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Abstract：
UNASSIGNED: Secondary treatment of recurrent colorectal peritoneal metastases after previous cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) is poorly investigated.
UNASSIGNED: To evaluate the overall survival outcome of secondary (repeat) CRS + HIPEC compared to palliative treatment in recurrent peritoneal disease.
UNASSIGNED: Patients with colorectal peritoneal metastases treated with an index CRS + HIPEC and subsequently having recurrent peritoneal disease were identified from the prospective Swedish national HIPEC registry. Patients were divided into interventional group (secondary CRS + HIPEC) or palliative group. Multivariable logistic regression, propensity-score matching, and survival outcomes were calculated.
UNASSIGNED: Among 575 patients who underwent complete CRS between 2010 and 2021, 208 (36 %) were diagnosed with a subsequent recurrent peritoneal disease. Forty-two patients (20 %) were offered secondary CRS + HIPEC. Propensity-score matching of secondary interventional cases with palliative cases succeeded in 88 % (n = 37) in which female sex, lower peritoneal cancer index at index surgery, longer disease-free interval, and absence of extra-peritoneal metastases were identified as the most relevant matching covariates. Median OS from date of recurrence was 38 months (95%CI 30-58) in the interventional group and 19 months (95%CI: 15-24) in the palliative group (HR 0.35 95%CI: 0.20-0.63, p = 0.0004). Sensitivity analyses confirmed the results. As reference, the median OS from index CRS + HIPEC in the whole colorectal registry (n = 575) was 41 months (95%CI: 38-45).
UNASSIGNED: After matching for relevant factors, the hazard ratio for death was significantly reduced in patients who were offered a secondary CRS + HIPEC procedure for recurrent peritoneal disease. Selection bias is inherent, but survival outcomes were comparable to those achieved after the initial procedure.
UNASSIGNED: To evaluate the overall survival outcome of secondary (repeat) CRS + HIPEC compared to palliative treatment in recurrent peritoneal disease.
UNASSIGNED: Patients with colorectal peritoneal metastases treated with an index CRS + HIPEC and subsequently having recurrent peritoneal disease were identified from the prospective Swedish national HIPEC registry. Patients were divided into interventional group (secondary CRS + HIPEC) or palliative group. Multivariable logistic regression, propensity-score matching, and survival outcomes were calculated.
UNASSIGNED: Among 575 patients who underwent complete CRS between 2010 and 2021, 208 (36 %) were diagnosed with a subsequent recurrent peritoneal disease. Forty-two patients (20 %) were offered secondary CRS + HIPEC. Propensity-score matching of secondary interventional cases with palliative cases succeeded in 88 % (n = 37) in which female sex, lower peritoneal cancer index at index surgery, longer disease-free interval, and absence of extra-peritoneal metastases were identified as the most relevant matching covariates. Median OS from date of recurrence was 38 months (95%CI 30-58) in the interventional group and 19 months (95%CI: 15-24) in the palliative group (HR 0.35 95%CI: 0.20-0.63, p = 0.0004). Sensitivity analyses confirmed the results. As reference, the median OS from index CRS + HIPEC in the whole colorectal registry (n = 575) was 41 months (95%CI: 38-45).
UNASSIGNED: After matching for relevant factors, the hazard ratio for death was significantly reduced in patients who were offered a secondary CRS + HIPEC procedure for recurrent peritoneal disease. Selection bias is inherent, but survival outcomes were comparable to those achieved after the initial procedure.
摘要：
■先前的细胞减灭术（CRS）和腹腔热化疗（HIPEC）后复发性结直肠腹膜转移的二次治疗研究甚少。
■评估继发性（重复）CRS+HIPEC与姑息治疗在复发性腹膜疾病中的总体生存结果。
■使用CRS+HIPEC指数治疗的结直肠腹膜转移患者，随后患有复发性腹膜疾病，从瑞典国家前瞻性HIPEC注册中确定。将患者分为介入组(继发性CRS+HIPEC)或姑息组。多变量逻辑回归，倾向得分匹配，并计算生存结局.
■在2010年至2021年期间接受完全CRS的575例患者中，有208例（36％）被诊断为随后的复发性腹膜疾病。42名患者（20％）接受了二级CRS+HIPEC。在88％（n=37）的女性中，继发性介入病例与姑息性病例的倾向评分匹配成功，索引手术时腹膜癌指数较低，更长的无病间隔，无腹膜外转移被确定为最相关的匹配协变量。介入治疗组自复发之日起的中位OS为38个月(95CI30-58),姑息治疗组为19个月(95CI:15-24)(HR0.3595CI:0.20-0.63,p=0.0004)。敏感性分析证实了结果。作为参考，整个结直肠登记处(n=575)的CRS+HIPEC指数的中位OS为41个月(95CI:38~45).
■匹配相关因素后，在为复发性腹膜疾病提供二次CRS+HIPEC手术的患者中,死亡风险比显著降低.选择偏见是固有的，但生存结局与初次手术后的生存结局相当.
■评估继发性（重复）CRS+HIPEC与姑息治疗在复发性腹膜疾病中的总体生存结果。
■使用CRS+HIPEC指数治疗的结直肠腹膜转移患者，随后患有复发性腹膜疾病，从瑞典国家前瞻性HIPEC注册中确定。将患者分为介入组(继发性CRS+HIPEC)或姑息组。多变量逻辑回归，倾向得分匹配，并计算生存结局.
■在2010年至2021年期间接受完全CRS的575例患者中，有208例（36％）被诊断为随后的复发性腹膜疾病。42名患者（20％）接受了二级CRS+HIPEC。在88％（n=37）的女性中，继发性介入病例与姑息性病例的倾向评分匹配成功，索引手术时腹膜癌指数较低，更长的无病间隔，无腹膜外转移被确定为最相关的匹配协变量。介入治疗组自复发之日起的中位OS为38个月(95CI30-58),姑息治疗组为19个月(95CI:15-24)(HR0.3595CI:0.20-0.63,p=0.0004)。敏感性分析证实了结果。作为参考，整个结直肠登记处(n=575)的CRS+HIPEC指数的中位OS为41个月(95CI:38~45).
■匹配相关因素后，在为复发性腹膜疾病提供二次CRS+HIPEC手术的患者中,死亡风险比显著降低.选择偏见是固有的，但生存结局与初次手术后的生存结局相当.
