Hassan Sarah, Malcomson Lee, Soh Yen Jia, Wilson Malcom S, Clouston Hamish, O'Dwyer Sarah T, Kochhar Rohit, Aziz Omer
The Christie Peritoneal and Oncology Centre, Manchester, M20 4 BX, United Kingdom.
Division of Cancer Sciences, School of Medical Sciences, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre, University of Manchester, Manchester, United Kingdom.
Eur J Surg Oncol. 2023 Jan;49(1):202-208. doi: 10.1016/j.ejso.2022.07.019. Epub 2022 Aug 4.
Cytoreductive Surgery and Hyperthermic Intraperitoneal Chemotherapy (CRS/HIPEC) is an established treatment of Colorectal Peritoneal Metastases (CRPM). This study aims to determine the timing and patterns of recurrent disease on imaging following complete CRS/HIPEC.
Retrospective analysis of a national peritoneal tumour service database identified CRPM patients with complete CRS/HIPEC(CC0) from 2005 to-2018. Patients with<2 years follow-up or and those where post-operative histology from the CRS/HIPEC procedure did not confirm CRPM from their original colorectal cancer were excluded. Time to recurrence was measured from surgery to first radiologically illustrated recurrence. CT was the primary modality used, supplemented by PET-CT or MRI if required. Outcomes of interest were survival data (including overall survival (OS), disease-free survival (DFS) and peritoneal-recurrence free survival (PRFS)), timing and patterns of recurrent disease.
146 of the 176 patients identified were eligible for inclusion. Median OS for all study patients was 45.2 months (95% CI 38-53 months), median DFS was 11.7 months (95% CI 9-14 months), and median PRFS was 25.2 months (95% CI 14.7-30 months). Recurrent disease was seen in 112 cases (77%), radiologically classified as intraperitoneal in 50 patients (44%), single site systemic in 21 patients (19%) and multi-site in 41 patients (37%). CT detection rate for disease recurrence was 88%. Subgroup analyses showed that PCI ≥12, positive nodal primary disease and synchronous peritoneal disease were associated with worse outcomes.
Patients selected for CRS/HIPEC for CRPM have an OS > 45 months, with the majority recurring systemically within a year. Peritoneal recurrence is a later event after several years. Surveillance programs in this group should be most intensive in the first 2 years after surgery, using CT with oral and intravenous contrast.
细胞减灭术和热灌注化疗（CRS/HIPEC）是结直肠癌腹膜转移（CRPM）的一种既定治疗方法。本研究旨在确定完全CRS/HIPEC后影像学上复发疾病的时间和模式。
对一个国家腹膜肿瘤服务数据库进行回顾性分析，确定了2005年至2018年接受完全CRS/HIPEC（CC0）的CRPM患者。随访时间<2年的患者以及CRS/HIPEC手术的术后组织学未证实其原发性结直肠癌存在CRPM的患者被排除。从手术到首次影像学显示复发的时间为复发时间。主要使用CT进行检查，如有需要，辅以PET-CT或MRI。感兴趣的结果包括生存数据（包括总生存期（OS）、无病生存期（DFS）和无腹膜复发生存期（PRFS））、复发疾病的时间和模式。
176例确定的患者中有146例符合纳入标准。所有研究患者的中位OS为45.2个月（95%CI 38 - 53个月），中位DFS为11.7个月（95%CI 9 - 14个月），中位PRFS为25.2个月（95%CI 14.7 - 30个月）。112例（77%）出现复发疾病，影像学分类为腹膜内复发50例（44%），单部位全身复发21例（19%），多部位复发41例（37%）。疾病复发的CT检测率为88%。亚组分析表明，腹膜癌指数（PCI）≥12、阳性淋巴结原发性疾病和同步性腹膜疾病与较差的预后相关。
因CRPM而选择CRS/HIPEC治疗的患者的OS>45个月，大多数患者在一年内出现全身复发。腹膜复发是几年后的较晚事件。该组患者的监测计划在术后头2年应最为密集，采用口服和静脉造影剂增强的CT检查。
