Peritoneal Malignancy Institute, Basingstoke North Hampshire Hospital Foundation Trust, Basingstoke, UK.
Ann Surg Oncol. 2024 Dec;31(13):8585-8595. doi: 10.1245/s10434-024-15942-1. Epub 2024 Aug 11.
The presence at diagnosis, or development of, colorectal peritoneal metastases (CPM) is common in colorectal cancer. Cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) show promising results in selected patients with CPM. The current study aimed to describe oncologic outcomes of patients with CPM, focusing on recurrence patterns and risk factors for adverse events.
We conducted a retrospective review of patients with CPM treated by CRS and HIPEC at a single institution between 2000 and 2021.
A total of 555 patients were included, of whom 480 (86.5%) had complete cytoreduction, with a median age of 59 years and median Peritoneal Cancer Index (PCI) of 6. Following complete cytoreduction, 5-year overall survival (OS) and disease-free survival (DFS) were 51% and 31%, respectively. In multivariable Cox regression, PCI >6 (hazard ratio [HR] 2.25), pathological node positivity (pN+; HR 1.94), and perineural invasion (HR 1.85) were associated with decreased OS, while PCI >6, pN+, and previous systemic metastases resulted in reduced DFS. Overall, 284 (62%) patients developed recurrence, of whom 97 (34%) had local recurrence (LR), 100 (35%) had systemic recurrence (SR), and 87 (31%) had combined recurrence (5-year OS: 49.3%, 46%, and 37.4%, respectively). Mutated KRAS (mKRAS) was associated with lower 5-year OS (55.8%) and DFS (27.9%) compared with wild-type KRAS (wtKRAS; 70.7% and 37.6%, respectively). In multivariable analyses, mKRAS was related to decreased OS (HR 1.82), DFS (HR 1.55), and SR (OS 1.89), but not to LR.
Complete cytoreduction results in good survival outcomes for patients with CPM. Burden of peritoneal disease and tumor biology are the main predictors of survival. Patients with mKRAS are a high-risk cohort, with increased probability of SR and reduced survival.
结直肠癌患者在诊断时或诊断后常出现结直肠腹膜转移（CPM）。细胞减灭术（CRS）和腹腔热灌注化疗（HIPEC）在有 CPM 的选定患者中显示出良好的效果。本研究旨在描述 CPM 患者的肿瘤学结果，重点关注复发模式和不良事件的危险因素。
我们对 2000 年至 2021 年期间在一家机构接受 CRS 和 HIPEC 治疗的 CPM 患者进行了回顾性研究。
共纳入 555 例患者，其中 480 例（86.5%）完全减瘤，中位年龄为 59 岁，中位腹膜肿瘤指数（PCI）为 6。完全减瘤后，5 年总生存率（OS）和无病生存率（DFS）分别为 51%和 31%。多变量 Cox 回归分析显示，PCI>6（风险比[HR]2.25）、病理淋巴结阳性（pN+；HR 1.94）和神经周围侵犯（HR 1.85）与 OS 降低相关，而 PCI>6、pN+和先前的全身转移与 DFS 降低相关。总体而言，284 例（62%）患者出现复发，其中 97 例（34%）发生局部复发（LR），100 例（35%）发生全身复发（SR），87 例（31%）发生联合复发（5 年 OS：分别为 49.3%、46%和 37.4%）。与野生型 KRAS（wtKRAS；分别为 70.7%和 37.6%）相比，KRAS 突变（mKRAS）与较低的 5 年 OS（55.8%）和 DFS（27.9%）相关。多变量分析显示，mKRAS 与 OS 降低（HR 1.82）、DFS 降低（HR 1.55）和 SR 相关（OS 1.89），但与 LR 无关。
CPM 患者完全减瘤可获得良好的生存结果。腹膜疾病负担和肿瘤生物学是生存的主要预测因素。mKRAS 患者是高危人群，SR 发生率增加，生存率降低。
