Oncological Outcomes From Cytoreductive Surgery and Heated Intraperitoneal Chemotherapy for Colorectal Cancer Peritoneal Metastases

IF 3.3 3区医学 Q2 ONCOLOGY

Clinical colorectal cancer Pub Date : 2024-12-12 DOI:10.1016/j.clcc.2024.12.001

Nadina Tinsley , Sarah T. O'Dwyer , Raghavendar Nagaraju , Michael Braun , Saifee Mullamitha , Konstantinos Kamposioras , F.E. Marti Marti , Mark Saunders , Hamish Clouston , Chelliah Selvasekar , Jonathan Wild , Malcolm Wilson , Andrew Renehan , Omer Aziz , Jorge Barriuso

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引用次数: 0

Abstract

Background

Cytoreductive surgery (CRS) is effective for colorectal cancer peritoneal metastases (CRPM) at increasing overall survival (OS) compared to systemic anticancer treatment (SACT) alone. The addition of Oxaliplatin heated intraperitoneal chemotherapy (HIPEC) has been shown in a randomized controlled trial to result in increased complications without significant OS benefit. This study evaluates outcomes for CRPM patients undergoing CRS+HIPEC with Oxaliplatin (Ox) 368mg/m² (30 min), versus Mitomycin C (MMC) 35mg/m² (90min). 

Methods

A prospective CRPM real-world database was used to collect outcomes for patients undergoing CRS+HIPEC at a single center. OS, recurrence-free (RFS), peritoneal RFS (PeRFS) were compared amongst all patients with histologically proven CRPM, those with completeness of cytoreduction (CC) score =0/1, and those with CC score=0/1 who were SACT naïve. 

Results

Between April 2005 and April 2021, 409 patients underwent CRS+HIPEC: 271 (66%) had MMC, 138 (34%) Ox. Of these, 395 (97%) had histologically confirmed CRPM, 336 (85%) achieved CC=0/1, 188 (47%) were SACT naïve; median OS =39.5, 44.4, and 47.2 months respectively. MMC versus Ox median OS in CC0/1=43.7 (95% CI 35.9-48.3) versus 50.1 (39.7-70.2) months, P = .28; Median OS in SACT naïve=45.7 (39.4-65.9) versus 59.9 (38.3-82.0) months, P = .31; multivariable analysis for CC0/1, SACT naïve patients showed Ox was comparable to MMC: HR=0.90, (0.64-1.27) P = .55 versus HR=0.88, (0.53-1.44) P = .60, respectively. Ox resulted in a significantly improved PeRFS in CC0/1 patients (MMC=9.0 versus Ox=12.6months, P = .01). A multivariable model for PeRFS showed a HR=0.63, (0.43-0.95), P = .03 for Ox. 

Conclusion

This study suggests a role for Ox HIPEC in CRPM which should be explored further in clinical trials.

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结直肠癌腹膜转移的细胞减少手术和腹腔加热化疗的肿瘤预后。

背景：与单纯全身抗癌治疗（SACT）相比，腹腔镜手术（CRS）能有效提高结直肠癌腹膜转移（CRPM）患者的总生存率（OS）。一项随机对照试验显示，加用奥沙利铂腹腔内加温化疗（HIPEC）会导致并发症增加，但对 OS 却无明显益处。本研究评估了接受奥沙利铂（Ox）368mg/m2（30 分钟）与丝裂霉素 C（MMC）35mg/m2（90 分钟）CRS+HIPEC 的 CRPM 患者的疗效。方法：使用前瞻性 CRPM 真实世界数据库收集在单个中心接受 CRS+HIPEC 治疗的患者的疗效。在所有经组织学证实的CRPM患者、细胞减灭完全性（CC）评分=0/1的患者和CC评分=0/1但未接受SACT的患者中比较了OS、无复发（RFS）和腹膜RFS（PeRFS）。结果：2005年4月至2021年4月，409名患者接受了CRS+HIPEC治疗：271人（66%）接受了MMC治疗，138人（34%）接受了Ox治疗。其中，395 例（97%）经组织学证实为 CRPM，336 例（85%）达到 CC=0/1，188 例（47%）为 SACT 天真患者；中位 OS 分别为 39.5、44.4 和 47.2 个月。MMC与Ox相比，CC0/1的中位OS=43.7（95% CI 35.9-48.3）个月对50.1（39.7-70.2）个月，P = .28；SACT新患者的中位OS=45.7（39.4-65.9）个月对59.9（38.3-82.0）个月，P = .31；对CC0/1、SACT新患者的多变量分析显示，Ox与MMC的疗效相当：HR=0.90，（0.64-1.27）P=.55对HR=0.88，（0.53-1.44）P=.60。Ox可明显改善CC0/1患者的PeRFS（MMC=9.0个月对Ox=12.6个月，P = .01）。PeRFS的多变量模型显示，Ox的HR=0.63，(0.43-0.95)，P=0.03。结论：本研究表明，Ox HIPEC 可在 CRPM 中发挥作用，应在临床试验中进一步探讨。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Clinical colorectal cancer 医学-肿瘤学

CiteScore

5.50

自引率

2.90%

发文量

审稿时长

27 days

期刊介绍： Clinical Colorectal Cancer is a peer-reviewed, quarterly journal that publishes original articles describing various aspects of clinical and translational research of gastrointestinal cancers. Clinical Colorectal Cancer is devoted to articles on detection, diagnosis, prevention, and treatment of colorectal, pancreatic, liver, and other gastrointestinal cancers. The main emphasis is on recent scientific developments in all areas related to gastrointestinal cancers. Specific areas of interest include clinical research and mechanistic approaches; drug sensitivity and resistance; gene and antisense therapy; pathology, markers, and prognostic indicators; chemoprevention strategies; multimodality therapy; and integration of various approaches.