揭示恶性腹水在晚期胃肠道癌症中的预后意义：腹膜癌病负担的一个标志物。
Unveiling the prognostic significance of malignant ascites in advanced gastrointestinal cancers: a marker of peritoneal carcinomatosis burden.
作者信息
Provenzano Leonardo, Gwee Yong Xiang, Conca Veronica, Lonardi Sara, Bozzarelli Silvia, Tamburini Emiliano, Passardi Alessandro, Zaniboni Alberto, Tosi Federica, Aprile Giuseppe, Nasca Vincenzo, Boccaccino Alessandra, Ambrosini Margherita, Vetere Guglielmo, Carullo Martina, Guaglio Marcello, Battaglia Luigi, Zhao Joseph Jonathan, Chia Daryl Kai Ann, Yong Wei Peng, Tan Patrick, So Jimmy, Kim Guowei, Shabbir Asim, Ong Chin-Ann Johnny, Casella Francesco, Cremolini Chiara, Bencivenga Maria, Sundar Raghav, Pietrantonio Filippo
机构信息
Medical Oncology Department, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy.
Department of Haematology-Oncology, National University Cancer Institute, Singapore, Singapore.
出版信息
Ther Adv Med Oncol. 2024 Nov 4;16:17588359241289517. doi: 10.1177/17588359241289517. eCollection 2024.
BACKGROUND
Ascites is common in advanced gastrointestinal cancers with peritoneal metastases (PM) and negatively impacts patient survival. No study to date has specifically evaluated the relationship between ascites, PM and survival outcomes in metastatic colorectal cancer (mCRC) and metastatic gastric cancer (mGC).
OBJECTIVES
This study aims to investigate and elucidate the relationship between malignant ascites, PM and survival outcomes in both mCRC and mGC patients.
DESIGN
This is a retrospective analysis of prospectively collected clinical trial data of mCRC and mGC patients with PM.
METHODS
We performed two pooled analyses, firstly of two Italian randomized trials enrolling patients with mCRC eligible for systemic therapy (TRIBE2; VALENTINO), and secondly of gastric cancer and peritoneal metastasis (GCPM) patients who underwent bi-directional therapeutic treatment comprising systemic and peritoneal-directed therapies.
RESULTS
Of 900 mCRC patients, 39 (4.3%) had PM with malignant ascites. Compared to the group without PM, median progression-free and overall survival were significantly inferior in the ascites group (hazard ratio (HR) for progression-free survival (PFS) 1.68, 95% confidence interval (CI): 1.21-2.35, = 0.007; HR for overall survival (OS) 2.14, 95% CI: 1.57-3.01, < 0.001), but not in the group of PM without ascites (HR for PFS 1.10, 95% CI: 0.91 - 1.34; HR for OS 1.04, 95% CI: 0.84 - 1.30). Of 170 patients with GCPM, those with ascites had higher median Peritoneal Cancer Index scores (23 vs 9, < 0.001). Median OS was significantly inferior among those with ascites compared to those without (13.0 vs 21.0 months, HR 1.71, 95% CI: 1.16-2.52, = 0.007).
CONCLUSION
Ascites identifies a subgroup of patients with PM and poor outcomes, for whom tailored research are needed.
背景
腹水在伴有腹膜转移（PM）的晚期胃肠道癌症中很常见，并且对患者生存产生负面影响。迄今为止，尚无研究专门评估转移性结直肠癌（mCRC）和转移性胃癌（mGC）中腹水、PM与生存结局之间的关系。
目的
本研究旨在调查并阐明mCRC和mGC患者中恶性腹水、PM与生存结局之间的关系。
设计
这是一项对前瞻性收集的mCRC和mGC伴PM患者的临床试验数据进行的回顾性分析。
方法
我们进行了两项汇总分析，第一项分析纳入两项意大利随机试验中符合全身治疗条件的mCRC患者（TRIBE2；VALENTINO），第二项分析纳入接受包括全身和腹膜定向治疗的双向治疗的胃癌和腹膜转移（GCPM）患者。
结果
在900例mCRC患者中，39例（4.3%）有伴恶性腹水的PM。与无PM的组相比，腹水组的无进展生存期和总生存期的中位数显著较差（无进展生存期（PFS）的风险比（HR）为1.68，95%置信区间（CI）：1.21 - 2.35，P = 0.007；总生存期（OS）的HR为2.14，95%CI：1.57 - 3.01，P < 0.001），但在无腹水的PM组中并非如此（PFS的HR为1.10，95%CI：0.91 - 1.34；OS的HR为1.04，95%CI：0.84 - 1.30）。在170例GCPM患者中，有腹水的患者腹膜癌指数评分中位数更高（23对9，P < 0.001）。有腹水的患者的OS中位数明显低于无腹水的患者（13.0对21.0个月，HR 1.71，95%CI：1.16 - 2.52，P = 0.007）。
结论
腹水可识别出一组PM且预后较差的患者，对此需要开展针对性研究。
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