Vanderbilt University Medical Center, Section of Surgical Sciences, Department of Surgery, Division of Surgical Oncology and Endocrine Surgery, Nashville, Tennessee.
Icahn School of Medicine at Mount Sinai University, Department of Surgery, Division of Surgical Oncology, New York, New York.
J Surg Res. 2023 Apr;284:94-100. doi: 10.1016/j.jss.2022.10.085. Epub 2022 Dec 21.
Many patients undergoing cytoreductive surgery with hyperthermic intraperitoneal chemotherapy (CRS-HIPEC) for appendiceal adenocarcinoma peritoneal metastases (APM) undergo preoperative systemic chemotherapy. The primary aim of this study is to evaluate differences in oncologic outcomes among two popular chemotherapy approaches in patients with APM undergoing CRS-HIPEC.
We performed a multicenter retrospective review of patients who underwent CRS-HIPEC for APM due to high or intermediate grade disease between 2013 and 2019. Patients in the total neoadjuvant therapy group (TNT) received 12 cycles of preoperative chemotherapy. Patients in the "sandwich" chemotherapy group (SAND) received six cycles of preoperative chemotherapy with a maximum of six cycles of postoperative chemotherapy. The primary outcomes were overall survival (OS) and recurrence-free survival (RFS) defined as months from date of first treatment or surgery, respectively.
A total of 39 patients were included in this analysis, with 25 (64%) patients in the TNT group and 14 (36%) patients in the SAND group. Patients in the TNT group had a median OS of 62 mo, while median OS in the SAND group was 45 mo (P = 0.01). In addition, patients in the TNT group had significantly longer RFS compared to the SAND group (35 versus 12 mo, P = 0.03). In a multivariable analysis, TNT approach was independently associated with improved OS and RFS.
In this multicenter retrospective analysis, a TNT approach was associated with improved overall and recurrence-free survival compared to a sandwiched chemotherapy approach in patients undergoing CRS-HIPEC for high or intermediate grade APM.
许多接受细胞减灭术联合腹腔热灌注化疗（CRS-HIPEC）治疗阑尾腺癌腹膜转移（APM）的患者在术前接受全身化疗。本研究的主要目的是评估两种在接受 CRS-HIPEC 治疗 APM 的患者中常用的化疗方法在肿瘤学结果方面的差异。
我们对 2013 年至 2019 年间因高级别或中级别疾病而行 CRS-HIPEC 治疗 APM 的患者进行了一项多中心回顾性研究。接受完全新辅助治疗的患者（TNT）接受 12 个周期的术前化疗。接受“夹心”化疗的患者（SAND）接受 6 个周期的术前化疗，最多可接受 6 个周期的术后化疗。主要终点是总生存期（OS）和无复发生存期（RFS），分别定义为首次治疗或手术的时间。
共纳入 39 例患者，其中 TNT 组 25 例（64%），SAND 组 14 例（36%）。TNT 组患者的中位 OS 为 62 个月，而 SAND 组患者的中位 OS 为 45 个月（P=0.01）。此外，TNT 组患者的 RFS 明显长于 SAND 组（35 个月 vs. 12 个月，P=0.03）。在多变量分析中，TNT 方法与 OS 和 RFS 的改善独立相关。
在这项多中心回顾性分析中，与夹心化疗方法相比，TNT 方法在接受 CRS-HIPEC 治疗高级别或中级别 APM 的患者中与改善的总体生存率和无复发生存率相关。
