Herold Zoltan, Acs Miklos, Szasz Attila Marcell, Olasz Katalin, Hussong Jana, Mayr Max, Dank Magdolna, Piso Pompiliu
Division of Oncology, Department of Internal Medicine and Oncology, Semmelweis University, H-1083 Budapest, Hungary.
Department of General and Visceral Surgery, Hospital Barmherzige Brüder, D-93049 Regensburg, Germany.
Cancers (Basel). 2022 Aug 17;14(16):3978. doi: 10.3390/cancers14163978.
Mucinous adenocarcinoma is a frequent subtype in colorectal cancer (CRC). A higher initial T-stage, poorer differentiation, worse response to anti-tumor therapies, and shorter survival are characteristic of mucinous CRC. Moreover, the therapeutic benefit of cytoreductive surgery with hyperthermic intraperitoneal chemotherapy (CRS + HIPEC) in mucinous CRC has not been significantly investigated.
A retrospective analysis of 218 CRC patients with synchronous or metachronous peritoneal metastases was conducted.
129 and 89 patients had synchronous and metachronous metastases, and 36 (27.8%) and 22 (24.8%) of these were mucinous CRC, respectively. Mucinous CRC was more frequent in the proximal colon, with a higher T-stage and N-stage and with an average peritoneal carcinomatosis index that was 2 values higher. Disease-specific survival was significantly worse in the synchronous mucinous group (median survival: 22.4 months vs. 36.3 months, = 0.0229). In contrast, no such difference was observed in the metachronous cohort (32.6 months vs. 34.4 months, = 0.6490).
In the case of synchronous peritoneal metastases originating from mucinous CRC, the positive effect of CRS+HIPEC cannot be verified, and the added value of this highly invasive treatment is therefore somewhat questioned. However, CRS + HIPEC is recommended for metachronous metastases, since no difference between the two CRC-subtypes could be verified.
黏液腺癌是结直肠癌（CRC）中常见的一种亚型。黏液性结直肠癌的特征是初始T分期较高、分化较差、对抗肿瘤治疗反应较差以及生存期较短。此外，对于黏液性结直肠癌，减瘤手术联合热灌注化疗（CRS+HIPEC）的治疗益处尚未得到充分研究。
对218例伴有同步或异时性腹膜转移的结直肠癌患者进行回顾性分析。
129例和89例患者分别有同步和异时性转移，其中黏液性结直肠癌分别为36例（27.8%）和22例（24.8%）。黏液性结直肠癌在近端结肠更为常见，T分期和N分期更高，平均腹膜癌指数高出2个值。同步黏液性组的疾病特异性生存期明显较差（中位生存期：22.4个月对36.3个月，P=0.0229）。相比之下，在异时性队列中未观察到此类差异（32.6个月对34.4个月，P=0.6490）。
对于源自黏液性结直肠癌的同步腹膜转移，无法证实CRS+HIPEC的积极效果，因此这种高侵袭性治疗的附加价值受到一定质疑。然而，对于异时性转移，建议采用CRS+HIPEC，因为在这两种结直肠癌亚型之间未证实有差异。
