Department of Surgery, Amsterdam University Medical Centers, University of Amsterdam, Cancer Centre Amsterdam, Amsterdam, The Netherlands.
Department of Gastroenterology and Hepatology, Amsterdam University Medical Centers, University of Amsterdam, Cancer Centre Amsterdam, Amsterdam, The Netherlands.
Ann Surg Oncol. 2020 Aug;27(8):2762-2773. doi: 10.1245/s10434-020-08327-7. Epub 2020 Mar 13.
Controversy exists on emergency setting as a risk factor for peritoneal metastases (PM) in colon cancer patients. Data in patients with obstruction are scarce. The aim of this study was to determine the incidence of synchronous and metachronous PM, risk factors for the development of metachronous PM, and prognostic implications within a large nationwide cohort of left-sided obstructive colon cancer (LSOCC).
Patients with LSOCC treated between 2009 and 2016 were selected from the Dutch ColoRectal Audit. Additional treatment and long-term outcome data were retrospectively collected from original patient files in 75 hospitals in 2017.
In total, 3038 patients with confirmed obstruction and without perforation were included. Synchronous PM (at diagnosis or < 30 days postoperatively) were diagnosed in 148/2976 evaluable patients (5.0%), and 3-year cumulative metachronous PM rate was 9.9%. Multivariable Cox regression analyses revealed pT4 stage (HR 1.782, 95% CI 1.191-2.668) and pN2 stage (HR 2.101, 95% CI 1.208-3.653) of the primary tumor to be independent risk factors for the development of metachronous PM. Median overall survival in patients with or without synchronous PM was 20 and 63 months (p < 0.001) and 3-year overall survival of patients that did or did not develop metachronous PM was 48.1% and 77.0%, respectively (p < 0.001).
This population based study revealed a 5.0% incidence of synchronous peritoneal metastases in patients who underwent resection of left-sided obstructive colon cancer. The subsequent 3-year cumulative metachronous PM rate was 9.9%, with advanced tumor and nodal stage as independent risk factors for the development of PM.
在结肠癌患者中，急诊环境是否为腹膜转移（PM）的危险因素存在争议。关于梗阻患者的数据较少。本研究的目的是在一个大型全国性左侧梗阻性结肠癌（LSOCC）患者队列中，确定同步和异时性 PM 的发生率、异时性 PM 发展的危险因素以及预后意义。
从荷兰 ColoRectal Audit 中选择 2009 年至 2016 年间治疗的 LSOCC 患者。2017 年，从 75 家医院的原始患者档案中回顾性收集额外的治疗和长期结果数据。
共纳入 3038 例确诊梗阻且无穿孔的患者。在 2976 例可评估患者中，148 例（5.0%）诊断为同步 PM（在诊断时或术后<30 天），3 年累积异时性 PM 发生率为 9.9%。多变量 Cox 回归分析显示，原发肿瘤的 pT4 期（HR 1.782，95%CI 1.191-2.668）和 pN2 期（HR 2.101，95%CI 1.208-3.653）是异时性 PM 发展的独立危险因素。有或无同步 PM 的患者的中位总生存期分别为 20 和 63 个月（p<0.001），发生或未发生异时性 PM 的患者的 3 年总生存率分别为 48.1%和 77.0%（p<0.001）。
本基于人群的研究显示，接受左侧梗阻性结肠癌切除术的患者中同步腹膜转移的发生率为 5.0%。随后 3 年的异时性 PM 累积发生率为 9.9%，肿瘤和淋巴结分期较晚是 PM 发展的独立危险因素。
