Bakkers Checca, van de Vlasakker Vincent C J, Rovers Koen P B, Lurvink Robin J, Nienhuijs Simon W, Burger Jacobus W A, Creemers Geert-Jan M, Bonhof Cynthia S, Mols Floortje, de Hingh Ignace H J T
Department of Surgery, Catharina Cancer Institute, P.O. Box 1350, 5602 ZA Eindhoven, The Netherlands.
Department of Medical Oncology, Catharina Cancer Institute, P.O. Box 1350, 5602 ZA Eindhoven, The Netherlands.
Cancers (Basel). 2023 Jan 27;15(3):788. doi: 10.3390/cancers15030788.
Purpose-To compare patient-reported outcomes (PROs) of patients undergoing cytoreductive surgery and hyperthermic intraperitoneal chemotherapy (CRS-HIPEC) for colorectal peritoneal metastases to PROs of colorectal cancer (CRC) patients undergoing conventional surgery. Methods-Data were extracted from the CAIRO6 trial (CRS-HIPEC group) and the PROCORE study (conventional surgery group). Nine predefined PROs (derived from the EORTC QLQ-C30 questionnaire) were compared at baseline, in the early postoperative period and one year postoperatively, with correction for treatment with systemic therapy using linear mixed modeling. Results-In total, 331 patients were included: 71 in the CRS-HIPEC group and 260 in the conventional surgery group. All predefined PROs (fatigue, diarrhea, C30 summary score, Global Health Status, physical, role, emotional, cognitive, and social functioning) did not differ significantly between the groups at all three timepoints, and differential effects over time for all PROs did not differ significantly between the groups. Significant worsening of fatigue, C30 summary score, physical and role functioning (both groups), and cognitive and social functioning (conventional surgery group only) was present in the early postoperative period. All scores returned to baseline at one year postoperatively, except for physical and cognitive functioning in the conventional surgery group. Emotional functioning improved postoperatively in both groups compared to baseline. Conclusion-Despite a more extensive procedure with greater risk of morbidity, CRS-HIPEC in patients with colorectal peritoneal metastases did not have a greater negative impact on PROs than conventional surgery in patients with CRC. Further, systemic therapy did not affect these PROs. These findings may facilitate future patient counseling and shared decision making in clinical practice.
目的——比较接受减瘤手术及腹腔热灌注化疗（CRS-HIPEC）治疗结直肠腹膜转移患者与接受传统手术的结直肠癌（CRC）患者的患者报告结局（PROs）。方法——数据取自CAIRO6试验（CRS-HIPEC组）和PROCORE研究（传统手术组）。采用线性混合模型对9项预先定义的PROs（源自欧洲癌症研究与治疗组织QLQ-C30问卷）在基线、术后早期及术后1年进行比较，并对全身治疗进行校正。结果——共纳入331例患者：CRS-HIPEC组71例，传统手术组260例。在所有三个时间点，两组间所有预先定义的PROs（疲劳、腹泻、C30总结评分、总体健康状况、身体、角色、情感、认知和社会功能）均无显著差异，且两组间所有PROs随时间的差异效应也无显著差异。术后早期出现疲劳、C30总结评分、身体和角色功能（两组）以及认知和社会功能（仅传统手术组）的显著恶化。除传统手术组的身体和认知功能外，所有评分在术后1年均恢复至基线水平。与基线相比，两组术后情感功能均有所改善。结论——尽管CRS-HIPEC手术范围更广、发病风险更高，但结直肠腹膜转移患者接受CRS-HIPEC对PROs的负面影响并不比CRC患者接受传统手术更大。此外，全身治疗并未影响这些PROs。这些发现可能有助于未来临床实践中的患者咨询和共同决策。
