Department of Digestive, Hepatobiliary and Liver Transplantation Surgery, Hôpital de la Pitié Salpêtrière, Assistance Publique-Hôpitaux de Paris and Sorbonne Université, Paris, France.
Sorbonne University, Paris, France.
J Surg Oncol. 2023 Sep;128(4):576-584. doi: 10.1002/jso.27359. Epub 2023 May 25.
In patients at high risk of peritoneal metastasis (PM) recurrence following surgical treatment of colon cancer (CC), second-look laparoscopic exploration (SLLE) is mandatory; however, the best timing is unknown. We created a tool to refine the timing of early SLLE in patients at high risk of PM recurrence.
This international cohort study included patients who underwent CC surgery between 2009 and 2020. All patients had PM recurrence. Factors associated with PM-free survival (PMFS) were assessed using Cox regression. The primary endpoint was early PM recurrence defined as a PMFS of <6 months. A model (logistic regression) was fitted and corrected using bootstrap.
In total, 235 patients were included. The median PMFS was 13 (IQR, 8-22) months, and 15.7% of the patients experienced an early PM recurrence. Synchronous limited PM and/or ovarian metastasis (hazard ratio [HR]: 2.50; 95% confidence interval [CI]: [1.66-3.78]; p < 0.001) were associated with a very high-risk status requiring SLLE. T4 (HR: 1.47; 95% CI: [1.03-2.11]; p = 0.036), transverse tumor localization (HR: 0.35; 95% CI: [0.17-0.69]; p = 0.002), emergency surgery (HR: 2.06; 95% CI: [1.36-3.13]; p < 0.001), mucinous subtype (HR: 0.50; 95% CI [0.30, 0.82]; p = 0.006), microsatellite instability (HR: 2.29; 95% CI [1.06, 4.93]; p = 0.036), KRAS mutation (HR: 1.78; 95% CI: [1.24-2.55]; p = 0.002), and complete protocol of adjuvant chemotherapy (HR: 0.93; 95% CI: [0.89-0.96]; p < 0.001) were also prognostic factors for PMFS. Thus, a model was fitted (area under the curve: 0.87; 95% CI: [0.82-0.92]) for prediction, and a cutoff of 150 points was identified to classify patients at high risk of early PM recurrence.
Using a nomogram, eight prognostic factors were identified to select patients at high risk for early PM recurrence objectively. Patients reaching 150 points could benefit from an early SLLE.
在接受结肠癌（CC）手术治疗后有腹膜转移（PM）复发高风险的患者中，必须进行二次腹腔镜探查（SLLE）；然而，最佳时机尚不清楚。我们创建了一个工具来细化高 PM 复发风险患者的早期 SLLE 时机。
本国际队列研究纳入了 2009 年至 2020 年间接受 CC 手术的患者。所有患者均有 PM 复发。使用 Cox 回归评估与 PM 无复发生存（PMFS）相关的因素。主要终点为早期 PM 复发，定义为 PMFS<6 个月。建立并使用 bootstrap 对模型（逻辑回归）进行校正。
共纳入 235 例患者。中位 PMFS 为 13（IQR，8-22）个月，15.7%的患者发生早期 PM 复发。同步局限性 PM 和/或卵巢转移（风险比[HR]：2.50；95%置信区间[CI]：[1.66-3.78]；p<0.001）与需要 SLLE 的极高风险状态相关。T4（HR：1.47；95%CI：[1.03-2.11]；p=0.036）、肿瘤横向定位（HR：0.35；95%CI：[0.17-0.69]；p=0.002）、紧急手术（HR：2.06；95%CI：[1.36-3.13]；p<0.001）、黏液型亚型（HR：0.50；95%CI [0.30, 0.82]；p=0.006）、微卫星不稳定性（HR：2.29；95%CI [1.06, 4.93]；p=0.036）、KRAS 突变（HR：1.78；95%CI：[1.24-2.55]；p=0.002）和辅助化疗完整方案（HR：0.93；95%CI：[0.89-0.96]；p<0.001）也是 PMFS 的预后因素。因此，拟合了一个模型（曲线下面积：0.87；95%CI：[0.82-0.92]）进行预测，并确定了 150 分的截断值来对早期 PM 复发高风险的患者进行分类。
使用列线图确定了 8 个预后因素，客观地选择有早期 PM 复发高风险的患者。达到 150 分的患者可以从早期 SLLE 中获益。
