Department of Abdominal Surgery, University Hospitals Gasthuisberg, Leuven, Belgium; Department of Surgical Oncology, The Netherlands Cancer Institute/Antoni van Leeuwenhoek-Hospital, Amsterdam, The Netherlands.
J Surg Oncol. 2014 May;109(6):527-32. doi: 10.1002/jso.23546. Epub 2013 Dec 28.
Oxaliplatin and Mitomycin C (MMC) are both suitable as intraperitoneal chemotherapy agents in HIPEC for peritoneal carcinomatosis (PC) of colorectal cancer (CRC).
Patient cohorts from two different HIPEC-centers underwent cytoreductive surgery and HIPEC with Oxaliplatin (39 patients) and MMC (56 patients), respectively. They were compared for toxicity and survival data. The extent of PC was assessed using the Dutch 7-region count.
The median 7-region count was 4 [range 0-7] for Oxaliplatin-patients versus 2.5 [range 1-6] for MMC-patients (P = 0.004). Median intra-operative blood loss was 650 ml [0-6,000 ml] in Oxaliplatin-patients versus 1,230 ml [range 0-5,300 ml] in MMC-patients (P < 0.001). Only MMC-patients developed neutropenia/leucopenia (26.8%, P < 0.001). After statistical correction for the extent of PC, the overall postoperative complication rate was significantly higher in MMC-patients (OR = 2.68 (95% CI: 1.04-6.91), P = 0.04), with a comparable intra-abdominal complication (IAC) rate (OR = 0.78 (95% CI: 0.30-2.03), P = 0.61), but a tendency towards more extra-abdominal complications (EAC) in MMC-patients (OR = 2.23 (95% CI: 0.91-5.43), P = 0.079). Median follow-up was significantly shorter for Oxaliplatin-patients (2.8 years) than for MMC-patients (5.1 years). Median RFS was 12.2 months [IQR: 7.2-undefined] in the Oxaliplatin-group and 13.8 months [IQR: 7.0-25.8] in the MMC-group (P = 0.87). Median OS is 37.1 months [IQR: 22.4-52.8] for Oxaliplatin-patients and 26.5 months [IQR: 16.9-64.8] for MMC-patients (P = 0.45). Logistic regression analysis (corrected for extent of PC) shows RFS (HR = 1.24 (95% CI: 0.75-2.05), P = 0.39) and OS (HR = 1.37 (95% CI: 0.74-2.54), P = 0.32) are not significantly different.
No clear benefit in RFS and OS for HIPEC with Oxaliplatin or MMC could be demonstrated in patients with PC from CRC.
奥沙利铂和丝裂霉素 C（MMC）均可作为结直肠癌腹膜转移（PC）患者腹腔热灌注化疗（HIPEC）的腹腔内化疗药物。
来自两个不同 HIPEC 中心的患者队列分别接受了奥沙利铂（39 例）和 MMC（56 例）的细胞减灭术和 HIPEC 治疗。对他们的毒性和生存数据进行了比较。使用荷兰 7 区计数评估 PC 的程度。
奥沙利铂组的中位 7 区计数为 4[0-7]，而 MMC 组为 2.5[1-6]（P=0.004）。奥沙利铂组术中失血量中位数为 650ml[0-6000ml]，而 MMC 组为 1230ml[0-5300ml]（P<0.001）。只有 MMC 组患者发生中性粒细胞减少/白细胞减少（26.8%，P<0.001）。对 PC 程度进行统计校正后，MMC 组患者的总体术后并发症发生率显著更高（OR=2.68（95%CI：1.04-6.91），P=0.04），腹腔内并发症（IAC）发生率相当（OR=0.78（95%CI：0.30-2.03），P=0.61），但 MMC 组患者的腹腔外并发症（EAC）发生率有增加趋势（OR=2.23（95%CI：0.91-5.43），P=0.079）。奥沙利铂组的中位随访时间明显短于 MMC 组（2.8 年与 5.1 年）。奥沙利铂组的中位 RFS 为 12.2 个月[IQR：7.2-未定义]，MMC 组为 13.8 个月[IQR：7.0-25.8]（P=0.87）。奥沙利铂组的中位 OS 为 37.1 个月[IQR：22.4-52.8]，MMC 组为 26.5 个月[IQR：16.9-64.8]（P=0.45）。逻辑回归分析（校正 PC 程度）显示 RFS（HR=1.24（95%CI：0.75-2.05），P=0.39）和 OS（HR=1.37（95%CI：0.74-2.54），P=0.32）无显著差异。
对于结直肠癌 PC 患者，HIPEC 中使用奥沙利铂或 MMC 并不能显示出在 RFS 和 OS 方面的明显获益。
