Center for Minimally Invasive Surgery, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo, 113-8519, Japan,
J Gastroenterol. 2014 Apr;49(4):646-54. doi: 10.1007/s00535-013-0820-3. Epub 2013 Jun 24.
Peritoneal metastasis is well-known as a poor prognostic factor in patients with colorectal cancer. It is important to improve the prognosis of patients with colorectal cancer and synchronous peritoneal metastasis. This study aimed to clarify the factors affecting R0 resection and the prognosis of colorectal cancer patients with synchronous peritoneal metastasis.
We investigated the data of patients with stage IV colorectal cancer between 1991 and 2007 in 16 hospitals that were members of the Japanese Society for Cancer of the Colon and Rectum.
Of the 564 colorectal cancer patients with synchronous peritoneal metastases, 341 also had hematogenous metastases. The 5-year overall survival rates in patients with and without R0 resection were 32.4 and 4.7 %, respectively. A Cox proportional hazards model showed that histologic type of poorly differentiated adenocarcinoma, regional lymph node metastasis, liver metastasis, chemotherapy after surgery, R0 resection, the Japanese classification of peritoneal metastasis, and the size of peritoneal metastases were independent prognostic factors. Of the 564 patients, 28.4 % had R0 resection. The Japanese classification of peritoneal metastasis (P1-P2, p = 0.0024) and absence of hematogenous metastases (p < 0.0001) were associated with R0 resection.
P1-P2 peritoneal metastasis and the absence of hematogenous metastasis were the most favorable factors benefiting from synchronous resection of peritoneal metastasis. In addition, chemotherapy after surgery was essential.
腹膜转移是结直肠癌患者预后不良的已知因素。提高结直肠癌伴同步腹膜转移患者的预后至关重要。本研究旨在阐明影响结直肠癌患者 RO 切除和同步腹膜转移患者预后的因素。
我们调查了 1991 年至 2007 年间日本结直肠癌协会 16 家成员医院 4 期结直肠癌患者的数据。
在 564 例伴有同步腹膜转移的结直肠癌患者中，341 例同时伴有血行转移。RO 切除患者和未切除患者的 5 年总生存率分别为 32.4%和 4.7%。Cox 比例风险模型显示，组织学类型为低分化腺癌、区域淋巴结转移、肝转移、术后化疗、RO 切除、腹膜转移日本分类和腹膜转移大小是独立的预后因素。在 564 例患者中，有 28.4%的患者接受了 RO 切除。腹膜转移日本分类（P1-P2，p=0.0024）和无血行转移（p<0.0001）与 RO 切除相关。
P1-P2 腹膜转移和无血行转移是最有利于同步切除腹膜转移的有利因素。此外，术后化疗至关重要。
