Comparison of Survival in Patients with Isolated Peritoneal Carcinomatosis from Colorectal Cancer Treated with Cytoreduction and Melphalan or Mitomycin-C as Hyperthermic Intraperitoneal Chemotherapy Agent.

IF 1.6 Q4 ONCOLOGY
International Journal of Surgical Oncology Pub Date : 2018-12-13 eCollection Date: 2018-01-01 DOI:10.1155/2018/1920276
Arkadii Sipok, Armando Sardi, Carol Nieroda, Mary Caitlin King, Michelle Sittig, Vadim Gushchin
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引用次数: 13

Abstract

Background: The role of hyperthermic intraperitoneal chemotherapy (HIPEC) for peritoneal carcinomatosis (PC) from colorectal cancer (CRC) is debated. Melphalan as a perfusion agent has also demonstrated survival benefit in other recurrent and chemoresistant malignancies. Thus, we hypothesize that melphalan as a HIPEC agent may improve overall survival (OS) and progression-free survival (PFS) in patients with PC from CRC.

Methods: A retrospective review of a prospective database of 48 patients who underwent optimal CRS (CC-0/1) and HIPEC from 2001-2016 was performed. Nineteen had CRS/HIPEC with melphalan (group I) and 29 with mitomycin-C (group II). Survival was estimated using the Kaplan-Meier method. Cox regression was used for multivariate analysis. Perioperative variables were compared.

Results: Mean age at CRS/HIPEC was 53±10 years. Median peritoneal cancer index (PCI) was 17 vs 13 in groups I and II, respectively (p=0.86). PCI≥20 occurred in 9 (47%) and 13 (45%) patients in groups I and II, respectively. Positive lymph nodes were identified in 8/19 (42%) vs 12/29 (41%) in groups I and II, respectively (p=0.73). Multivariate analysis identified PCI≥20 as a predictive factor of survival (HR: 7.5). Median OS in groups I and II was 36 and 28 months, respectively (p=0.54). Median PFS in groups I and II was 10 and 20 months, respectively (p=0.05).

Conclusions: CRS/HIPEC with MMC had longer median PFS in PC from CRC. PCI≥20 was the only independent predictive factor for survival. Until longer follow-up is available, we recommend using MMC in CRS/HIPEC for PC from CRC. Further prospective randomized studies are necessary.

Abstract Image

Abstract Image

细胞减量与美法兰或丝裂霉素c腹腔高温化疗对结直肠癌腹膜分离性癌患者生存的影响。
背景:热腹腔化疗(HIPEC)在结直肠癌(CRC)腹膜癌病(PC)中的作用一直存在争议。美法兰作为灌注剂在其他复发性和化疗耐药恶性肿瘤中也显示出生存益处。因此,我们假设melphalan作为HIPEC药物可以改善CRC PC患者的总生存期(OS)和无进展生存期(PFS)。方法:对2001-2016年48例接受最佳CRS (CC-0/1)和HIPEC的前瞻性数据库进行回顾性分析。19例患者使用美法兰(I组),29例使用丝裂霉素- c (II组)进行CRS/HIPEC治疗。使用Kaplan-Meier法估计生存率。多因素分析采用Cox回归。比较围手术期变量。结果:CRS/HIPEC患者平均年龄为53±10岁。I组和II组中位腹膜癌指数(PCI)分别为17和13 (p=0.86)。PCI≥20的患者I组9例(47%),II组13例(45%)。ⅰ组和ⅱ组淋巴结阳性率分别为8/19(42%)和12/29(41%),差异有统计学意义(p=0.73)。多因素分析发现PCI≥20是生存的预测因素(HR: 7.5)。I组和II组的中位OS分别为36个月和28个月(p=0.54)。I组和II组的中位PFS分别为10个月和20个月(p=0.05)。结论:CRS/HIPEC合并MMC在大肠癌中有更长的中位PFS。PCI≥20是生存的唯一独立预测因素。在有更长的随访之前,我们建议在CRS/HIPEC中使用MMC治疗CRC的PC。进一步的前瞻性随机研究是必要的。
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来源期刊
CiteScore
3.70
自引率
0.00%
发文量
5
审稿时长
20 weeks
期刊介绍: International Journal of Surgical Oncology is a peer-reviewed, Open Access journal that publishes original research articles, review articles, and clinical studies in all areas of surgical oncology.
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