Devilee R A, Simkens G A, van Oudheusden T R, Rutten H J, Creemers G J, Ten Tije A J, de Hingh I H
Department of Surgical Oncology, Catharina Hospital, Eindhoven, The Netherlands.
Department of Medical Oncology, Catharina Hospital, Eindhoven, The Netherlands.
Ann Surg Oncol. 2016 Sep;23(9):2841-8. doi: 10.1245/s10434-016-5214-3. Epub 2016 Apr 4.
Cytoreductive surgery and hyperthermic intraperitoneal chemotherapy (CRS + HIPEC) can result in long-term survival for selected patients with colorectal peritoneal metastases (PM). Most patients are additionally treated with systemic chemotherapy, but timing (adjuvant vs. preoperative) varies between treatment centers. This study aimed to compare short- and long-term outcomes for patients with synchronous colorectal PM undergoing CRS + HIPEC who received preoperative or adjuvant chemotherapy.
This study enrolled patients with synchronous colorectal PM who underwent macroscopically complete or near complete CRS + HIPEC. Data were collected from a prospective database containing all patients between 2007 and 2014. Perioperative outcome and survival were compared between patients who underwent adjuvant chemotherapy (adjuvant strategy [AS]) and those who had preoperative chemotherapy followed by adjuvant systemic chemotherapy if possible (preoperative strategy [PS]).
The study enrolled 91 patients, 25 (28 %) of whom received preoperative chemotherapy. The peritoneal cancer index (PCI) score was lower and the operation length shorter for the patients receiving preoperative chemotherapy (both p = 0.02). The complication rates were comparable between the two groups. The median survival after diagnosis was 38.6 months in the AS group, whereas median survival was not reached in the PS group (p < 0.01). The 3-year overall survival rates were 50 and 89 %, respectively. After correction for other significant prognostic factors, preoperative chemotherapy was independently associated with improved survival (HR 0.23; 95 % confidence interval, 0.07-0.75; p = 0.01).
Treatment with preoperative chemotherapy was associated with improved long-term survival after CRS + HIPEC compared with adjuvant chemotherapy. Ideally, a randomized controlled trial should be performed to investigate the optimal timing of systemic chemotherapy for colorectal PM patients.
细胞减灭术和腹腔内热灌注化疗（CRS + HIPEC）可使部分患有结直肠腹膜转移（PM）的患者获得长期生存。大多数患者还接受全身化疗，但治疗中心之间化疗的时机（辅助化疗与术前化疗）有所不同。本研究旨在比较接受术前或辅助化疗的同步性结直肠PM患者接受CRS + HIPEC后的短期和长期结局。
本研究纳入了接受肉眼下完全或接近完全CRS + HIPEC的同步性结直肠PM患者。数据来自一个前瞻性数据库，该数据库包含2007年至2014年间的所有患者。比较接受辅助化疗的患者（辅助策略[AS]）和接受术前化疗且如有可能随后接受辅助全身化疗的患者（术前策略[PS]）的围手术期结局和生存率。
该研究共纳入91例患者，其中25例（28%）接受了术前化疗。接受术前化疗的患者腹膜癌指数（PCI）评分较低，手术时间较短（均p = 0.02）。两组的并发症发生率相当。AS组诊断后的中位生存期为38.6个月，而PS组未达到中位生存期（p < 0.01）。3年总生存率分别为50%和89%。在校正其他重要的预后因素后，术前化疗与生存率提高独立相关（HR 0.23；95%置信区间，0.07 - 0.75；p = 0.01）。
与辅助化疗相比，术前化疗与CRS + HIPEC后的长期生存改善相关。理想情况下，应进行一项随机对照试验，以研究结直肠PM患者全身化疗的最佳时机。
