Department of Surgical Oncology, Nagasaki University Graduate School of Biomedical Science, 1-7-1 Sakamoto, Nagasaki, 852-8501, Japan.
Department of Surgery, Isahaya General Hospital, 24-1 Isahaya, Nagasaki, 854-8501, Japan.
Int J Colorectal Dis. 2023 Apr 18;38(1):101. doi: 10.1007/s00384-023-04407-8.
Several guidelines have recommended surgical resection for localized peritoneal metastases, but the prognosis remains poor. In addition, the efficacy of adjuvant chemotherapy (AC) after curative resection is under debate. The present study compared long-term outcomes between curative and non-curative resection and evaluated the effects of AC after curative resection.
Using a multicenter database, we retrospectively reviewed 123 colorectal cancer patients with peritoneal metastases between April 2016 and December 2021. Of these patients, 49 underwent curative resection, and 74 underwent non-curative resection.
The frequency of broad metastases was lower in the curative resection group (8.2%) than in the non-curative resection group (43.2%, p < 0.001). Among all patients, 5-year overall survival rate was higher in the curative resection group (43.0%) than in the non-curative resection group (7.3%, p = 0.004). Among patients who underwent curative resection, 5-year overall survival rate was significantly higher in the AC group (48.2%) than in the non-AC group (38.1%, p = 0.037). Multivariate analysis of all patients revealed pathological N status and non-curative resection as independent predictors of overall survival. In patients who underwent curative resection, advanced age was an independent predictor of relapse-free survival, and AC was an independent predictor of overall survival.
This multicenter study of colorectal cancer patients with peritoneal metastases revealed that prognosis was more favorable for curable cases than for non-curable cases. Prognosis was more favorable in the AC group than in the non-AC group after curative resection.
有几项指南建议对局部腹膜转移灶进行手术切除，但预后仍然较差。此外，根治性切除术后辅助化疗（AC）的疗效存在争议。本研究比较了根治性和非根治性切除的长期结果，并评估了根治性切除术后 AC 的效果。
本研究使用多中心数据库，回顾性分析了 2016 年 4 月至 2021 年 12 月期间的 123 例结直肠癌腹膜转移患者。其中 49 例患者接受根治性切除术，74 例患者接受非根治性切除术。
在根治性切除组中广泛转移的频率较低（8.2%），而非根治性切除组中广泛转移的频率较高（43.2%，p<0.001）。在所有患者中，根治性切除组的 5 年总生存率（43.0%）高于非根治性切除组（7.3%，p=0.004）。在接受根治性切除术的患者中，AC 组的 5 年总生存率（48.2%）显著高于非 AC 组（38.1%，p=0.037）。多变量分析显示，病理 N 状态和非根治性切除术是总生存的独立预测因素。在接受根治性切除术的患者中，年龄较大是无复发生存的独立预测因素，而 AC 是总生存的独立预测因素。
本研究对结直肠癌腹膜转移患者进行了多中心研究，结果显示可治愈病例的预后优于不可治愈病例。根治性切除术后，AC 组的预后优于非 AC 组。
