Glehen O, Kwiatkowski F, Sugarbaker P H, Elias D, Levine E A, De Simone M, Barone R, Yonemura Y, Cavaliere F, Quenet F, Gutman M, Tentes A A K, Lorimier G, Bernard J L, Bereder J M, Porcheron J, Gomez-Portilla A, Shen P, Deraco M, Rat P
Centre Hospitalo-Universitaire Lyon Sud, Pierre Bénite, France.
J Clin Oncol. 2004 Aug 15;22(16):3284-92. doi: 10.1200/JCO.2004.10.012.
The three principal studies dedicated to the natural history of peritoneal carcinomatosis (PC) from colorectal cancer consistently showed median survival ranging between 6 and 8 months. New approaches combining cytoreductive surgery and perioperative intraperitoneal chemotherapy suggest improved survival.
A retrospective multicenter study was performed to evaluate the international experience with this combined treatment and to identify the principal prognostic indicators. All patients had cytoreductive surgery and perioperative intraperitoneal chemotherapy (intraperitoneal chemohyperthermia and/or immediate postoperative intraperitoneal chemotherapy). PC from appendiceal origin was excluded.
The study included 506 patients from 28 institutions operated between May 1987 and December 2002. Their median age was 51 years. The median follow-up was 53 months. The morbidity and mortality rates were 22.9% and 4%, respectively. The overall median survival was 19.2 months. Patients in whom cytoreductive surgery was complete had a median survival of 32.4 months, compared with 8.4 months for patients in whom complete cytoreductive surgery was not possible (P <.001). Positive independent prognostic indicators by multivariate analysis were complete cytoreduction, treatment by a second procedure, limited extent of PC, age less than 65 years, and use of adjuvant chemotherapy. The use of neoadjuvant chemotherapy, lymph node involvement, presence of liver metastasis, and poor histologic differentiation were negative independent prognostic indicators.
The therapeutic approach combining cytoreductive surgery with perioperative intraperitoneal chemotherapy achieved long-term survival in a selected group of patients with PC from colorectal origin with acceptable morbidity and mortality. The complete cytoreductive surgery was the most important prognostic indicator.
三项专门针对结直肠癌腹膜癌转移（PC）自然史的主要研究一致显示，中位生存期在6至8个月之间。将减瘤手术与围手术期腹腔内化疗相结合的新方法显示生存期有所改善。
进行了一项回顾性多中心研究，以评估这种联合治疗的国际经验并确定主要的预后指标。所有患者均接受了减瘤手术和围手术期腹腔内化疗（腹腔内热化疗和/或术后即刻腹腔内化疗）。排除阑尾来源的PC。
该研究纳入了1987年5月至2002年12月期间在28家机构接受手术的506例患者。他们的中位年龄为51岁。中位随访时间为53个月。发病率和死亡率分别为22.9%和4%。总体中位生存期为19.2个月。减瘤手术完成的患者中位生存期为32.4个月，而无法完成减瘤手术的患者中位生存期为8.4个月（P<.001）。多变量分析显示，独立的阳性预后指标为减瘤彻底、二次手术治疗、PC范围局限、年龄小于65岁以及使用辅助化疗。新辅助化疗的使用、淋巴结受累、肝转移的存在以及组织学分化差为独立的阴性预后指标。
减瘤手术与围手术期腹腔内化疗相结合的治疗方法在一组特定的结直肠癌来源的PC患者中实现了长期生存，且发病率和死亡率可接受。减瘤彻底是最重要的预后指标。
