背景:诊断时的存在,或发展,结直肠腹膜转移(CPM)在结直肠癌中很常见。细胞减灭术(CRS)和腹腔热化疗(HIPEC)在选定的CPM患者中显示出可喜的结果。当前的研究旨在描述CPM患者的肿瘤学结果,重点关注不良事件的复发模式和危险因素。
方法:我们对2000年至2021年在单一机构接受CRS和HIPEC治疗的CPM患者进行了回顾性审查。
结果:共纳入555例患者,其中480人(86.5%)细胞完全减少,中位年龄为59岁,中位腹膜癌指数(PCI)为6。在完全细胞减少后,5年总生存率(OS)和无病生存率(DFS)分别为51%和31%,分别。在多变量Cox回归中,PCI>6(危险比[HR]2.25),病理淋巴结阳性(pN+;HR1.94),神经周浸润(HR1.85)与OS降低有关,而PCI>6,pN+,和先前的全身转移导致DFS降低。总的来说,284例(62%)患者复发,其中97(34%)有局部复发(LR),100例(35%)有全身复发(SR),87例(31%)合并复发(5年OS:49.3%,46%,和37.4%,分别)。与野生型KRAS相比,突变的KRAS(mKRAS)与较低的5年OS(55.8%)和DFS(27.9%)相关(wtKRAS;70.7%和37.6%,分别)。在多变量分析中,mKRAS与OS下降有关(HR1.82),DFS(HR1.55),和SR(OS1.89),但不是LR。
结论:完全细胞减灭术可导致CPM患者良好的生存结果。腹膜疾病的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的可能性增加,生存率降低。
BACKGROUND: 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.
METHODS: We conducted a retrospective review of patients with CPM treated by CRS and
HIPEC at a single institution between 2000 and 2021.
RESULTS: 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.
CONCLUSIONS: 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.