Department of Surgery, Catharina Cancer Institute, P. O. Box 1350, 5602 ZA, Eindhoven, Netherlands.
Department of Research, Netherlands Comprehensive Cancer Organization, Utrecht, Netherlands.
Ann Surg Oncol. 2021 Dec;28(13):9073-9083. doi: 10.1245/s10434-021-10190-z. Epub 2021 Jun 2.
This study aimed to compare treatment strategies and survival of patients with synchronous colorectal peritoneal metastases (CPM) and patients with metachronous CPM in a nationwide cohort.
All patients from the Netherlands Cancer Registry with synchronous or metachronous CPM whose primary colorectal cancer (CRC) was diagnosed between 1 January and 30 June 2015 were included in the study. Treatments were categorized as (A) cytoreductive surgery and hyperthermic intraperitoneal chemotherapy [CRS-HIPEC]; (B) palliative treatment; or (C) best supportive care. Overall survival (OS) for all the patients and disease-free survival (DFS) for those who underwent CRS-HIPEC were compared between the two groups.
Of 7233 patients, 743 had a diagnosis of CPM, including 409 patients with synchronous CPM and 334 patients with metachronous CPM. The median OS was 8.1 months for the patients with synchronous CPM versus 12 months for the patients with metachronous CPM (p = 0.003). After multivariable correction, OS no longer differed between the patients with synchronous CPM and those with metachronous CPM (HR 1.03 [0.83-1.27]). The patients with metachronous CPM more often underwent CRS-HIPEC than the patients with synchronous CPM (16 % vs 8 %; p = 0.001). The two groups did not differ statistically in terms of DFS and OS (median DFS, 21.5 vs 14.1 months, respectively; p = 0.094; median OS, 37.8 vs. 35.8 months, respectively; p = 0.553).
This population-based study showed that survival for the patients with synchronous CPM and patients with metachronous CPM did not significantly differ. This suggests that a similar prognosis may be expected for patients selected for treatment regardless of the onset of CPM.
本研究旨在对荷兰全国性队列中同时性和异时性结直肠腹膜转移（CPM）患者的治疗策略和生存情况进行比较。
所有于 2015 年 1 月 1 日至 6 月 30 日期间诊断为原发性结直肠癌（CRC）并伴有同时性或异时性 CPM 的荷兰癌症登记处患者均被纳入本研究。治疗方案分为（A）细胞减灭术联合腹腔热灌注化疗[CRS-HIPEC]；（B）姑息治疗；或（C）最佳支持治疗。比较两组患者的总生存期（OS）和接受 CRS-HIPEC 治疗患者的无病生存期（DFS）。
在 7233 名患者中，有 743 名患者被诊断为 CPM，其中 409 名患者为同时性 CPM，334 名患者为异时性 CPM。同时性 CPM 患者的中位 OS 为 8.1 个月，而异时性 CPM 患者的中位 OS 为 12 个月（p = 0.003）。经多变量校正后，同时性 CPM 患者的 OS 与异时性 CPM 患者的 OS 无显著差异（HR 1.03[0.83-1.27]）。与同时性 CPM 患者相比，异时性 CPM 患者更常接受 CRS-HIPEC（16%比 8%；p = 0.001）。两组患者在 DFS 和 OS 方面无统计学差异（中位 DFS，分别为 21.5 个月和 14.1 个月，p = 0.094；中位 OS，分别为 37.8 个月和 35.8 个月，p = 0.553）。
本基于人群的研究表明，同时性 CPM 患者和异时性 CPM 患者的生存情况无显著差异。这表明，无论 CPM 的发病时间如何，对治疗选择的患者都可能预期具有相似的预后。
