From the Division of General Surgery, Jewish General Hospital, Montréal, Que. (Benzaquen, Wang, Wiseman, Rosenfeld, Pelletier, Vanounou); and the Division of Surgical Oncology, Hôpital Maisonneuve-Rosemont, Montréal, Que. (Sideris, Dubé).
Can J Surg. 2021 Mar 2;64(2):E111-E118. doi: 10.1503/cjs.001619.
The raw costs of mitomycin C (MMC) and oxaliplatin for hyperthermic intraperitoneal chemotherapy (HIPEC) differ substantially. We sought to compare the morbidity and toxicity profiles associated with the use of oxaliplatin and MMC in patients undergoing cytoreductive surgery (CRS) and HIPEC for peritoneal carcinomatosis (PC) of colorectal or appendiceal origin, to evaluate whether the costeffectiveness of these 2 agents should dictate drug choice.
We conducted a retrospective multi-institutional study of all patients with PC of colorectal or appendiceal origin treated with CRS-HIPEC using MMC or oxaliplatin from 2010 to 2015. Demographic, perioperative, morbidity, toxicity and cost data were compared between the 2 treatment groups and between cancer-origin subgroups.
Forty-two patients treated with MMC and 76 treated with oxaliplatin were included in the study. Baseline demographic and tumour characteristics were comparable in the 2 groups, except that the patients treated with MMC had higher Charlson Comorbidity Index scores. The MMC group had a higher rate of cancer of colorectal origin (76.2% v. 57.9%, p = 0.047) and longer operative times (553 v. 320 min, p < 0.001). In the subgroup of patients whose cancer was of colorectal origin, patients treated with MMC had a higher transfusion rate (50.0% v. 28.6%, p = 0.023) and lower postoperative baseline hemoglobin level (100 v. 119 g/L, p = 0.002) than those treated with oxaliplatin. There was no difference in hematologic toxicity scores after controlling for postoperative anemia. There was no difference in the rates of major complications and 90-day mortality. However, MMC was less costly than oxaliplatin ($724 v. $8928).
MMC and oxaliplatin are both suitable agents for HIPEC and are associated with comparable morbidity and toxicity profiles, regardless of cancer origin. Thus, we propose that cost-effectiveness should ultimately dictate drug selection.
丝裂霉素 C（MMC）和奥沙利铂用于腹腔热灌注化疗（HIPEC）的原材料成本有很大差异。我们旨在比较在接受结直肠或阑尾来源腹膜癌（PC）细胞减灭术（CRS）和 HIPEC 治疗的患者中使用奥沙利铂和 MMC 的发病率和毒性特征，以评估这两种药物的成本效益是否应该决定药物选择。
我们对 2010 年至 2015 年期间接受 MMC 或奥沙利铂治疗的结直肠或阑尾来源 PC 接受 CRS-HIPEC 治疗的所有患者进行了回顾性多机构研究。比较了两组患者以及癌症来源亚组之间的人口统计学、围手术期、发病率、毒性和成本数据。
研究纳入了 42 例接受 MMC 治疗和 76 例接受奥沙利铂治疗的患者。两组患者的基线人口统计学和肿瘤特征相似，但接受 MMC 治疗的患者Charlson 合并症指数评分较高。MMC 组结直肠来源 PC 的比例较高（76.2%比 57.9%，p=0.047），手术时间较长（553 比 320 分钟，p<0.001）。在结直肠来源 PC 患者亚组中，接受 MMC 治疗的患者输血率较高（50.0%比 28.6%，p=0.023），术后基线血红蛋白水平较低（100 比 119g/L，p=0.002）。在控制术后贫血后，血液学毒性评分没有差异。主要并发症发生率和 90 天死亡率无差异。然而，MMC 比奥沙利铂更便宜（724 比 8928 美元）。
MMC 和奥沙利铂均为 HIPEC 的适用药物，与癌症来源无关，具有相似的发病率和毒性特征。因此，我们建议成本效益最终应决定药物选择。
