The Colorectal and Peritoneal Oncology Centre, The Christie NHS Foundation Trust, 6 Tatton Grove, Manchester, M20 4BU, Greater Manchester, United Kingdom.
The Colorectal and Peritoneal Oncology Centre, The Christie NHS Foundation Trust, 6 Tatton Grove, Manchester, M20 4BU, Greater Manchester, United Kingdom; Division of Cancer Sciences, School of Medical Sciences, Faculty of Biology, Medicine and Health Sciences, University of Manchester, 46 Grafton Street, Manchester, M13 9NT, UK.
Eur J Surg Oncol. 2019 Dec;45(12):2310-2315. doi: 10.1016/j.ejso.2019.07.008. Epub 2019 Jul 4.
Traditionally patients with colorectal peritoneal metastases (CRPM) were offered palliative chemotherapy and best supportive care. With the introduction of cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC), patients in the UK have been referred to nationally approved centres. This study describes the pattern of referral and outcomes of patients managed through one UK centre.
and Methods: A prospective register recorded referrals, demographics, prior treatment pathways, and specialist multidisciplinary team (MDT) decisions (2002-2015). Peritoneal cancer index (PCI) was recorded intra-operatively; complete cytoreduction was deemed when a CC0/1 was achieved. Complications were classified using NCI CTCAE. v.4. Median overall survivals (OS) were described for those treated by CRS/HIPEC and in derived estimates for patients with isolated peritoneal metastases treated by chemotherapy alone in the ARCAD trials consortium.
Two-hundred-eighty-six patients with CRPM were referred. Despite increasing numbers of referrals annually, the proportion of patients selected for CRS/HIPEC decreased from 64.5%, to 40%, and to 37.1% for 2002-09, 2010-12, and 2013-15, respectively (p < 0.017). CRS/HIPEC was undertaken in 117 patients with a median PCI of 7 and CC0/1 achieved in 86.3%. NCI CTCAE grade 3/4 complication rates were 9.4%; 30-day mortality was 0.85%. Median OS following CRS/HIPEC was 46.0 months: that for patients not receiving CRS/HIPEC was 13.2 months.
The evolution of the national peritoneal treatment centre over 14 years has been associated with increased referral numbers, refinement of selection for major surgery, matched with achievements of low complication rates and survival advantages in selected patients compared with traditional non-surgical treatments.
传统上，结直肠腹膜转移（CRPM）患者接受姑息性化疗和最佳支持治疗。随着细胞减灭术（CRS）和腹腔热灌注化疗（HIPEC）的引入，英国的患者被转介到国家认可的中心。本研究描述了通过英国一个中心管理的患者的转诊模式和结果。
前瞻性登记册记录了转诊、人口统计学、既往治疗途径和多学科团队（MDT）决策（2002-2015 年）。术中记录腹膜癌指数（PCI）；当达到 CC0/1 时，认为完全减瘤。使用 NCI CTCAE v.4 对并发症进行分类。描述了接受 CRS/HIPEC 治疗的患者的中位总生存期（OS），并根据 ARCAD 试验联盟中仅接受化疗治疗的孤立性腹膜转移患者的衍生估计值进行了描述。
共有 286 例 CRPM 患者被转诊。尽管每年转诊人数不断增加，但接受 CRS/HIPEC 治疗的患者比例从 2002-09 年的 64.5%、2010-12 年的 40%和 2013-15 年的 37.1%逐渐下降（p < 0.017）。117 例患者接受了 CRS/HIPEC 治疗，中位数 PCI 为 7，86.3%达到 CC0/1。NCI CTCAE 3/4 级并发症发生率为 9.4%；30 天死亡率为 0.85%。CRS/HIPEC 后中位 OS 为 46.0 个月：未接受 CRS/HIPEC 治疗的患者中位 OS 为 13.2 个月。
14 年来，国家腹膜治疗中心的发展与转诊人数的增加有关，对主要手术的选择更加精细，与传统非手术治疗相比，在选定患者中实现了较低的并发症率和生存优势。
