大肠癌腹膜转移患者的预后分析
创作:szx 审核:szx 02月22日
  • 505名接受减瘤手术+腹腔热灌注化疗的结直肠癌腹膜转移患者,82.1%接受了术前化疗,中位随访25个月;
  • 患者的中位无病生存期及总生存期分别为12个月及51个月;
  • 361名患者(71.5%)复发,单独的腹膜及血行复发患者占比分别为24.6%及28.3%,混合复发患者占比为13.9%;
  • 单独腹膜复发、混合复发及单独血行复发患者复发后的中位生存期分别为21个月、22个月及43个月;
  • RAS突变及淋巴结阳性为腹膜复发的预测因素。
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JNCI-Journal of the National Cancer Institute上发表的一项队列研究结果,对505名结直肠癌腹膜转移患者的术后情况进行随访分析:患者的中位总生存期为51个月,71.5%的患者复发,而腹膜复发与更差的预后相关。
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Site of Recurrence and Survival after Surgery for Colorectal Peritoneal Metastasis

结直肠癌腹膜转移患者术后的复发部位及生存期

10.1093/jnci/djab001

01-23, Article

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Background: Multimodal treatment, including systemic treatment and surgery, improved the prognosis of peritoneal metastasis (PM). Despite all efforts, recurrence rates remain high, and only little data is available about clinical behavior or molecular patterns of PM in comparison to hematogenous metastasis. Here, we aimed to analyze recurrence patterns after multimodal treatment for PM from colorectal cancer.
Methods: Patients with colorectal PM undergoing multimodal treatment including systemic chemotherapy and cytoreductive surgery plus hyperthermic intraperitoneal chemotherapy (CRS/HIPEC) between 2005–2017 at four centers were analyzed retrospectively.
Results: A total of 505 patients undergoing CRS/HIPEC were analyzed. 82.1% of patients received preoperative chemotherapy. Median peritoneal cancer index (PCI) was 6 (IQR = 3–11). Median disease-free and overall survival was 12 months (95% confidence interval [CI] = 11 to 14 months) and 51 months (95% CI = 43 to 62 months) respectively. Disease recurred in 361 (71.5%) patients, presenting as isolated peritoneal recurrence in 24.6%, isolated hematogenous recurrence in 28.3%, and mixed recurrence in 13.9% of patients. Recurrence to the peritoneum was associated with an impaired time from recurrence to death of 21 months (95% CI = 18 to 31 months) for isolated peritoneal, and 22 months (95% CI = 16 to 30 months) for mixed recurrence, compared to 43 months (95% CI = 31 to > 121 months) for hematogenous recurrence (hazard ratio [HR] = 1.79, 95% CI = 1.27 to 2.53, p = .001 and HR = 2.44, 95% CI = 1.61 to 3.79, p < .001). On multiple logistic regression analysis, RAS mutational status (OR = 2.42, 95% CI = 1.11 to 5.47, p = .03) and positive nodal stage of the primary (OR = 3.88, 95% CI = 1.40 to 11.86, p = .01) were identified as predictive factors for peritoneal recurrence.
Conclusions: This study highlights the heterogeneity of peritoneal metastasis in patients with colorectal cancer. Recurrent peritoneal metastasis after radical treatment represents a more aggressive subset of metastatic colorectal cancer.

First Authors:
Eva Breuer

Correspondence Authors:
Kuno Lehmann

All Authors:
Eva Breuer,Monika Hebeisen,Marcel André Schneider,Lilian Roth,Chantal Pauli,Katharina Frischer-Ordu,Janina Eden,Basile Pache,Thomas Steffen,Martin Hübner,Laurent Villeneuve,Vahan Kepenekian,Guillaume Passot,Philippe Gertsch,Anurag Gupta,Olivier Glehen,Kuno Lehmann

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