Uppal Abhineet, Helmink Beth, Grotz Travis E, Konishi Tsuyoshi, Fournier Keith F, Nguyen Sa, Taggart Melissa W, Shen John Paul, Bednarski Brian K, You Yi-Qian N, Chang George J
Department of Colon and Rectal Surgery, University of Texas MD Anderson Cancer Center, Houston, TX, USA.
Department of Surgery, Washington University School of Medicine, St Louis, MO, USA.
Ann Surg Oncol. 2022 Mar 19. doi: 10.1245/s10434-022-11472-w.
Patients with T4 colon adenocarcinomas have an increased risk of peritoneal metastases (PM) but the histopathologic risk factors for its development are not well-described.
The purpose of this study was to determine factors associated with PM, time to recurrence, and survival after recurrence among patients with T4 colon cancer.
Patients with pathologic T4 colon cancer who underwent curative resection from 2005 to 2017 were identified from a prospectively maintained institutional database and classified by recurrence pattern: (a) none - 68.8%; (b) peritoneal only - 7.9%; (c) peritoneal and extraperitoneal - 9.9%; and (d) extraperitoneal only - 13.2%. Associations between PM development and patient, primary tumor, and treatment factors were assessed.
Overall, 151 patients were analyzed, with a median follow-up of 66.2 months; 27 patients (18%) developed PM (Groups B and C) and 20 (13%) patients recurred at non-peritoneal sites only (Group D). Median time to developing metastases was shorter for Groups B and C compared with Group D (B and C: 13.7 months; D: 46.7 months; p = 0.022). Tumor deposits (TDs) and nodal stage were associated with PM (p < 0.05), and TDs (p = 0.048) and LVI (p = 0.015) were associated with additional extraperitoneal recurrence. Eleven (41%) patients with PM underwent salvage surgery, and median survival after recurrence was associated with the ability to undergo cytoreduction (risk ratio 0.20, confidence interval 0.06-0.70).
PM risk after resection of T4 colon cancer is independently associated with factors related to lymphatic spread, such as N stage and TDs. Well-selected patients can undergo cytoreduction with long-term survival. These findings support frequent postoperative surveillance and aggressive early intervention, including cytoreduction.
T4期结肠腺癌患者发生腹膜转移（PM）的风险增加，但其发生的组织病理学危险因素尚未得到充分描述。
本研究旨在确定T4期结肠癌患者中与PM、复发时间及复发后生存相关的因素。
从一个前瞻性维护的机构数据库中识别出2005年至2017年间接受根治性切除的病理T4期结肠癌患者，并根据复发模式进行分类：（a）无复发 - 68.8%；（b）仅腹膜转移 - 7.9%；（c）腹膜和腹膜外转移 - 9.9%；（d）仅腹膜外转移 - 13.2%。评估PM发生与患者、原发肿瘤及治疗因素之间的关联。
总体分析了151例患者，中位随访时间为66.2个月；27例患者（18%）发生PM（B组和C组），20例患者（13%）仅在非腹膜部位复发（D组）。与D组相比，B组和C组发生转移的中位时间更短（B组和C组：13.7个月；D组：46.7个月；p = 0.022）。肿瘤结节（TDs）和淋巴结分期与PM相关（p < 0.05），TDs（p = 0.048）和淋巴管浸润（LVI，p = 0.015）与额外的腹膜外复发相关。11例（41%）发生PM的患者接受了挽救性手术，复发后的中位生存与减瘤能力相关（风险比0.20，置信区间0.06 - 0.70）。
T4期结肠癌切除术后的PM风险与淋巴转移相关因素独立相关，如N分期和TDs。经过精心挑选的患者可进行减瘤手术并获得长期生存。这些发现支持术后频繁监测和积极的早期干预，包括减瘤手术。
