Steffens Daniel, Koh Cherry, Ansari Nabila, Solomon Michael J, Brown Kilian, McBride Kate, Young Jane, Young Christopher J, Moran Brendan
Surgical Outcomes Research Centre (SOuRCe), Royal Prince Alfred Hospital (RPAH), Sydney, NSW, Australia.
Faculty of Medicine and Health, The University of Sydney, Sydney, Australia.
Ann Surg Oncol. 2020 Oct;27(10):3986-3994. doi: 10.1245/s10434-020-08443-4. Epub 2020 Apr 13.
This study aimed to describe short- and medium-term longitudinal quality-of-life (QoL) outcomes after cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC).
Consecutive patients undergoing CRS and HIPEC were recruited. The primary outcome was QoL, measured using the short-form 36 questionnaire and expressed as a physical component score (PCS) and a mental component score (MCS), with higher scores representing better QoL. Data were collected prospectively at baseline and before discharge, then 3, 6, and 12 months postoperatively. Trajectories of the PCS and MCS were described for the study period and grouped according to a peritoneal carcinomatosis index (PCI) (≤ 12 vs. ≥ 13) and a completeness of cytoreduction (CC) score (CC0 vs. CC1-CC3).
Overall, 117 patients underwent CRS and HIPEC and 115 (98.3%) of the 117 patients participated in the study. The main primary pathology was colorectal in 52 (45%) of the 115 patients and appendiceal in 27 (23.5%) of the 115 patients. The median baseline PCS [48.16; interquartile range (IQR), 38.6-54.9] had decreased at pre-discharge (35.34; IQR, 28.7-41.8), then increased slightly at 3 months (42.54; IQR, 37.6-51.6), before returning to baseline within 6 months (48.35; IQR, 39.1-52.5) and remaining unchanged 12 months after surgery (48.55; IQR, 40.8-55.5). The MCS remained unchanged during the study period. The patients with a PCI of 13 or higher had worse PCS and MCS during the postoperative period than the patients with a PCI of 12 or lower.
The CRS and HIPEC procedures impaired PCS, with scores returning to baseline within 6 months after surgery, whereas MCS remained unchanged. The patients with a lower PCI had better postoperative QoL outcomes. For patients with peritoneal malignancy, CRS and HIPEC can be performed with acceptable short- to medium-term QoL outcomes.
本研究旨在描述细胞减灭术（CRS）和热灌注化疗（HIPEC）后的短期和中期纵向生活质量（QoL）结果。
招募接受CRS和HIPEC的连续患者。主要结局是QoL，使用简短健康调查问卷36进行测量，并表示为身体成分得分（PCS）和心理成分得分（MCS），得分越高表示QoL越好。前瞻性收集基线和出院前的数据，然后在术后3、6和12个月收集数据。描述研究期间PCS和MCS的轨迹，并根据腹膜癌指数（PCI）（≤12 vs.≥13）和细胞减灭的完整性（CC）评分（CC0 vs. CC1 - CC3）进行分组。
总体而言，117例患者接受了CRS和HIPEC，117例患者中的115例（98.3%）参与了研究。115例患者中，主要原发病理为结直肠癌的有52例（45%），阑尾癌的有27例（23.5%）。基线PCS中位数[48.16；四分位数间距（IQR），38.6 - 54.9]在出院前下降（35.34；IQR，28.7 - 41.8），然后在3个月时略有上升（42.54；IQR，37.6 - 51.6），在6个月内恢复到基线水平（48.35；IQR，39.1 - 52.5），术后12个月保持不变（48.55；IQR，40.8 - 55.5）。MCS在研究期间保持不变。PCI为13或更高的患者术后期间的PCS和MCS比PCI为12或更低的患者更差。
CRS和HIPEC手术损害了PCS，术后6个月内得分恢复到基线水平，而MCS保持不变。PCI较低的患者术后QoL结果更好。对于腹膜恶性肿瘤患者，CRS和HIPEC可以在可接受的短期至中期QoL结果下进行。
