Baron Ekaterina, Sardi Armando, King Mary Caitlin, Nikiforchin Andrei, Lopez-Ramirez Felipe, Nieroda Carol, Gushchin Vadim, Ledakis Panayotis
Surgical Oncology Department, The Institute for Cancer Care, Mercy Medical Center, Baltimore, MD, 21202, USA.
Surgical Oncology Department, The Institute for Cancer Care, Mercy Medical Center, Baltimore, MD, 21202, USA.
Eur J Surg Oncol. 2023 Jan;49(1):179-187. doi: 10.1016/j.ejso.2022.08.022. Epub 2022 Sep 2.
There are no available data on the efficacy of adjuvant chemotherapy (ACT) in stage IVA/B high-grade mucinous appendiceal cancer treated with CRS/HIPEC. We evaluated the association between ACT and survival in this cohort.
A single-institution retrospective cohort study using a prospective database was conducted. Stage IVA/B high-grade mucinous appendiceal cancer patients who underwent CRS/HIPEC with CC-0/1 were included. Survival was compared between ACT and no chemotherapy (NoCT) patients. Subgroup analysis was performed with adjustment for confounding variables.
We identified 180 patients: 77 ACT and 103 NoCT. ACT regimens included 5-FU/capecitabine (13%), oxaliplatin-based (63%), and irinotecan-based (21%), combined with bevacizumab in 27% of cases. Median number of cycles was 9 (IQR: 6-12). Median overall survival (OS) did not significantly differ between ACT and NoCT (53 vs 75 months, p = 0.566). Multivariable Cox regression showed no OS benefit for ACT vs NoCT in patients with neoadjuvant chemotherapy (HR 1.14; 95%CI: 0.38-3.39) or without it (HR 1.33; 95%CI: 0.69-2.57), with signet ring cell (HR 0.89; 95%CI: 0.38-2.06) or other histologies (HR 1.11; 95%CI: 0.50-2.46), positive lymph nodes (HR 1.60; 95%CI: 0.74-3.49), or peritoneal cancer index ≥20 (HR 1.08; 95%CI: 0.55-2.11) after adjusting for other factors.
In our cohort, colon-type ACT was not associated with better OS in stage IVA/B mucinous appendiceal cancer after CRS/HIPEC, even after adjusting for confounders. This may be due to different tumor biology than colon cancer or small sample size. Prospective collaborative studies are needed.
关于辅助化疗（ACT）在接受CRS/HIPEC治疗的IVA/B期高级别黏液性阑尾癌中的疗效，目前尚无可用数据。我们评估了该队列中ACT与生存率之间的关联。
使用前瞻性数据库进行了一项单机构回顾性队列研究。纳入接受CRS/HIPEC且CC-0/1的IVA/B期高级别黏液性阑尾癌患者。比较了接受ACT和未接受化疗（NoCT）患者的生存率。进行了亚组分析，并对混杂变量进行了调整。
我们确定了180例患者：77例接受ACT，103例未接受化疗。ACT方案包括5-氟尿嘧啶/卡培他滨（13%）、奥沙利铂为基础的方案（63%）和伊立替康为基础的方案（21%），27%的病例联合使用了贝伐单抗。中位周期数为9（IQR：6-12）。ACT组和NoCT组的中位总生存期（OS）无显著差异（53个月对75个月，p = 0.566）。多变量Cox回归显示，在新辅助化疗患者（HR 1.14；95%CI：0.38-3.39）或未接受新辅助化疗的患者（HR 1.33；95%CI：0.69-2.57）中，与印戒细胞（HR 0.89；95%CI：0.38-2.06）或其他组织学类型（HR 1.11；95%CI：0.50-2.46）、阳性淋巴结（HR 1.60；95%CI：0.74-3.49）或腹膜癌指数≥20（HR 1.08；95%CI：0.55-2.11）的患者相比，ACT组与NoCT组在调整其他因素后OS无获益。
在我们的队列中，即使在调整混杂因素后，结肠型ACT与CRS/HIPEC术后IVA/B期黏液性阑尾癌的更好OS无关。这可能是由于肿瘤生物学特性与结肠癌不同或样本量较小。需要进行前瞻性协作研究。
