Bazarbashi Shouki, Alghabban Abdulrahman, Aseafan Mohamed, Aljubran Ali H, Alzahrani Ahmed, Elhassan Tusneem Am
Oncology Center, King Faisal Specialist Hospital & Research Center, Riyadh 11211, Riyadh, Saudi Arabia.
World J Clin Cases. 2022 Mar 16;10(8):2429-2438. doi: 10.12998/wjcc.v10.i8.2429.
Peritoneal metastasis from colorectal cancer (CRC) carries a poor prognosis in most studies. The majority of those studies used either a single-agent or doublet chemotherapy regimen in the first-line setting.
To investigate the prognostic significance of peritoneal metastasis in a cohort of patients treated with triplet chemotherapy in the first-line setting.
We retrospectively evaluated progression-free survival (PFS) and overall survival (OS) in 51 patients with metastatic CRC treated in a prospective clinical trial with capecitabine, oxaliplatin, irinotecan, and bevacizumab in the first-line setting according to the presence and absence of peritoneal metastasis. Furthermore, univariate and multivariate analyses for PFS and OS were performed to assess the prognostic significance of peritoneal metastasis at the multivariate level.
Fifty-one patients were treated with the above triplet therapy. Fifteen had peritoneal metastasis. The patient characteristics of both groups showed a significant difference in the sidedness of the primary tumor (left-sided primary tumor in 60% of the peritoneal group 86% in the nonperitoneal group, = 0.03) and the presence of liver metastasis (40% for the peritoneal group 75% for the nonperitoneal group, = 0.01). Univariate analysis for PFS showed a statistically significant difference for age less than 65 years ( = 0.034), presence of liver metastasis ( = 0.046), lung metastasis ( = 0.011), and those who underwent metastasectomy ( = 0.001). Only liver metastasis and metastasectomy were statistically significant for OS, with values of 0.001 and 0.002, respectively. Multivariate analysis showed that age (less than 65 years) and metastasectomy were statistically significant for PFS, with values of 0.002 and 0.001, respectively. On the other hand, the absence of liver metastasis and metastasectomy were statistically significant for OS, with values of 0.003 and 0.005, respectively.
Peritoneal metastasis in patients with metastatic CRC treated with first-line triple chemotherapy does not carry prognostic significance at univariate and multivariate levels. Confirmatory larger studies are warranted.
在大多数研究中，结直肠癌（CRC）的腹膜转移预后较差。这些研究大多在一线治疗中使用单药或双药化疗方案。
探讨一线接受三联化疗的患者队列中腹膜转移的预后意义。
我们回顾性评估了51例转移性CRC患者的无进展生存期（PFS）和总生存期（OS），这些患者在一项前瞻性临床试验中一线接受了卡培他滨、奥沙利铂、伊立替康和贝伐单抗治疗，根据有无腹膜转移进行分组。此外，对PFS和OS进行单因素和多因素分析，以评估腹膜转移在多因素水平上的预后意义。
51例患者接受了上述三联疗法。15例有腹膜转移。两组患者的特征在原发肿瘤部位（腹膜转移组60%为左侧原发肿瘤，非腹膜转移组为86%，P = 0.03）和肝转移情况（腹膜转移组为40%，非腹膜转移组为75%，P = 0.01）方面存在显著差异。PFS的单因素分析显示，年龄小于65岁（P = 0.034）、存在肝转移（P = 0.046）、肺转移（P = 0.011）以及接受转移灶切除术的患者（P = 0.001）存在统计学显著差异。对于OS，只有肝转移和转移灶切除术具有统计学显著性，P值分别为0.001和0.002。多因素分析显示，年龄（小于65岁）和转移灶切除术对PFS具有统计学显著性，P值分别为0.002和0.001。另一方面，无肝转移和转移灶切除术对OS具有统计学显著性，P值分别为0.003和0.005。
一线接受三联化疗的转移性CRC患者的腹膜转移在单因素和多因素水平上均不具有预后意义。需要进行更大规模的确证性研究。
