Division of Surgical Oncology, National Cancer Centre Singapore, 9 Hospital Drive, Singapore, 169610, Singapore.
World J Surg Oncol. 2020 Jan 13;18(1):10. doi: 10.1186/s12957-020-1784-4.
Colorectal peritoneal metastases (CPM) occur in up to 13% of patients with colorectal cancer, presenting either synchronously or metachronously. Cytoreductive surgery and hyperthermic intraperitoneal chemotherapy (CRS and HIPEC) have been increasingly utilised for selected CPM patients with favourable outcomes, though its benefits may differ for synchronous (s-CPM) and metachronous CPM (m-CPM).
A retrospective analysis of CPM patients treated with CRS and HIPEC at the National Cancer Centre Singapore over 15 years was performed. In the s-CPM group, CPM was diagnosed at primary presentation with CRS and HIPEC performed at the time of or within 6 months from primary surgery. In the m-CPM group, patients developed CPM > 6 months after primary curative surgery.
One hundred two patients with CPM were treated with CRS and HIPEC. Twenty (19.6%) patients had s-CPM and 82 (80.4%) had m-CPM. Recurrences occurred in 45% of s-CPM and in 54% of m-CPM (p = 0.619). Median overall survival was significantly prolonged in patients with m-CPM (45.2 versus 26.9 months, p = 0.025). In a subset of m-CPM patients with limited PCI in whom ICU stay was not required, a survival advantage was seen (p = 0.031).
A survival advantage was seen a subset of m-CPM patients, possibly representing differences in disease biology.
结直肠癌患者中多达 13%会发生结直肠腹膜转移（CPM），其表现为同步或异时性。细胞减灭术和腹腔热灌注化疗（CRS 和 HIPEC）已越来越多地用于治疗具有良好预后的特定 CPM 患者，但对于同步性 CPM（s-CPM）和异时性 CPM（m-CPM），其获益可能不同。
对在新加坡国家癌症中心接受 CRS 和 HIPEC 治疗的 15 年来的 CPM 患者进行回顾性分析。在 s-CPM 组中，CPM 在初次就诊时被诊断出，在初次手术时或初次手术后 6 个月内进行了 CRS 和 HIPEC。在 m-CPM 组中，患者在初次治愈性手术后 6 个月以上发展为 CPM。
102 例 CPM 患者接受了 CRS 和 HIPEC 治疗。20 例（19.6%）患者为 s-CPM，82 例（80.4%）为 m-CPM。s-CPM 患者中 45%出现复发，m-CPM 患者中 54%出现复发（p = 0.619）。m-CPM 患者的总生存中位数明显延长（45.2 个月与 26.9 个月，p = 0.025）。在无需入住 ICU 的 m-CPM 患者亚组中，具有有限 PCI 的患者的生存优势明显（p = 0.031）。
m-CPM 患者的亚组观察到生存优势，这可能代表疾病生物学的差异。
