Department of Surgery, Division of Surgical Oncology and Endocrine Surgery, Section of Surgical Sciences , Vanderbilt University Medical Center, Nashville, Tennessee, USA.
Department of Surgery, Division of Surgical Oncology, Icahn School of Medicine at Mount Sinai University, New York City, New York, USA.
J Surg Oncol. 2023 Mar;127(3):442-449. doi: 10.1002/jso.27136. Epub 2022 Nov 9.
The primary aim of this study is to evaluate the oncologic outcomes of two popular systemic chemotherapy approaches in patients with colorectal peritoneal metastases (CPM) undergoing cytoreductive surgery with hyperthermic intraperitoneal chemotherapy (CRS-HIPEC).
We performed a dual-center retrospective review of consecutive patients who underwent CRS-HIPEC for CPM due to high or intermediate-grade colorectal cancer. Patients in the total neoadjuvant therapy (TNT) group received 6 months of preoperative chemotherapy. Patients in the "sandwich" (SAND) chemotherapy group received 3 months of preoperative chemotherapy with a maximum of 3 months of postoperative chemotherapy.
A total of 34 (43%) patients were included in the TNT group and 45 (57%) patients in the SAND group. The median overall survival (OS) in the TNT and SAND groups were 77 and 61 months, respectively (p = 0.8). Patients in the TNT group had significantly longer recurrence-free survival (RFS) than the SAND group (29 vs. 12 months, p = 0.02). In a multivariable analysis, the TNT approach was independently associated with improved RFS.
In this retrospective study, a TNT approach was associated with improved RFS, but not OS when compared with a SAND approach. Further prospective studies are needed to examine these systemic chemotherapeutic approaches in patients with CPM undergoing CRS-HIPEC.
本研究的主要目的是评估在接受细胞减灭术联合腹腔热灌注化疗（CRS-HIPEC）的结直肠腹膜转移（CPM）患者中，两种流行的全身化疗方法的肿瘤学结局。
我们对连续接受 CRS-HIPEC 治疗的高或中分化结直肠癌 CPM 患者进行了双中心回顾性研究。全新辅助治疗（TNT）组的患者接受 6 个月的术前化疗。“夹心”（SAND）化疗组的患者接受 3 个月的术前化疗，最多接受 3 个月的术后化疗。
共有 34 例（43%）患者纳入 TNT 组，45 例（57%）患者纳入 SAND 组。TNT 组和 SAND 组的中位总生存期（OS）分别为 77 个月和 61 个月（p=0.8）。TNT 组的无复发生存率（RFS）明显长于 SAND 组（29 个月 vs. 12 个月，p=0.02）。多变量分析显示，TNT 方法与 RFS 的改善独立相关。
在这项回顾性研究中，与 SAND 方法相比，TNT 方法与 RFS 的改善相关，但与 OS 无关。需要进一步的前瞻性研究来检查这些在接受 CRS-HIPEC 的 CPM 患者中应用的全身化疗方法。
