Department of Radiology, University Hospital of Saint-Etienne, Saint-Priest-en-Jarez, France.
Department of Radiology, CHU Lyon Sud, Hospices Civils de Lyon, CICLY EMR 3738, Lyon 1 University, Pierre Bénite, France.
Ann Surg Oncol. 2024 Apr;31(4):2378-2390. doi: 10.1245/s10434-023-14840-2. Epub 2024 Jan 3.
Selection of colorectal cancer patients with concomitant peritoneal (PM) and liver metastases (LM) for radical treatment with cytoreductive surgery (CRS), including liver resection and hyperthermic intraperitoneal chemotherapy (HIPEC), needs improvement. This retrospective, monocentric study was designed to evaluate the predictive factors for early recurrence, disease-free survival (DFS), and overall survival (OS) in such patients treated in a referral center.
Consecutive colorectal cancer patients with concomitant LM and PM treated with curative intent with perioperative systemic chemotherapy, simultaneous complete CRS, liver resection, and HIPEC in 2011-2022 were included. Clinical, radiological (before and after preoperative chemotherapy), surgical, and pathological data were investigated, along with long-term oncologic outcomes. A multivariate analysis was performed to identify predictive factors associated with early recurrence (diagnosed <6 months after surgery), DFS, and OS.
Of more than 61 patients included, 31 (47.1%) had pT4 and 27 (40.9%) had pN2 primary tumors. Before preoperative chemotherapy, the median number of LM was 2 (1-4). The median surgical PCI (peritoneal carcinomatosis index) was 3 (5-8.5). The median DFS and OS were 8.15 (95% confidence interval [CI] 5.5-10.1) and 34.1 months (95% CI 28.1-53.5), respectively. In multivariate analysis, pT4 (odds ratio [OR] = 4.14 [1.2-16.78], p = 0.032]) and pN2 (OR = 3.7 [1.08-13.86], p = 0.042) status were independently associated with an early recurrence, whereas retroperitoneal lymph node metastasis (hazard ratio [HR] = 39 [8.67-175.44], p < 0.001) was independently associated with poor OS.
In colorectal cancer patients with concomitant PM and LM, an advanced primary tumor (pT4 and/or pN2) was associated with a higher risk of early recurrence following a radical multimodal treatment, whereas RLN metastases was strongly detrimental for OS.
对于接受细胞减灭术（CRS）联合肝切除术和腹腔内热灌注化疗（HIPEC）的结直肠癌伴腹膜（PM）和肝转移（LM）患者，需要改善选择。本回顾性单中心研究旨在评估在转诊中心接受治疗的此类患者的早期复发、无病生存（DFS）和总生存（OS）的预测因素。
纳入了 2011 年至 2022 年间接受围手术期全身化疗、同时进行完全 CRS、肝切除术和 HIPEC 以治愈为目的的结直肠癌伴同时 LM 和 PM 的连续患者。调查了临床、影像学（术前化疗前后）、手术和病理数据以及长期肿瘤学结果。进行了多变量分析以确定与早期复发（诊断<6 个月后）、DFS 和 OS 相关的预测因素。
超过 61 名患者中，31 名（47.1%）患者的原发肿瘤为 pT4，27 名（40.9%）患者的原发肿瘤为 pN2。术前化疗前，LM 的中位数为 2（1-4）个。手术 PCI（腹膜癌指数）的中位数为 3（5-8.5）。DFS 和 OS 的中位数分别为 8.15（95%置信区间 [CI] 5.5-10.1）和 34.1 个月（95% CI 28.1-53.5）。多变量分析显示，pT4（比值比 [OR] = 4.14 [1.2-16.78]，p = 0.032]）和 pN2（OR = 3.7 [1.08-13.86]，p = 0.042）状态与早期复发独立相关，而腹膜后淋巴结转移（风险比 [HR] = 39 [8.67-175.44]，p < 0.001）与不良 OS 独立相关。
在结直肠癌伴同时 PM 和 LM 的患者中，原发肿瘤进展（pT4 和/或 pN2）与根治性多模态治疗后早期复发的风险增加相关，而 RLN 转移对 OS 有严重影响。
