结直肠腹膜转移术后复发和生存部位。

Site of Recurrence and Survival After Surgery for Colorectal Peritoneal Metastasis.

机构信息

Department of Surgery & Transplantation, Surgical Oncology Research Laboratory, University Hospital of Zurich, Zurich, Switzerland.

Department of Biostatistics at Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Zurich, Switzerland.

出版信息

J Natl Cancer Inst. 2021 Aug 2;113(8):1027-1035. doi: 10.1093/jnci/djab001.

DOI:10.1093/jnci/djab001

PMID:33484560

Abstract

BACKGROUND

Multimodal treatment, including systemic treatment and surgery, improved the prognosis of peritoneal metastasis (PM). Despite all efforts, recurrence rates remain high, and little data are available about clinical behavior or molecular patterns of PM in comparison to hematogenous metastasis. Here, we aimed to analyze recurrence patterns after multimodal treatment for PM from colorectal cancer.

METHODS

Patients with colorectal PM undergoing multimodal treatment including systemic chemotherapy and cytoreductive surgery plus hyperthermic intraperitoneal chemotherapy (CRS/HIPEC) between 2005 and 2017 at 4 centers were analyzed retrospectively.

RESULTS

A total of 505 patients undergoing CRS/HIPEC were analyzed. Of the patients, 82.1% received preoperative chemotherapy. Median peritoneal cancer index was 6 (interquartile range = 3-11). Median disease-free and overall survival was 12 (95% confidence interval [CI] = 11 to 14) months and 51 (95% CI = 43 to 62) months, respectively. Disease recurred in 361 (71.5%) patients, presenting as isolated peritoneal recurrence in 24.6%, isolated hematogenous recurrence in 28.3%, and mixed recurrence in 13.9% of patients. Recurrence to the peritoneum was associated with an impaired time from recurrence to death of 21 (95% CI = 18 to 31) months for isolated peritoneal and 22 (95% CI = 16 to 30) months for mixed recurrence, compared with 43 (95% CI = 31 to >121) months for hematogenous recurrence (hazard ratio [HR] = 1.79, 95% CI = 1.27 to 2.53; P = .001; and HR = 2.44, 95% CI = 1.61 to 3.79; P < .001). On multiple logistic regression analysis, RAS mutational status (odds ratio [OR] = 2.42, 95% CI = 1.11 to 5.47; P = .03) and positive nodal stage of the primary (OR = 3.88, 95% CI = 1.40 to 11.86; P = .01) were identified as predictive factors for peritoneal recurrence.

CONCLUSIONS

This study highlights the heterogeneity of peritoneal metastasis in patients with colorectal cancer. Recurrent peritoneal metastasis after radical treatment represents a more aggressive subset of metastatic colorectal cancer.

摘要

背景

包括全身治疗和手术在内的多模式治疗改善了腹膜转移（PM）的预后。尽管已经做出了所有努力，但复发率仍然很高，与血行转移相比，关于 PM 的临床行为或分子模式的数据很少。在这里，我们旨在分析结直肠癌多模式治疗后 PM 的复发模式。

方法

对 2005 年至 2017 年间在 4 个中心接受包括全身化疗和细胞减灭术加腹腔内热灌注化疗（CRS/HIPEC）在内的多模式治疗的结直肠 PM 患者进行回顾性分析。

结果

对 505 例接受 CRS/HIPEC 治疗的患者进行了分析。其中 82.1%的患者接受了术前化疗。腹膜癌指数中位数为 6（四分位距=3-11）。无病生存期和总生存期中位数分别为 12 个月（95%置信区间[CI] = 11 至 14）和 51 个月（95%CI = 43 至 62）。361 例（71.5%）患者出现疾病复发，孤立性腹膜复发 24.6%，孤立性血行复发 28.3%，混合性复发 13.9%。腹膜复发与复发至死亡的时间相关，孤立性腹膜复发为 21 个月（95%CI = 18 至 31），混合性复发为 22 个月（95%CI = 16 至 30），而血行复发为 43 个月（95%CI = 31 至 >121）（风险比[HR] = 1.79，95%CI = 1.27 至 2.53；P = 0.001；和 HR = 2.44，95%CI = 1.61 至 3.79；P < 0.001）。在多因素逻辑回归分析中，RAS 突变状态（比值比[OR] = 2.42，95%CI = 1.11 至 5.47；P = 0.03）和原发性淋巴结阳性分期（OR = 3.88，95%CI = 1.40 至 11.86；P = 0.01）被确定为腹膜复发的预测因素。