The Ohio State University Comprehensive Cancer Center, Columbus, OH, USA.
Johns Hopkins University, Baltimore, MD, USA.
Ann Surg Oncol. 2023 Mar;30(3):1840-1849. doi: 10.1245/s10434-022-12753-0. Epub 2022 Oct 30.
The long-term prognosis of patients who undergo cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) for peritoneal surface malignancies (PSM) varies considerably on the basis of histological and operative factors. While overall survival (OS) estimates are used to inform adjuvant therapy and surveillance strategies, conditional survival may provide more clinically relevant estimates of prognosis by accounting for disease-free time elapsed.
All patients from 12 academic institutions who underwent CRS ± HIPEC for PSM from 2000 to 2017 were retrospectively analyzed. OS and disease-free survival (DFS) rates were calculated using the Kaplan-Meier method while conditional overall (COS) and conditional disease-free survival (CDFS) rates were calculated at 1, 2, or 3 years from surgery for different tumor histologies.
Overall, 1610 patients underwent CRS ± HIPEC. Among patients with benign appendiceal mucinous tumors (N = 460), 5-year OS and COS at 3 years were 92.1% and 96.3% (Δ4.2%), respectively. For patients with well-differentiated appendiceal cancers (N = 400), 5-year OS and COS at 3 years were 76.3% and 88.3% (Δ12.0%), respectively. For patients with high-grade appendiceal cancers (N = 258), 5-year OS and COS at 3 years were 43.8% and 75.4% (Δ31.6%), respectively. For patients with colorectal cancers (N = 362), 5-year OS and COS at 3 years were 31.8% and 67.3% (Δ35.5%), respectively. For patients with peritoneal mesothelioma (N = 130), 5-year OS and COS at 3 years were 67.6% and 89.7% (Δ22.1%), respectively. Similar trends were observed for DFS/CDFS.
The conditional survival of patients undergoing CRS ± HIPEC for PSM is associated with tumor histology. COS and CDFS provide a more accurate, dynamic estimate of survival than OS and DFS, especially for patients with more aggressive histologies.
接受细胞减灭术（CRS）和腹腔热灌注化疗（HIPEC）治疗腹膜表面恶性肿瘤（PSM）的患者的长期预后因组织学和手术因素而有很大差异。虽然总体生存率（OS）估计值用于告知辅助治疗和监测策略，但通过考虑无疾病时间的流逝，条件生存率可能提供更具临床相关性的预后估计。
回顾性分析了 2000 年至 2017 年期间，12 个学术机构的所有接受 CRS±HIPEC 治疗 PSM 的患者。使用 Kaplan-Meier 方法计算 OS 和无病生存率（DFS），并根据不同肿瘤组织学，在手术后 1、2 或 3 年计算条件总生存率（COS）和条件无病生存率（CDFS）。
总体而言，有 1610 名患者接受了 CRS±HIPEC。在良性阑尾粘液性肿瘤患者（N=460）中，5 年 OS 和 3 年时的 COS 分别为 92.1%和 96.3%（Δ4.2%）。对于分化良好的阑尾癌患者（N=400），5 年 OS 和 3 年时的 COS 分别为 76.3%和 88.3%（Δ12.0%）。对于高级别阑尾癌患者（N=258），5 年 OS 和 3 年时的 COS 分别为 43.8%和 75.4%（Δ31.6%）。对于结直肠癌患者（N=362），5 年 OS 和 3 年时的 COS 分别为 31.8%和 67.3%（Δ35.5%）。对于腹膜间皮瘤患者（N=130），5 年 OS 和 3 年时的 COS 分别为 67.6%和 89.7%（Δ22.1%）。DFS/CDFS 也观察到类似的趋势。
接受 CRS±HIPEC 治疗 PSM 的患者的条件生存率与肿瘤组织学相关。COS 和 CDFS 比 OS 和 DFS 提供更准确、动态的生存估计，特别是对于具有侵袭性组织学的患者。
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