接受或未接受热灌注化疗的结直肠癌腹膜转移患者的长期细胞减灭治疗结果
Long-Term Cytoreduction Outcomes With or Without Heated Intraperitoneal Chemotherapy For Colorectal Peritoneal Metastases.
作者信息
White Michael G, Smith Paula Marincola, Bhutiani Neal, Helmink Beth, Galbraith Norman, Kopetz Scott, Overman Michael, Mansfield Paul, Fournier Keith, Uppal Abhineet
机构信息
From the Departments of Colon & Rectal Surgery (White, Bhutiani, Galbraith, Uppal), The University of Texas MD Anderson Cancer Center, Houston, TX.
Surgical Oncology (Smith, Helmink, Mansfield, Fournier), The University of Texas MD Anderson Cancer Center, Houston, TX.
出版信息
J Am Coll Surg. 2025 Jul 1;241(1):28-37. doi: 10.1097/XCS.0000000000001355. Epub 2025 Jun 13.
BACKGROUND
Patients with peritoneal metastases from colorectal adenocarcinoma (CRC) benefit from cytoreductive surgery (CRS). However, the role of heated intraperitoneal chemotherapy (HIPEC) remains unclear. We studied associations between HIPEC, peritoneal disease-free survival (PDFS), and overall survival (OS) in patients with CRC undergoing CRS.
STUDY DESIGN
All patients with CRC undergoing CRS between 2008 and 2023 were retrospectively identified at our center. Patient clinicodemographic factors were determined by chart review. OS and PDFS were evaluated using the Kaplan-Meier method. Associations between clinical factors and survival were determined using Cox proportional hazard models.
RESULTS
A total of 147 patients were identified with 24.5-month median follow-up. Most patients (111; 75.5%) had a low peritoneal cancer index (PCI; less than 11), whereas 36 patients (24.5%) had high PCI (11 or more). Eighty-three patients (55.8%) had CRS alone. Sixty-four patients underwent CRS with HIPEC (42 [66%] mitomycin C [MMC], 19 [30%] oxaliplatin [OX], 3 [4.7%] cisplatin). The median OS was 59.8 (95% CI 41.7 to 83.0) months. The median PDFS was 13.3 (95% CI 10.4 to 18.5) months. OS was equivalent comparing HIPEC with MMC, HIPEC with OX (hazard ratio [HR] 0.49, 95% CI 0.22 to 1.09, p = 0.08), and CRS alone (HR 0.74, 95% CI 0.41 to 1.32, p = 0.31). Multivariable analysis showed only PCI was associated with OS (HR 1.08, 95% CI 1.03 to 1.14, p = 0.003). Low PCI patients had similar PDFS after CRS-HIPEC (HR 1.07, 95% CI 0.61 to 1.87, p = 0.814) compared with CRS alone. High PCI patients had improved OS comparing CRS-HIPEC with CRS (MMC: HR 0.17, 95% CI 0.04 to 0.76, p = 0.02; OX: HR 0.048, 95% CI 0.006 to 0.37, p = 0.004).
CONCLUSIONS
HIPEC was not associated with OS or PDFS in patients with PCI 10 or less but was associated with improved OS and PDFS in patients with PCI 11 or more. The use of HIPEC for high PCI may be warranted, although randomized prospective data are needed to confirm this.
背景
结直肠癌（CRC）腹膜转移患者可从减瘤手术（CRS）中获益。然而，热灌注化疗（HIPEC）的作用仍不明确。我们研究了接受CRS的CRC患者中HIPEC、无腹膜疾病生存期（PDFS）和总生存期（OS）之间的关联。
研究设计
回顾性确定2008年至2023年间在本中心接受CRS的所有CRC患者。通过查阅病历确定患者的临床人口统计学因素。采用Kaplan-Meier法评估OS和PDFS。使用Cox比例风险模型确定临床因素与生存期之间的关联。
结果
共纳入147例患者，中位随访时间为24.5个月。大多数患者（111例；75.5%）腹膜癌指数（PCI）较低（小于11），而36例患者（24.5%）PCI较高（11或更高）。83例患者（55.8%）仅接受了CRS。64例患者接受了CRS联合HIPEC（42例[66%]使用丝裂霉素C[MMC]，19例[30%]使用奥沙利铂[OX]，3例[4.7%]使用顺铂）。中位OS为59.8（95%CI 41.7至83.0）个月。中位PDFS为13.3（95%CI 10.4至18.5）个月。比较HIPEC联合MMC、HIPEC联合OX（风险比[HR]0.49，95%CI 0.22至1.09，p = 0.08）和单纯CRS，OS相当（HR 0.74，95%CI 0.41至1.32，p = 0.31）。多变量分析显示，仅PCI与OS相关（HR 1.08，95%CI 1.03至1.14，p = 0.003）。与单纯CRS相比，低PCI患者在CRS-HIPEC后的PDFS相似（HR 1.07，95%CI 0.61至1.87，p = 0.814）。与CRS相比（MMC：HR 0.17，95%CI 0.04至0.76，p = 0.02；OX：HR 0.048，95%CI 0.006至0.37，p = 0.004），高PCI患者的OS有所改善。
结论
对于PCI为10或更低的患者，HIPEC与OS或PDFS无关，但对于PCI为11或更高的患者，HIPEC与OS和PDFS的改善相关。尽管需要随机前瞻性数据来证实，但对于高PCI患者使用HIPEC可能是合理的。
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