结直肠癌引起的腹膜和肝转移患者的细胞减灭手术联合热腹腔化疗和肝切除治疗方案研究

Cytoreductive Surgery With Hyperthermic Intraperitoneal Chemotherapy and Liver Resection is a Treatment Option for Patients With Peritoneal and Liver Metastases From Colorectal Cancer

ANNALS OF SURGERY

影响因子:6.4

分区:医学1区 Top / 外科1区

发表日期:2024 Nov 01

作者: Vegar Johansen Dagenborg, Kristoffer Watten Brudvik, Christin Lund-Andersen, Annette Torgunrud, Marius Lund-Iversen, Kjersti Flatmark, Stein Gunnar Larsen, Sheraz Yaqub

DOI: 10.1097/SLA.0000000000006492

摘要

本研究旨在评估在同时接受结直肠肝转移（CLM）治疗的患者中，细胞减灭手术联合热腹腔化疗（CRS-HIPEC）后的预后情况。结直肠癌（CRC）常转移至肝脏和腹膜，预后较差。经过筛选的患者中，发现接受CRS-HIPEC治疗的腹膜转移（PM-CRC）患者以及接受手术切除的CLM患者，均表现出一定的总体生存（OS）获益。然而，存在CLM被视为CRS-HIPEC的相对禁忌症，导致该类患者的预后数据有限。纳入本研究的患者为2007年至2023年在单一国家中心接受CRS-HIPEC治疗的PM-CRC患者，且同时接受CLM的额外干预（允许既往有外腹膜和肝外转移的根治性治疗）。患者分为三组：CRS-HIPEC前的CLM（pre-CRS-HIPEC）、与CRS-HIPEC同时切除的CLM（sim-CRS-HIPEC）及CRS-HIPEC后再切除的CLM（post-CRS-HIPEC），旨在回顾性分析预后。共纳入57例患者，分类为：pre-CRS-HIPEC（n=11）、sim-CRS-HIPEC（n=29）及post-CRS-HIPEC（n=17）。中位腹膜癌指数（PCI）为8；13例患者发生严重并发症（Clavien-Dindo ≥3），无90天死亡。CRS-HIPEC后中位总生存期（OS）为48个月。PCI是OS的预测因子（风险比：1.11，P<0.001）。三组间短期及长期预后无显著差异。本研究表明，伴有CLM的患者接受CRS-HIPEC后，其总生存期与仅接受CRS-HIPEC的患者相当，可能与低PCI有关。同步切除CLM未增加严重并发症风险。在此全国队列中，CRS-HIPEC结合CLM治疗可实现长期生存，提示可考虑为选定的PM-CRC伴发CLM患者提供这种治疗方案。

Abstract

To study outcomes after cytoreductive surgery and hyperthermic intraperitoneal chemotherapy (CRS-HIPEC) in patients also treated for colorectal liver metastases (CLM).Colorectal cancer (CRC) frequently metastasizes to the liver and peritoneum and is associated with a poor prognosis. In selected patients, a benefit in overall survival (OS) was shown for both peritoneal metastases (PM-CRC) offered CRS-HIPEC, and CLM treated with surgical resection. However, the presence of CLM was considered a relative contraindication to CRS-HIPEC, causing a paucity of outcome data in this patient group.Patients with PM-CRC having CRS-HIPEC at a single national center between 2007 and 2023, with additional intervention for CLM, were included (previous curative treatment for extraperitoneal and extrahepatic metastases was allowed). Three groups were defined: CLM before CRS-HIPEC (pre-CRS-HIPEC), CLM resected simultaneously with CRS-HIPEC (sim-CRS-HIPEC), and CLM after CRS-HIPEC (post-CRS-HIPEC), aiming to retrospectively analyze outcomes.Fifty-seven patients were included and classified as: pre-CRS-HIPEC (n = 11), sim-CRS-HIPEC (n = 29), and post-CRS-HIPEC (n = 17). Median Peritoneal Cancer Index (PCI) was 8; 13 patients had severe complications (Clavien-Dindo ≥3), and no 90-day mortality. Median OS was 48 months after CRS-HIPEC. PCI was a predictor of OS (hazard ratio: 1.11, P < 0.001). We observed no difference in short or long-term outcomes between intervention groups.This study demonstrated that patients with CLM having CRS-HIPEC had comparable OS to reports on CRS-HIPEC only, likely explained by a low PCI. Simultaneous CLM resection did not increase the risk of severe complications.In this national cohort, CRS-HIPEC and CLM intervention offers long-term survival, suggesting that this treatment may be offered to selected patients with PM-CRC and CLM.