PDF(Pubmed)
Abstract：
Peritoneal carcinomatosis is one of the leading causes of death in patients with gastrointestinal cancer. Newer locoregional treatment concepts include pressurized intraperitoneal aerosol chemotherapy (PIPAC), the regional application of pressurized chemotherapeutic agents to the abdominal cavity, which is usually performed every 4 to 8 weeks. One of the main challenges of PIPAC therapy remains the objective assessment of treatment response. The present study describes a new scoring system to histologically assess the regression of peritoneal cancer following PIPAC therapy, quantitative assessment of histological regression in peritoneal carcinomatosis (QARP). Peritoneal biopsies from 27 patients with peritoneal metastases undergoing PIPAC were obtained and processed in a standardized fashion. Biopsies were scored according to the QARP grading system. The five-tiered system was graded as follows, Grade 0, no residual tumor cells with regressive changes present; grade 1, 1-25% viable tumor cells per tumor focus with regressive changes present; grade 2, 26-50% viable tumor cells per tumor focus with regressive changes present; grade 3, 51-75% viable tumor cells per tumor focus with few regressive changes; grade 4, >75% viable tumor cells per tumor focus with minimal or no regressive changes. Based on the new grading system, the study cohort was divided into QARP responders and QARP non-responders following PIPAC treatment. Higher QARP scores were significantly correlated with higher PCI scores (r=0.32; P=0.007). However, no difference in overall survival was detected between QARP responders and QARP non-responders. Further studies are required to ascertain the reproducibility and prognostic significance of QARP.
摘要：
腹膜癌病是胃肠道肿瘤患者死亡的主要原因之一。较新的局部治疗概念包括加压腹膜内气溶胶化疗（PIPAC），加压化疗药物局部应用于腹腔，通常每4到8周进行一次。PIPAC治疗的主要挑战之一仍然是治疗反应的客观评估。本研究描述了一种新的评分系统，用于组织学评估PIPAC治疗后腹膜癌的消退。定量评估腹膜癌（QARP）的组织学消退。以标准化方式获得并处理了27例接受PIPAC的腹膜转移患者的腹膜活检。根据QARP分级系统对活检进行评分。五层系统分级如下,0级，无复发肿瘤细胞；1级，每个肿瘤病灶1-25％的活肿瘤细胞存在消退变化；2级，每个肿瘤病灶26-50％的活肿瘤细胞存在消退变化；3级，每个肿瘤病灶51-75％的活肿瘤细胞几乎没有消退变化；4级，每个肿瘤病灶>75％的活肿瘤细胞，最小或没有消退变化。基于新的分级制度，本研究队列分为QARP应答者和PIPAC治疗后QARP非应答者.较高的QARP评分与较高的PCI评分显著相关(r=0.32;P=0.007)。然而,QARP应答者和无应答者的总生存期没有差异.需要进一步的研究来确定QARP的可重复性和预后意义。
