From the Department of General Surgery, Surgical Oncology (Lundy, Moaven, Perry, Mangieri, Valenzuela, Bordelon, Shen, Votanopoulos, Levine), Wake Forest School of Medicine, Winston-Salem, NC.
the Department of Biostatistics and Data Science (Russell), Wake Forest School of Medicine, Winston-Salem, NC.
J Am Coll Surg. 2022 Apr 1;234(4):546-556. doi: 10.1097/XCS.0000000000000091.
Cytoreductive surgery (CRS) is at the forefront of treatment for colorectal cancer with peritoneal metastasis or "carcinomatosis" (CRC-PC). We report outcomes of the operative management of CRC-PC at a single center.
We retrospectively reviewed our database from 1992 through 2021. The Kaplan-Meier method was used to estimate survival. Proportional hazards regression and multivariable models were used for assessments.
This study included 345 patients with mean age 53.5 years. Multivariate analysis revealed performance and resection status were associated with overall survival (OS; p < 0.001). Within the R0/R1 group, adverse impact on OS was found with increasing Peritoneal Cancer Index (PCI) score starting at 9 (hazard ratio [HR] = 1.98, CI 1.39-2.82, p = 0.0001) with the most significant hazard noted at PCI >14 (HR = 2.35, CI 1.52-3.63, p = 0.0001). Incomplete resection (R2) had significantly worse OS compared with complete CRS 33.4 (n = 206) vs R2: 12.7 months (n = 139; p < 0.0001. When stratified by PCI for the R0/R1 group, median OS for PCI less than 10, 10 to 15, and greater than 15 was 38.2, 19.7, and 22.2 m, respectively (p = 0.0007 comparing PCI less than 10 and greater than 15). Ten-year increments-1991 through 2000, 2001 through 2010, 2011 through 2020-revealed improvement in median OS (13.4 [n = 66], 19.3 [n = 139], and 29.1 months [n = 140]). However, by resection status, median OS remained stable for R0/R1 (32.3 [n = 23], 31.1 [n = 76], and 34.1 months [n = 107]) and improved for R2 (5.2 [n = 43], 14.4 [n = 63], and 14.6 months [n = 33]). Clavien-Dindo complication rate (greater than or equal to grade III) was 29.4%.
CRS improves outcomes for CRC-PC compared with historic outcomes with nonoperative management. This benefit is greatest with complete resection and lower disease burden. Results of CRS (with or without heated intraperitoneal chemotherapy) are improving, and surgery for CRC-PC should be routinely considered.
细胞减灭术（CRS）是治疗结直肠癌伴腹膜转移或“癌性腹膜转移”（CRC-PC）的前沿方法。我们报告了在单中心对 CRC-PC 进行手术治疗的结果。
我们回顾了 1992 年至 2021 年的数据库。使用 Kaplan-Meier 方法估计生存率。使用比例风险回归和多变量模型进行评估。
本研究纳入了 345 名平均年龄为 53.5 岁的患者。多变量分析显示，表现和切除状态与总生存率（OS；p<0.001）相关。在 R0/R1 组内，随着腹膜肿瘤指数（PCI）评分的增加（起始值为 9），OS 受到不利影响（危险比 [HR] = 1.98，CI 1.39-2.82，p=0.0001），评分>14 时危害最大（HR = 2.35，CI 1.52-3.63，p=0.0001）。不完全切除（R2）的 OS 明显差于完全 CRS（33.4 例[206 例]），R2 为 12.7 个月（139 例；p<0.0001）。对于 R0/R1 组按 PCI 分层时，PCI 小于 10、10-15 和大于 15 的中位 OS 分别为 38.2、19.7 和 22.2 m（p=0.0007 比较 PCI 小于 10 和大于 15）。1991 年至 2000 年、2001 年至 2010 年、2011 年至 2020 年，OS 中位数逐年提高（13.4 个月[66 例]、19.3 个月[139 例]和 29.1 个月[140 例]）。然而，按切除状态，R0/R1 的 OS 保持稳定（32.3 个月[23 例]、31.1 个月[76 例]和 34.1 个月[107 例]），R2 的 OS 有所改善（5.2 个月[43 例]、14.4 个月[63 例]和 14.6 个月[33 例]）。Clavien-Dindo 并发症发生率（≥3 级）为 29.4%。
与非手术治疗相比，CRS 可改善 CRC-PC 的结果。完整切除和疾病负担较低的获益最大。CRS（伴或不伴腹腔加热化疗）的结果正在改善，CRC-PC 的手术治疗应常规考虑。
