Fanget Florian, Kefleyesus Amaniel, Peron Julien, Bonnefoy Isabelle, Villeneuve Laurent, Passot Guillaume, Rousset Pascal, You Benoit, Benzerdjeb Nazim, Glehen Olivier, Kepenekian Vahan
Surgical Oncology Department, Service de Chirurgie Digestive et Oncologique, Hôpital Lyon Sud, Hospices Civils de Lyon, Pierre Bénite, France.
EA3738 CICLY, Université Claude Bernard Lyon 1 (UCBL1), Villeurbanne, France.
Ann Surg Oncol. 2023 Jun;30(6):3304-3315. doi: 10.1245/s10434-023-13150-x. Epub 2023 Feb 2.
Selected patients with colorectal cancer peritoneal metastases (CRPM) could be offered a curative-intent strategy based on complete cytoreductive surgery (CRS), potentially combined with hyperthermic intraperitoneal chemotherapy (HIPEC) and perioperative systemic chemotherapy. The impact of different neoadjuvant systemic chemotherapy (NACT) regimens remains unclear due to a lack of comparative data.
Consecutive CRPM patients from a monocentric database who were treated with complete CRS after single-line NACT were included in this study. Chemotherapy regimens were tailored as a doublet drug (FOLFOX/FOLFIRI) with/without targeted therapy (anti-epidermal growth factor receptor/bevacizumab) and triplet-drug combination (FOLFIRINOX). Morphological response (MR) was assessed using the Response Evaluation Criteria in Solid Tumors criteria, and pathological response (PR) was assessed using the Peritoneal Regression Grading Score (PRGS). Long-term oncologic outcomes were compared.
The cohort comprised 388 patients, including 127, 202, and 59 patients in the doublet, doublet + targeted, and triplet groups, respectively. MR rates were higher in the triplet (68.0%) and doublet + targeted groups (64.2%) when compared with the doublet group (42.4%, p = 0.003). Complete and major PRs were observed in 13.6% and 32.0% of patients, respectively. Higher MR rates were observed after doublet + targeted or triplet regimens, while no difference was observed for PR rates. In multivariate analysis, FOLFIRINOX was independently associated with better overall survival (hazard ratio 0.49, 95% confidence interval 0.25-0.96; p = 0.037). FOLFIRINOX also resulted in a higher rate of severe postoperative complications.
In this retrospective study, a FOLFIRINOX regimen as NACT seemed to result in better long-term outcomes for CRPM patients after complete CRS/HIPEC, although with higher morbidity. Prospective studies are needed, including groups without NACT and those with FOLFIRINOX + bevacizumab.
部分结直肠癌腹膜转移（CRPM）患者可接受基于根治性细胞减灭术（CRS）的治愈性治疗策略，可能联合热灌注腹腔化疗（HIPEC）及围手术期全身化疗。由于缺乏比较数据，不同新辅助全身化疗（NACT）方案的影响尚不清楚。
本研究纳入了来自单中心数据库的连续CRPM患者，这些患者在接受一线NACT后接受了根治性CRS治疗。化疗方案根据双药联合（FOLFOX/FOLFIRI）加或不加靶向治疗（抗表皮生长因子受体/贝伐单抗）以及三药联合（FOLFIRINOX）进行定制。使用实体瘤疗效评价标准评估形态学反应（MR），并使用腹膜消退分级评分（PRGS）评估病理反应（PR）。比较长期肿瘤学结局。
该队列包括388例患者，其中双药联合组、双药联合+靶向治疗组和三药联合组分别有127例、202例和59例患者。与双药联合组（42.4%）相比，三药联合组（68.0%）和双药联合+靶向治疗组（64.2%）的MR率更高（p = 0.003）。分别有13.6%和32.0%的患者观察到完全和主要PR。双药联合+靶向治疗或三药联合方案后的MR率较高，而PR率无差异。在多变量分析中，FOLFIRINOX与更好的总生存期独立相关（风险比0.49，95%置信区间0.25-0.96；p = 0.037）。FOLFIRINOX还导致术后严重并发症的发生率更高。
在这项回顾性研究中，尽管发病率较高，但FOLFIRINOX方案作为NACT似乎能使CRPM患者在接受根治性CRS/HIPEC后获得更好的长期结局。需要进行前瞻性研究，包括无NACT的组以及FOLFIRINOX+贝伐单抗的组。
