Hübner Martin, Somashekhar S P, Teixeira Farinha Hugo, Abba Julio, Rao Ramya G, Alyami Mohammad, Willaert Wouter
From the Department of Visceral Surgery, University Hospital CHUV and University of Lausanne (UNIL), Lausanne, Switzerland.
Department of Surgical Oncology, Manipal Comprehensive Cancer Centre, Manipal Hospital, Bengaluru, India.
Ann Surg Open. 2022 Oct 24;3(4):e203. doi: 10.1097/AS9.0000000000000203. eCollection 2022 Dec.
The objective of this study is to analyze oncological outcomes of patients with peritoneal metastases (PM) of colorectal origin treated with Pressurized IntraPeritoneal Aerosol Chemotherapy (PIPAC).
PIPAC has been demonstrated to be a feasible and safe novel treatment for patients with PM of various origins. Only small series reports on survival after PIPAC by disease entity.
International retrospective cohort study of consecutive patients with PM of colorectal origin. Outcome measures were overall survival (OS), radiological response according to Response Evaluation Criteria in Solid Tumors (RECIST), histological response (peritoneal regression grading score [PRGS]: complete response: 1-4: no response), change of peritoneal cancer index (PCI), and symptom control.
Seventeen eligible centers compiled 256 non-selected patients (mean age 61 [50.6-69.2], 43% female) and 606 procedures. Sixty-three percent were treated after 2 lines of chemotherapy, median PCI at PIPAC1 was 18 (interquartile range [IQR] = 10-27). Median OS was 19.00 months (IQR = 12.9-29.8) from diagnosis and 9.4 months (IQR = 4.5-16.8) from PIPAC1. One hundred and four of 256 patients (40.6%) had ≥3 procedures (per protocol [pp]) with the following outcomes at PIPAC3: RECIST: 59.3% partial response/stable, 40.7% progression; mean PRGS: 2.1 ± 0.9. Median PCI was 21 (IQR = 15-29) at baseline and 20 (IQR = 12-27) at PIPAC3 ( = 0.02). Fifty-six (54%) and 48 (46%) patients were symptomatic at baseline and PIPAC3, respectively ( = 0.267). Median OS for the pp cohort was 11.9 months (IQR = 10.7-15.0) from PIPAC1. Independent predictors for survival were radiological response (HR = 3.0; 95% CI = 1.6-5.7) and no symptoms (HR = 4.5, 95% CI = 2.2-9.1) at PIPAC3.
Objective treatment response and encouraging survival were demonstrated after PIPAC for colorectal PM. Prospective registry data and comparative studies are now needed in to confirm these data.
本研究的目的是分析接受腹腔加压气雾剂化疗（PIPAC）治疗的结直肠源性腹膜转移（PM）患者的肿瘤学结局。
PIPAC已被证明是一种针对各种来源的PM患者可行且安全的新型治疗方法。目前仅有关于按疾病实体分类的PIPAC治疗后生存情况的小样本系列报道。
对结直肠源性PM的连续患者进行国际回顾性队列研究。结局指标包括总生存期（OS）、根据实体瘤疗效评价标准（RECIST）的影像学反应、组织学反应（腹膜消退分级评分[PRGS]：完全缓解：1 - 4级；无反应）、腹膜癌指数（PCI）的变化以及症状控制情况。
17个符合条件的中心汇总了256例未经过筛选的患者（平均年龄61岁[50.6 - 69.2岁]，43%为女性）以及606次治疗。63%的患者在接受2线化疗后接受治疗，PIPAC1时的PCI中位数为18（四分位间距[IQR]=10 - 27）。从诊断起的OS中位数为19.00个月（IQR = 12.9 - 29.8），从PIPAC1起为9.4个月（IQR = 4.5 - 16.8）。256例患者中有104例（40.6%）接受了≥3次治疗（符合方案[pp]），在PIPAC3时的结局如下：RECIST：59.3%部分缓解/病情稳定，40.7%进展；平均PRGS：2.1±0.9。基线时PCI中位数为21（IQR = 15 - 29），PIPAC3时为20（IQR = 12 - 27）（P = 0.02）。基线时有症状的患者为56例（54%），PIPAC3时为48例（46%）（P = 0.267）。符合方案队列从PIPAC1起OS中位数为11.9个月（IQR = 10.7 - 15.0）。PIPAC3时生存的独立预测因素为影像学反应（HR = 3.0；95%CI = 1.6 - 5.7）和无症状（HR = 4.5，95%CI = 2.2 - 9.1）。
PIPAC治疗结直肠PM后显示出客观的治疗反应和令人鼓舞的生存情况。现在需要前瞻性注册数据和比较研究来证实这些数据。
