Department of Surgery, Division of Surgical Oncology, Moores Cancer Center, University of California, San Diego, La Jolla, CA, USA.
Department of Family Medicine and Public Health, Division of Biostatistics and Bioinformatics, University of California, San Diego, San Diego, CA, USA.
Ann Surg Oncol. 2019 May;26(5):1421-1427. doi: 10.1245/s10434-019-07255-5. Epub 2019 Feb 27.
Primary tumor location has been shown to be prognostic of overall survival (OS) in patients with both locally advanced and metastatic colorectal cancer. The impact of sidedness on prognosis has not been evaluated in the setting of peritoneal-only metastases treated with cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC).
A retrospective review of prospectively maintained databases of patients with peritoneal surface malignancy undergoing CRS/HIPEC from three high-volume centers was performed.
A total of 115 patients with metastatic colon cancer to the peritoneum who underwent CRS/HIPEC with mitomycin C were identified. Fifty-one patients (45%) had left-sided primary tumors, and 64 (55%) had right-sided primary tumors. Patients with right-sided tumors were more likely to be older (median age 56 vs. 49 years, p = 0.007) and to have signet ring cell histology (17% vs. 4%, p = 0.026). Patients with right-sided tumors had median disease-free survival (DFS) and OS of 14 months (95% confidence interval [CI] 10.5-17.5) and 36 months (95% CI 27.4-44.6), respectively, versus 16 months (95% CI 11.0-21.0) and 69 months (95% CI 24.3-113.7) for those patients with left-sided tumors. On multivariate analysis, primary tumor side was an independent predictor of both DFS and OS.
In this study, there was a dramatic, clinically significant difference in OS between patients with right- and left-sided tumors, and primary tumor side was an independent predictor of DFS and OS. Primary tumor side should be considered in patient selection for CRS with or without HIPEC.
原发肿瘤位置已被证明与局部晚期和转移性结直肠癌患者的总生存期（OS）相关。在接受细胞减灭术（CRS）和腹腔热灌注化疗（HIPEC）治疗的单纯腹膜转移患者中，侧别对预后的影响尚未得到评估。
对三个高容量中心接受 CRS/HIPEC 治疗的腹膜表面恶性肿瘤患者的前瞻性数据库进行了回顾性分析。
共发现 115 例接受丝裂霉素 C 治疗的转移性结肠癌腹膜转移患者接受了 CRS/HIPEC。51 例（45%）患者的原发肿瘤位于左侧，64 例（55%）患者的原发肿瘤位于右侧。右侧肿瘤患者更可能年龄较大（中位年龄 56 岁 vs. 49 岁，p = 0.007）且具有印戒细胞组织学（17% vs. 4%，p = 0.026）。右侧肿瘤患者的无疾病生存期（DFS）和 OS 中位数分别为 14 个月（95%置信区间 [CI] 10.5-17.5）和 36 个月（95%CI 27.4-44.6），而左侧肿瘤患者的 DFS 和 OS 中位数分别为 16 个月（95%CI 11.0-21.0）和 69 个月（95%CI 24.3-113.7）。多变量分析显示，原发肿瘤侧别是 DFS 和 OS 的独立预测因素。
在这项研究中，右侧和左侧肿瘤患者的 OS 存在显著的临床差异，且原发肿瘤侧别是 DFS 和 OS 的独立预测因素。在选择接受或不接受 HIPEC 的 CRS 患者时，应考虑原发肿瘤侧别。
