentiated), 6 cases of peritoneal mixed epithelial carcinoma and 3 cases of peritoneal malignant Mullerian mixed tumor. Tumor cytoreductive surgery was performed in all patients, including satisfactory tumor cytoreductive surgery (residual tumor diameter <2cm) in 3 cases and unsatisfactory tumor cytoreductive surgery (residual tumor diameter ≥ 2cm) in 21 cases. Postoperative platinum-based combination chemotherapy, of which 13 cases of paclitaxel + cisplatin or carboplatin (TP) regimen chemotherapy, 9 cases of cisplatin + doxorubicin + cyclophosphamide (PAC) regimen chemotherapy. The initial chemotherapy response rate was 80%, of which the complete response rate was 55% and the partial response rate was 25%. The median survival time of patients was 42 months (22-62 months). The median survival time of patients with peritoneal serous papillary adenocarcinoma, Malignant Mullerian mixed tumor and mixed type epithelial cancer were 44 , 13 and 19 months respectively. The difference between the former two groups was statistically significant (P <0.05), while the latter was not significantly different from the former two groups (P> 0.05) The mean survival time of patients was 75 and 28 months, respectively, with significant difference between the two groups (P <0.05). Conclusion The treatment of primary peritoneal malignant tumor should be the first choice of appropriate cytoreductive surgery, the basic surgical procedures for bilateral attachment and omental resection, over-emphasis on the thoroughness of tumor reduction may not be conducive to the prognosis of patients; Should be given platinum-based combination chemotherapy, TP program may be superior to the PAC program. Pathological types and chemotherapy regimens are prognostic factors.