Peritoneal Colorectal Carcinomatosis Treated With Surgery and Perioperative Intraperitoneal Chemotherapy: Retrospective Analysis of 523 Patients From a Multicentric French Study
Peritoneal Colorectal Carcinomatosis Treated With Surgery and Perioperative Intraperitoneal Chemotherapy: Retrospective Analysis of 523 Patients From a Multicentric French Study
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DOI：
10.1200/jco.2009.23.9285
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发表时间：
2010-01-01
影响因子：
45.3
通讯作者：
Glehen, Olivier
中科院分区：
文献类型：
--
作者：
Elias, Dominique;Gilly, Francois;Glehen, Olivier
目的结直肠癌腹膜癌病(PC)传统上被认为是一种晚期疾病。细胞减灭术(CRS)和围手术期腹膜内化疗(PIC)相结合的方法是近年来发展起来的。这项研究的目的是评估接受该策略治疗的患者的早期和长期存活率。患者和方法进行了一项来自法语国家的回顾性队列多中心研究。所有连续接受CRS和PIC(加温或不加温)治疗的结直肠癌PC患者纳入研究对象。结果这项研究纳入了1990年至2007年间接受手术治疗的523名患者，这些患者来自4个法语国家的23个中心。中位随访时间为45个月。30d死亡率和3~4级发病率分别为3%和31%。中位生存期为30.1个月。五年总生存率为27%，五年无瘤生存率为10%。84%的患者接受了完全CRS，中位生存期为33个月。多因素分析中阳性独立预后因素为完全性CRS、范围有限的PC、无淋巴结侵犯和辅助化疗的使用。结论腹膜后腹膜癌的综合治疗具有较低的术后并发症和死亡率，对腹膜评分低于20分的患者有较好的远期存活率。这些结果将在未来得到改善，因为不同的团队将获得经验。这种方法在可行的情况下，现在被认为是法国指导方针中的黄金标准。
PurposePeritoneal carcinomatosis (PC) from colorectal cancer traditionally is considered a terminal condition. Approaches that combine cytoreductive surgery (CRS) and perioperative intraperitoneal chemotherapy (PIC) have been developed recently. The purpose of this study was to assess early and long-term survival in patients treated with that strategy.Patients and MethodsA retrospective-cohort, multicentric study from French-speaking countries was performed. All consecutive patients with PC from colorectal cancer who were treated with CRS and PIC (with or without hyperthermia) were included. Patients with PC of appendiceal origin were excluded.ResultsThe study included 523 patients from 23 centers in four French-speaking countries who underwent operation between 1990 and 2007. The median follow-up was 45 months. Mortality and grades 3 to 4 morbidity at 30 days were 3% and 31%, respectively. Overall median survival was 30.1 months. Five-year overall survival was 27%, and five-year disease-free survival was 10%. Complete CRS was performed in 84% of the patients, and median survival was 33 months. Positive independent prognostic factors identified in the multivariate analysis were complete CRS, PC that was limited in extent, no invaded lymph nodes, and the use of adjuvant chemotherapy. Neither the grade of disease nor the presence of liver metastases had a significant prognostic impact.ConclusionThis combined treatment approach against PC achieved low postoperative morbidity and mortality, and it provided good long-term survival in patients with peritoneal scores lower than 20. These results should improve in the future, because the different teams involved will gain experience. This approach, when feasible, is now considered the gold standard in the French guidelines.