Digestive Tumours Unit, Institut Bergonié, Bordeaux, France.
Clinical and Epidemiological Research Unit, Institut Bergonié, Bordeaux, France.
PLoS One. 2015 Mar 31;10(3):e0122816. doi: 10.1371/journal.pone.0122816. eCollection 2015.
Cytoreductive peritoneal surgery (CRS) associated with hyperthermic peritoneal chemotherapy (HIPEC) has long been considered the standard treatment for colorectal peritoneal metastases (CPM). However, although efficacy of surgery has been demonstrated, evidence supporting HIPEC's role is less certain.
Overall survival (OS), progression-free survival (PFS) and morbidity were analysed retrospectively for fifty consecutively included patients treated for colorectal CPM with complete CRS and systemic chemotherapy only.
Median peritoneal cancer index (PCI) was 8 (range 1-24). 23 patients had liver or lung metastases (LLM). 22 patients had synchronous CPM. 27 complications occurred (12 Grade 1/2, 14 Grade 3, 1 Grade 4a, 0 Grade 5). Median follow-up was 62.5 months (95 %CI 45.4-81.3), median survival 32.4 months (21.5-41.7). Three- and 5-year OS were 45.5% (0.31-0.59) and 29.64% (0.17-0.44) respectively. Presence of LLMs associated with peritoneal carcinomatosis was significantly associated with poorer prognosis, with survival at 5 years of 13.95% (95 %CI 2.9-33.6) vs. 43.87% (22.2-63.7) when no metastases were present (P= 0.018). Median PFS was 9.5 months (95 %CI 6.2-11.1).
With an equivalent PCI range and despite one of the highest rates of LLM in the literature, our survival data of CRS + systemic chemotherapy only compare well with results reported after additional HIPEC. Tolerance was better with acceptable morbidity without any mortality. Extra-hepatic metastasis (LLM) is a strong factor of poor prognosis. Awaiting the results of the randomized PRODIGE trial, these results indicate that CRS + systemic chemotherapy only is a robust hypothesis to treat colorectal CPM.
细胞减灭性腹腔手术（CRS）联合腹腔热灌注化疗（HIPEC）长期以来被认为是结直肠腹膜转移（CPM）的标准治疗方法。然而，尽管手术的疗效已经得到证实，但支持 HIPEC 作用的证据却不那么确定。
对 50 例连续接受完全 CRS 和全身化疗治疗的结直肠 CPM 患者的总生存（OS）、无进展生存（PFS）和发病率进行回顾性分析。
中位腹膜癌指数（PCI）为 8（范围 1-24）。23 例患者有肝或肺转移（LLM）。22 例患者有同步 CPM。27 例患者发生并发症（12 例为 1/2 级，14 例为 3 级，1 例为 4a 级，0 例为 5 级）。中位随访时间为 62.5 个月（95%CI 45.4-81.3），中位生存时间为 32.4 个月（21.5-41.7）。3 年和 5 年 OS 分别为 45.5%（0.31-0.59）和 29.64%（0.17-0.44）。存在 LLM 与腹膜癌病相关，预后显著较差，5 年生存率为 13.95%（95%CI 2.9-33.6），而无转移时为 43.87%（22.2-63.7）（P=0.018）。中位 PFS 为 9.5 个月（95%CI 6.2-11.1）。
在 PCI 范围相当的情况下，尽管本文 LLM 的发生率是文献中最高之一，但我们的 CRS+全身化疗治疗仅后的生存数据与报告的 HIPEC 后结果相比相当。耐受性良好，发病率可接受，无死亡率。肝外转移（LLM）是预后不良的一个重要因素。在等待随机 PRODIGE 试验的结果时，这些结果表明 CRS+全身化疗治疗是治疗结直肠 CPM 的一个强有力的假说。
