Program in Peritoneal Surface Oncology, Washington Cancer Institute, Medstar Washington Hospital Center, Washington, DC.
Program in Colorectal Surgery, Washington Cancer Institute, Medstar Washington Hospital Center, Washington, DC.
Dis Colon Rectum. 2018 Mar;61(3):347-354. doi: 10.1097/DCR.0000000000001003.
The prior surgical score estimates the extent of previous surgical intervention by quantitating surgical dissection within 9 abdominopelvic regions.
Our aim was to analyze the prognostic significance of the prior surgical score in our cohort of patients undergoing cytoreductive surgery and perioperative intraperitoneal chemotherapy for peritoneal carcinomatosis of a colorectal origin.
This was a retrospective analysis of a prospectively maintained database for all patients treated for peritoneal carcinomatosis of a colorectal origin.
The prospectively maintained surgical oncology tumor database was analyzed for the study period 1989-2014.
A total of 407 patients diagnosed with peritoneal carcinomatosis of a colorectal origin and treated with cytoreductive surgery and perioperative intraperitoneal chemotherapy were included in this analysis.
The prognostic significance and clinicopathologic factors associated with an initial nondefinitive surgical intervention in patients with peritoneal carcinomatosis of a colorectal origin undergoing cytoreductive surgery and perioperative intraperitoneal chemotherapy was evaluated.
There were 210 men (51.6%) and 197 women (48.4%) in the study. Mean age at presentation was 53.7 years (range, 19.0-87.0 y). Data on prior surgical score for 69 patients were missing, leaving us with a study cohort of 338 patients. Grouped by prior surgical score, 46 (13.6%) had a prior surgical score of 0 versus 25 (7.4%), 122 (36.1%), and 145 (42.9%) who had a prior surgical score of 1, 2, or 3. Overall survival was 53.0%. Three- and 5-year survival rates were 75% and 75% for group prior surgical score 0 versus 26% and 13%, 39% and 37%, and 21% and 16% for group prior surgical scores 1, 2, and 3. Median survival time for the various prior surgical score groups were 180.0, 30.4, 30.5, and 21.3 months for prior surgical scores 0, 1, 2, and 3 (p = 0.000). A total of 87.2% of the prior surgical score 0 group had a completeness of cytoreduction score of 0/1 (no residual disease/tumor <0.25 cm) versus 68.0%, 68.1%, and 48.6% for prior surgical scores of 1, 2, or 3 (p = 0.000). Significant independent predictors of a shorter survival in multivariate analysis included a high cytoreduction score status (p < 0.000) and a high prior surgical score (p = 0.05).
This study was limited by its retrospective, population-based design.
The extent of a previous nondefinitive surgical intervention contributes to the poor prognosis associated with peritoneal carcinomatosis of a colorectal origin. Independent predictors for an improved overall survival include completeness of cytoreduction and low prior surgical score. See Video Abstract at http://links.lww.com/DCR/A573.
先前的手术评分通过量化 9 个腹盆腔区域内的手术解剖程度来估计先前手术干预的程度。
我们旨在分析先前的手术评分在接受结直肠来源腹膜癌细胞减灭术和围手术期腹腔内化疗的患者队列中的预后意义。
这是对前瞻性维护的数据库进行的回顾性分析，该数据库用于所有接受结直肠来源腹膜癌细胞减灭术和围手术期腹腔内化疗的患者。
前瞻性维护的手术肿瘤学数据库在 1989-2014 年期间进行了分析。
共有 407 名诊断为结直肠来源腹膜癌并接受细胞减灭术和围手术期腹腔内化疗的患者纳入本分析。
评估结直肠来源腹膜癌患者在接受细胞减灭术和围手术期腹腔内化疗时初始非确定性手术干预的预后意义和临床病理因素。
研究中有 210 名男性（51.6%）和 197 名女性（48.4%）。患者的平均年龄为 53.7 岁（范围，19.0-87.0 岁）。69 名患者的先前手术评分数据缺失，因此我们的研究队列中有 338 名患者。按先前的手术评分分组，46 名（13.6%）患者的先前手术评分为 0，而 25 名（7.4%）、122 名（36.1%）和 145 名（42.9%）患者的先前手术评分为 1、2 或 3。总生存率为 53.0%。组 0 的 3 年和 5 年生存率分别为 75%和 75%，而组 1、2 和 3 的 3 年和 5 年生存率分别为 26%和 13%、39%和 37%以及 21%和 16%。各个先前手术评分组的中位生存时间为 0 分组的 180.0、30.4、30.5 和 21.3 个月（p = 0.000）。组 0 中 87.2%的患者的细胞减灭术完全缓解评分均为 0/1（无残留疾病/肿瘤<0.25cm），而评分 1、2 或 3 组的比例分别为 68.0%、68.1%和 48.6%（p = 0.000）。多变量分析中，显著的独立预后因素包括高细胞减灭术状态（p < 0.000）和高先前手术评分（p = 0.05）。
本研究受到其回顾性、基于人群的设计限制。
先前非确定性手术干预的程度与结直肠来源腹膜癌的不良预后相关。总生存率的独立预测因素包括细胞减灭术的完全缓解和低先前手术评分。
