Yonemura Yutaka, Canbay Emel, Ishibashi Haruaki
NPO to Support Peritoneal Surface Malignancy Treatment Unit, Peritoneal Carcinomatosis Center, Kishiwada Tokushukai and Kusatsu General Hospital, 1-26 Haruki-Moto-Machi, Kishiwada City, Osaka 596-0032, Japan.
ScientificWorldJournal. 2013 Apr 18;2013:978394. doi: 10.1155/2013/978394. Print 2013.
Prolonged survival of patients affected by peritoneal metastasis (PM) of colorectal origin treated with complete cytoreduction followed by intraoperative hyperthermic intraperitoneal chemotherapy (HIPEC) has been reported. However, two-thirds of the patients after complete cytoreduction and perioperative chemotherapy (POC) develop recurrence. This study is to analyze the prognostic factors of PM from colorectal cancer following the treatment with cytoreductive surgery (CRS) + POC.
During the last 8 years, 142 patients with PM of colorectal origin have been treated with CRS and perioperative chemotherapy. The surgical resections consisted of a combination of peritonectomy procedures.
Complete cytoreduction (CCR-0) was achieved at a higher rate in patients with peritoneal cancer index (PCI) score less than 10 (94.7%, 71/75) than those of PCI score above 11 (40.2%, 37/67). Regarding the PCI of small bowel (SB-PCI), 89 of 94 (91.5%) patients with ≤2 and 22 of 48 (45.8%) patients with SB-PCI ≥ 3 received CCR-0 resection (P < 0.001). Postoperative Grade 3 and Grade 4 complications occurred in 11 (7.7%) and 14 (9.9%). The overall operative mortality rate was 0.7% (1/142). Cox hazard model showed that CCR-0, SB-PCI ≤ 2, differentiated carcinoma, and PCI ≤ 10 were the independent favorite prognostic factors.
Complete cytoreduction, PCI, SB-PCI threshold, and histologic type were the independent prognostic factors.
据报道，接受了彻底细胞减灭术并术中进行热灌注化疗（HIPEC）的结直肠源性腹膜转移（PM）患者生存期延长。然而，三分之二接受了彻底细胞减灭术和围手术期化疗（POC）的患者会出现复发。本研究旨在分析结直肠癌腹膜转移患者接受细胞减灭术（CRS）+POC治疗后的预后因素。
在过去8年中，142例结直肠源性腹膜转移患者接受了CRS和围手术期化疗。手术切除包括多种腹膜切除术。
腹膜癌指数（PCI）评分低于10的患者实现完全细胞减灭（CCR-0）的比例（94.7%，71/75）高于PCI评分高于11的患者（40.2%，37/67）。关于小肠PCI（SB-PCI），SB-PCI≤2的94例患者中有89例（91.5%）和SB-PCI≥3的48例患者中有22例（45.8%）接受了CCR-0切除（P<0.001）。术后3级和4级并发症分别发生在11例（7.7%）和14例（9.9%）患者中。总体手术死亡率为0.7%（1/142）。Cox风险模型显示，CCR-0、SB-PCI≤2、分化型癌和PCI≤10是独立的有利预后因素。
完全细胞减灭、PCI、SB-PCI阈值和组织学类型是独立的预后因素。
