Dhir Mashaal, Ramalingam Lekshmi, Shuai Yongli, Pakrafter Sam, Jones Heather L, Hogg Melissa E, Zureikat Amer H, Holtzman Matthew P, Ahrendt Steven A, Bahary Nathan, Pingpank James F, Zeh Herbert J, Bartlett David L, Choudry Haroon A
Division of Surgical Oncology, University of Pittsburgh Medical Center, Pittsburgh, PA, USA.
Department of Biostatistics, University of Pittsburgh, Pittsburgh, PA, USA.
Ann Surg Oncol. 2017 Apr;24(4):875-883. doi: 10.1245/s10434-016-5689-y. Epub 2016 Dec 19.
Several studies suggest that young patients may derive less oncologic benefit from surgical resection of cancers compared with older patients. We hypothesized that young patients may have worse outcomes following cytoreductive surgery with hyperthermic intraperitoneal chemoperfusion (CRS/HIPEC) for peritoneal metastases.
Perioperative and oncologic outcomes in adolescent and young adults (AYA), defined as younger than age 40 years (n = 135), undergoing CRS/HIPEC between 2001 and 2015 were reviewed and compared with middle-aged adults, defined as aged 40-65 years (n = 684).
The two groups were similar with regards to perioperative characteristics except that AYA were more likely to be symptomatic at presentation (65.2 vs. 50.9%, p = 0.003), had lower Charleson comorbidity index (median 6 vs. 8, p < 0.001), were less likely to receive neoadjuvant chemotherapy (32.8 vs. 42.5%, p = 0.042), and had longer operative times (median 543 vs. 493 min, p = 0.010). Postoperative Clavien-Dindo grade 3-4 morbidity was lower in AYA (17 vs. 26%, p = 0.029), and they required fewer reoperations for complications (3.7 vs. 10.4%, p = 0.014). AYA had longer median overall survival (103.6 vs. 73.2 months, p = 0.053). In a multivariate Cox regression analysis, age was an independent predictor of improved overall survival [hazard ratio 0.705; 0.516-0.963, p = 0.028].
Young patients with peritoneal metastases derive similar benefits from CRS/HIPEC as middle-aged patients. Young age should not be a deterrent to consideration of CRS/HIPEC for peritoneal metastases.
多项研究表明，与老年患者相比，年轻患者从癌症手术切除中获得的肿瘤学益处可能更少。我们推测，对于腹膜转移癌患者，年轻患者在接受细胞减灭术联合腹腔热灌注化疗（CRS/HIPEC）后可能预后更差。
回顾2001年至2015年间接受CRS/HIPEC治疗的135例年龄小于40岁的青少年及青年成人（AYA）患者的围手术期及肿瘤学结局，并与684例年龄在40至65岁之间的中年成人患者进行比较。
两组患者围手术期特征相似，但AYA患者就诊时出现症状的可能性更高（65.2%对50.9%，p = 0.003），Charlson合并症指数更低（中位数为6对8，p < 0.001），接受新辅助化疗的可能性更小（32.8%对42.5%，p = 0.042），手术时间更长（中位数为543分钟对493分钟，p = 0.010）。AYA患者术后Clavien-Dindo 3-4级并发症发生率更低（17%对26%，p = 0.029），因并发症需要再次手术的比例也更低（3.7%对10.4%，p = 0.014）。AYA患者的中位总生存期更长（103.6个月对73.2个月，p = 0.053）。在多因素Cox回归分析中，年龄是总生存期改善的独立预测因素[风险比0.705；0.516 - 0.963，p = 0.028]。
患有腹膜转移癌的年轻患者从CRS/HIPEC中获得的益处与中年患者相似。年龄不应成为考虑对腹膜转移癌患者进行CRS/HIPEC治疗的阻碍。
