Peritoneal Surface Malignancy Unit, Department of Surgery, Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, Milan, Italy.
Unit of Colorectal and Peritoneal Surface Oncology, Department of Surgical Oncology, Tata Memorial Centre, Mumbai, India.
Ann Surg Oncol. 2024 Jan;31(1):556-566. doi: 10.1245/s10434-023-13640-y. Epub 2023 Nov 8.
The available data on the role of perioperative systemic chemotherapy (SC) for diffuse malignant peritoneal mesothelioma (DMPM) patients undergoing (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) is heterogeneous and unstandardized. This study aimed to evaluate the impact of SC on the survival outcomes of DMPM patients undergoing CRS-HIPEC and to identify prognostic factors that affect the decision to administer SC.
Patients who underwent CRS-HIPEC in the National Cancer Institute Milan (1995-2020) were retrospectively analyzed using propensity score-matching of known covariates. The patients were grouped into three groups: group A (neoadjuvant chemotherapy [NACT] and no-SC), group B (no-SC and adjuvant chemotherapy [ACT]), and group C (NACT and ACT). Overall survival (OS) and progression-free survival (PFS) were calculated using the Kaplan-Meir method, and prognostic factors were calculated using the Cox-regression method.
After a median follow-up period of 45 months (95% confidence interval [CI], 6.348-83.652 months) for group A, 115 months (95% CI, 44.379-185.621 months) for group B, and 88 months (95% CI, 3.296-172.704 months) for group C, the study analyzed 154 DMPM patients consisting of matched group A (NACT: 60 + no-SC: 52 = 112), group B (ACT: 38 + no-SC: 38 = 76), and group C (NACT: 31 + ACT: 31 = 62). The patients undergoing ACT had better 5-year OS and PFS than the patients undergoing NACT. In the multivariate analysis, ACT was significantly associated with improved OS by 48% (hazard ratio [HR], 0.52; 95% CI, 0.280-0.965, p = 0.038). For PFS, the association of ACT did not reach statistical significance (HR, 0.531; 95% CI, 0.266-1.058; p = 0.072).
The optimum treatment sequence for DMPM is CRS-HIPEC followed by adjuvant chemotherapy for high-risk patients. Upfront surgery appears preferable to NACT for patients amenable to complete CRS.
目前针对接受细胞减灭术和腹腔热灌注化疗（CRS-HIPEC）的弥漫性恶性腹膜间皮瘤（DMPM）患者围手术期全身化疗（SC）作用的相关数据存在异质性和不标准化。本研究旨在评估 SC 对接受 CRS-HIPEC 的 DMPM 患者生存结果的影响，并确定影响 SC 决策的预后因素。
采用倾向评分匹配已知协变量的方法，对意大利米兰国家癌症研究所（1995-2020 年）接受 CRS-HIPEC 的患者进行回顾性分析。将患者分为三组：A 组（新辅助化疗 [NACT] 加无 SC）、B 组（无 SC 和辅助化疗 [ACT]）和 C 组（NACT 和 ACT）。采用 Kaplan-Meier 法计算总生存期（OS）和无进展生存期（PFS），采用 Cox 回归法计算预后因素。
在中位随访 45 个月（95%置信区间 [CI]，6.348-83.652 个月）后，A 组中有 115 个月（95%CI，44.379-185.621 个月），B 组中有 88 个月（95%CI，3.296-172.704 个月），C 组中有 154 名 DMPM 患者，包括匹配的 A 组（NACT：60+无 SC：52=112）、B 组（ACT：38+无 SC：38=76）和 C 组（NACT：31+ACT：31=62）。接受 ACT 的患者的 5 年 OS 和 PFS 均优于接受 NACT 的患者。多变量分析显示，ACT 使 OS 显著提高 48%（风险比 [HR]，0.52；95%CI，0.280-0.965，p=0.038）。对于 PFS，ACT 的相关性没有达到统计学意义（HR，0.531；95%CI，0.266-1.058；p=0.072）。
DMPM 的最佳治疗顺序是 CRS-HIPEC 后高危患者行辅助化疗。对于可完全进行 CRS 的患者，初始手术优于 NACT。
