Bhandare Manish, Patil Prachi, Pai Vishwas, Bhamre Rahul, Engineer Reena, Ostwal Vikas, Saklani Avanish
Gastrointestinal and Hepato-Pancreato-Biliary Service, Department of Surgical Oncology, Tata Memorial Hospital, Mumbai, India.
Department of Medical Gastroenterology, Tata Memorial Hospital, Mumbai, India.
Clin Colorectal Cancer. 2017 Jun;16(2):e1-e6. doi: 10.1016/j.clcc.2016.08.001. Epub 2016 Aug 30.
Peritoneal carcinomatosis (PC) from colorectal cancers (CRC) either at initial presentation or at subsequent recurrence presents a significant treatment challenge. The aim of our study was to find its incidence and analyze outcomes of patients with PC from CRC origin managed by different treatment modalities.
A retrospective analysis of patients, from August 2013 to July 2014, presenting with metastatic peritoneal disease from CRC with or without metastasis to other sites was performed. PC was classified as limited (peritoneal carcinomatosis index [PCI] < 10) and widespread (PCI > 10).
This study included 70 patients; 45 patients had peritoneum as the only site of metastasis and the remaining 25 visceral metastasis with peritoneum. Resections were performed in 23 patients (19 underwent R0 resection and 4 were R+). All patients received systemic chemotherapy (FOLFOX [Oxaliplatin with fluorouracil and folinic acid]/CAPOX [oxaliplatin and capecitabine]). At a median follow-up of 11 months, the median OS was 14 months. Patients with PCI < 10 had significantly better survival (median not reached) as compared with those with PCI > 10 (15 months). Patients undergoing R0 resection had better survival (24 months) versus those with R+ resection (16 months). The survival of patients receiving only systemic chemotherapy was 11 months.
The incidence of peritoneal metastasis in CRC is about 10%. A select group of patients who have low PCI who undergo R0 resection of only the diseased portion, without entire peritonectomy, still do well. Where facilities for hyperthermic intraperitoneal chemotherapy are not available, cytoreduction followed by systemic chemotherapy should be considered. The added role of hyperthermic intraperitoneal chemotherapy in this subgroup needs to be evaluated.
结直肠癌（CRC）初次就诊或后续复发时出现的腹膜癌病（PC）是一个重大的治疗挑战。我们研究的目的是找出其发病率，并分析不同治疗方式管理的源自CRC的PC患者的预后。
对2013年8月至2014年7月出现CRC转移性腹膜疾病（有或无其他部位转移）的患者进行回顾性分析。PC分为局限性（腹膜癌病指数[PCI]<10）和广泛性（PCI>10）。
本研究纳入70例患者；45例患者腹膜是唯一转移部位，其余25例有内脏转移伴腹膜转移。23例患者接受了手术切除（19例接受R0切除，4例为R+）。所有患者均接受全身化疗（FOLFOX[奥沙利铂联合氟尿嘧啶和亚叶酸]/CAPOX[奥沙利铂和卡培他滨]）。中位随访11个月时，中位总生存期为14个月。PCI<10的患者生存率明显更好（中位生存期未达到），而PCI>10的患者为15个月。接受R0切除的患者生存率更好（24个月），而R+切除的患者为16个月。仅接受全身化疗的患者生存期为11个月。
CRC中腹膜转移的发生率约为10%。一组PCI低的患者，仅对病变部分进行R0切除，而不进行全腹膜切除术，预后仍然良好。在没有腹腔内热化疗设备的地方，应考虑行肿瘤细胞减灭术并随后进行全身化疗。腹腔内热化疗在该亚组中的附加作用需要评估。
