背景:腹腔热化疗(HIPEC)的细胞减灭术是腹膜转移的有效治疗方法。然而,HIPEC联合顺铂与肾毒性有关。硫代硫酸钠(ST)已被证明可以预防顺铂引起的毒性。
方法:回顾性研究,单中心分析治疗腹膜表面恶性肿瘤的患者,他们在2015年至2020年期间接受了基于顺铂的HIPEC的细胞减灭术。根据顺铂诱导的肾毒性的管理将患者分为三组:术前单纯高水合(PHH),术前高水化与ST(PHH+ST),只有ST。肾功能和并发症,在急性肾损伤(AKI)和慢性肾损伤(CKI)方面,术后3个月进行监测和分析。
结果:本研究包括220名连续患者。平均血清肌酐水平为95、57和61mmol/L,对于PHH,PHH+ST和ST组,分别(p<0.001)。肾小球滤过率(GFR)分别为96、94和78ml/min/1.73m2(p<0.001)。AKI和CKI分别为PHH,PHH+ST和ST组为21%(n=46),1%(n=2)和0%对19%(n=42),0%和0%(p<0.001),对于成对分析,PHH+ST和ST单独组合之间没有任何差异,关于肾病结果。所有患者术后3个月随访。
结论:在接受HIPEC细胞减灭性手术的患者中,当硫代硫酸钠用于预防顺铂诱导的肾毒性时,术前无需过度水化。这些发现对于改善和简化接受顺铂HIPEC治疗的腹膜转移患者的管理具有重要意义。
BACKGROUND: Cytoreductive surgery with hyperthermic intraperitoneal chemotherapy (HIPEC) is an effective treatment for peritoneal metastases. However, HIPEC with cisplatin is associated with renal toxicity. Sodium thiosulfate (ST) has been shown to prevent cisplatin-induced toxicity.
METHODS: A retrospective, single-center analysis of patients treated curatively for peritoneal surface malignancy, who underwent cytoreductive surgery with cisplatin-based HIPEC between 2015 and 2020. Patients were categorized into three groups based on the management of cisplatin-induced renal toxicity: preoperative hyperhydration alone (PHH), preoperative hyperhydration with ST (PHH + ST), and ST alone. Renal function and complications, in terms of Acute (AKI) and chronic kidney injury (CKI), were monitored and analyzed during 3 postoperative months.
RESULTS: This study included 220 consecutive patients. Mean serum creatinine levels were 95, 57 and 61 mmol/L, for PHH, PHH + ST and ST groups, respectively (p < 0.001). Glomerular Filtration Rate (GFR) were 96, 94 and 78 ml/min/1.73 m2, respectively (p < 0.001). AKI and CKI are respectively for PHH, PHH + ST and ST groups were 21 % (n = 46), 1 % (n = 2) and 0 % vs 19 % (n = 42), 0 % and 0 % (p < 0.001), for pairwise analysis did not show any difference between PHH + ST and ST alone combination, regarding nephrological outcomes. All patients were followed 3 months postoperatively.
CONCLUSIONS: There is no need for preoperative hyperhydration when sodium-thiosulfate is used to prevent cisplatin-induced nephrotoxicity in patients undergoing cytoreductive surgery with HIPEC. These findings have implications for improving and simplifying the management of patients with peritoneal metastases undergoing HIPEC with cisplatin.