Legué Laura M, Simkens Geert A, Creemers Geert-Jan M, Lemmens Valery E P P, de Hingh Ignace H J T
Department of Internal Medicine, Medical Oncology, Catharina Hospital, Eindhoven, The Netherlands; Department of Research, Netherlands Comprehensive Cancer Organisation, Eindhoven, The Netherlands.
Department of Surgical Oncology, Catharina Hospital, Eindhoven, The Netherlands.
Eur J Cancer. 2017 Dec;87:84-91. doi: 10.1016/j.ejca.2017.10.012. Epub 2017 Nov 10.
The aim of this population-based study was to provide insight into the incidence, risk factors and treatment-related survival of patients with peritoneal metastases (PM) of small bowel adenocarcinoma (SBA).
Data from the Netherlands Cancer Registry were used. All patients diagnosed with SBA between 2005 and 2014 were included. The influence of patient and tumour characteristics on the odds of developing PM was analysed. Subsequently, for all further analyses, patients without synchronous PM of SBA were excluded. The log-rank test and Kaplan-Meier analyses were conducted to estimate survival, and the Cox proportional hazards model was used to evaluate the risk of death.
Of the 1428 included patients diagnosed with SBA, 181 (13%) presented with synchronous PM. Synchronous PM was found in 9% of the duodenal tumours and in 17% of the more distal tumours. Median overall survival of all patients with PM was 5.9 months, whereas survival of both 11 months was observed in patients treated with primary tumour resection or palliative chemotherapy and 32 months after cytoreductive surgery with hyperthermic intraperitoneal chemotherapy (CRS+HIPEC). Poor prognostic factors for survival were age ≥70 years (hazard ratio [HR] 1.6, 95% confidence interval [CI] 1.1-2.2), systemic metastases other than PM (HR 2.0, 95% CI 1.4-2.9) and an advanced (HR 1.9, 95% CI 1.3-3.0) or unknown T-stage (HR 2.1, 95% CI 1.2-3.5).
Synchronous PM was frequently encountered in SBA. Without treatment, prognosis was extremely poor. Survival was higher after primary tumour resection, palliative chemotherapy and CRS+HIPEC, but selection bias probably played a significant role calling for further clinical research.
这项基于人群的研究旨在深入了解小肠腺癌（SBA）腹膜转移（PM）患者的发病率、危险因素及治疗相关生存率。
使用荷兰癌症登记处的数据。纳入2005年至2014年间所有诊断为SBA的患者。分析患者和肿瘤特征对发生PM几率的影响。随后，在所有进一步分析中，排除无SBA同步PM的患者。采用对数秩检验和Kaplan-Meier分析评估生存率，并使用Cox比例风险模型评估死亡风险。
在纳入的1428例诊断为SBA的患者中，181例（13%）出现同步PM。十二指肠肿瘤患者中9%发现同步PM，更远端肿瘤患者中17%发现同步PM。所有PM患者的中位总生存期为5.9个月，而接受原发肿瘤切除或姑息化疗的患者生存期为11个月，接受细胞减灭术联合热灌注化疗（CRS+HIPEC）后生存期为32个月。生存的不良预后因素为年龄≥70岁（风险比[HR] 1.6，95%置信区间[CI] 1.1 - 2.2）、除PM外的全身转移（HR 2.0，95% CI 1.4 - 2.9）以及晚期（HR 1.9，95% CI 1.3 - 3.0）或未知T分期（HR 2.1，95% CI 1.2 - 3.5）。
SBA中经常遇到同步PM。未经治疗，预后极差。原发肿瘤切除、姑息化疗和CRS+HIPEC后生存率较高，但选择偏倚可能起了重要作用，需要进一步的临床研究。
