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目的恶性黑色素瘤(malignant melanoma,MM)是临床上较为常见的高度恶性肿瘤,长期以来致残率和死亡率相当高。本研究探讨隔离热灌注化疗(hyperthermic isolated limb perfusion,HILP)技术应用于MM的治疗效果,并总结热灌注经验。方法收集2002-01-01-2016-06-30甘肃省肿瘤医院骨与软组织肿瘤科收治的93例ⅡB~Ⅲ期肢体MM患者的临床资料,根据治疗方案,将72例HILP配合手术患者纳入观察组,21例未行HILP的手术患者为对照组,术后随访观察疗效、局部复发、转移、并发症及化疗毒性反应等情况,两组5年无瘤生存率(disease free survival,DFS)及5年总生存率(overall survival,OS)比较采用χ~2检验。结果观察组完全缓解率(complete response,CR)为63.9%(46/72),部分缓解率(partial response,PR)为26.4%(19/72),总缓解率(owerall response,OR)为90.3%,局部复发率(local recurrence,LR)为11.1%(8/72),保肢率(limb salvage,LS)为95.8%(69/72)。无死亡、致残等严重并发症,Wieberdink毒性反应分级均为Ⅰ~Ⅲ级。观察组与对照组5年DFS分别为44.4%(16/36)和14.3%(3/21),差异有统计学意义,P=0.02;5年OS分别为52.8%(19/36)和19.0%(4/21),差异有统计学意义,P=0.01。结论 HILP疗效确切,毒副作用小,且安全性高,能降低LR,提高5年DFS及OS,该技术可在临床上广泛推广及应用。
Objective Malignant melanoma (MM) is a clinically common high-grade malignant tumor, with a long history of high morbidity and mortality. This study explored the therapeutic effect of Hyperthermic Isolated limb perfusion (HILP) on MM and summarized the experience of hyperthermic perfusion. Methods The clinical data of 93 patients with stage ⅡB ~ Ⅲ limb MM admitted to the Department of Bone and Soft Tissue Oncology, Gansu Provincial Tumor Hospital from January 2002 to January 2016 were collected. According to the treatment plan, 72 patients with HILP were included in the study The 21 patients who did not undergo HILP were selected as the control group. The follow-up was followed up for the observation of curative effect, local recurrence, metastasis, complications and chemotherapy toxicity. The two groups of 5-year disease free survival (DFS) 5-year overall survival (OS) compared with χ ~ 2 test. Results The complete response (CR) of observation group was 63.9% (46/72), partial response (PR) was 26.4% (19/72) and the total response rate (ORe) was 90.3 %, Local recurrence (LR) was 11.1% (8/72), limb salvage (LS) was 95.8% (69/72). No death, disability and other serious complications, Wieberdink toxicity grade were grade Ⅰ ~ Ⅲ. The 5-year DFS of the observation group and the control group were 44.4% (16/36) and 14.3% (3/21) respectively, with a significant difference (P = 0.02); the 5-year OS was 52.8% (19/36) % (4/21), the difference was statistically significant, P = 0.01. Conclusions HILP has definite effect, small toxic and side effects, high safety, reduced LR, increased 5-year DFS and OS. This technique can be widely applied in clinic.