Impact of Neoadjuvant Chemotherapy on the Outcomes of Cytoreductive Surgery and Hyperthermic Intraperitoneal Chemotherapy for Colorectal Peritoneal Metastases: A Multi-Institutional Retrospective Review

被引：32

作者：

Beal, Eliza W. ^{[1
,2
]}

Suarez-Kelly, Lorena P. ^{[1
,2
]}

Kimbrough, Charles W. ^{[1
,2
]}

Johnston, Fabian M. ^{[3
]}

Greer, Jonathan ^{[3
]}

Abbott, Daniel E. ^{[4
]}

Pokrzywa, Courtney ^{[4
]}

Raoof, Mustafa ^{[5
]}

Lee, Byrne ^{[5
]}

Grotz, Travis E. ^{[6
]}

Leiting, Jennifer L. ^{[6
]}

Fournier, Keith ^{[7
]}

Lee, Andrew J. ^{[7
]}

Dineen, Sean P. ^{[8
]}

Powers, Benjamin ^{[8
]}

Veerapong, Jula ^{[9
]}

Baumgartner, Joel M. ^{[9
]}

Clarke, Callisia ^{[10
]}

Mogal, Harveshp ^{[10
]}

Russell, Marti C. ^{[11
]}

Zaidi, Mohammed Y. ^{[11
]}

Patel, Sameer H. ^{[12
]}

Dhar, Vikrom ^{[12
]}

Lambert, Laura ^{[13
]}

Hendrix, Ryan J. ^{[13
]}

Hays, John ^{[1
,2
]}

Abdel-Misih, Sherif ^{[1
,2
]}

Cloyd, Jordan M. ^{[1
,2
]}

机构：

[1] Ohio State Univ, Wexner Med Ctr, Div Surg Oncol, Dept Surg, Columbus, OH 43201 USA

[2] James Canc Hosp, Columbus, OH 43201 USA

[3] Johns Hopkins Univ, Div Surg Oncol, Dept Surg, Baltimore, MD 21205 USA

[4] Univ Wisconsin, Div Surg Oncol, Dept Surg, Madison, WI 53792 USA

[5] City Hope Natl Med Ctr, Natl Med Ctr, Div Surg Oncol, Dept Surg, Duarte, CA 91010 USA

[6] Mayo Clin, Div Hepatobiliary & Pancreas Surg, Dept Surg, Rochester, MN 55905 USA

[7] Univ Texas MD Anderson Canc Ctr, Dept Surg Oncol, Houston, TX 44907 USA

[8] H Lee Moffitt Canc Ctr & Res Inst, Dept Gastrointestinal Surg, Tampa, FL 33612 USA

[9] Univ Calif San Diego, Div Surg Oncol, Dept Surg, La Jolla, CA 92093 USA

[10] Med Coll Wisconsin, Div Surg Oncol, Dept Surg, Milkwaukee, WI 53226 USA

[11] Emory Univ, Div Surg Oncol, Winship Canc Inst, Atlanta, GA 30322 USA

[12] Univ Cincinnati, Dept Surg, Cincinnati, OH 45219 USA

[13] Univ Massachusetts, Mem Med Ctr, Div Surg Oncol, Dept Surg, Worcester, MA 45219 USA

来源：

JOURNAL OF CLINICAL MEDICINE | 2020年 / 9卷 / 03期

关键词：

cytoreductive surgery; hyperthermic intraperitoneal chemotherapy; colorectal peritoneal metastases; SYSTEMIC CHEMOTHERAPY; CARCINOMATOSIS; CANCER; SURVIVAL; TRIALS; HIPEC; CHEMOPERFUSION; COMPLICATIONS; BEVACIZUMAB;

D O I：

10.3390/jcm9030748

中图分类号：

R5 [内科学];

学科分类号：

1002 ; 100201 ;

摘要：

Cytoreductive surgery (CRS) with or without hyperthermic intraperitoneal chemotherapy (HIPEC) is associated with improved survival for patients with colorectal peritoneal metastases (CR-PM). However, the role of neoadjuvant chemotherapy (NAC) prior to CRS-HIPEC is poorly understood. A retrospective review of adult patients with CR-PM who underwent CRS+/-HIPEC from 2000-2017 was performed. Among 298 patients who underwent CRS+/-HIPEC, 196 (65.8%) received NAC while 102 (34.2%) underwent surgery first (SF). Patients who received NAC had lower peritoneal cancer index score (12.1 + 7.9 vs. 14.3 + 8.5, p = 0.034). There was no significant difference in grade III/IV complications (22.4% vs. 16.7%, p = 0.650), readmission (32.3% vs. 23.5%, p = 0.114), or 30-day mortality (1.5% vs. 2.9%, p = 0.411) between groups. NAC patients experienced longer overall survival (OS) (median 32.7 vs. 22.0 months, p = 0.044) but similar recurrence-free survival (RFS) (median 13.8 vs. 13.0 months, p = 0.456). After controlling for confounding factors, NAC was not independently associated with improved OS (OR 0.80) or RFS (OR 1.04). Among patients who underwent CRS+/-HIPEC for CR-PM, the use of NAC was associated with improved OS that did not persist on multivariable analysis. However, NAC prior to CRS+/-HIPEC was a safe and feasible strategy for CR-PM, which may aid in the appropriate selection of patients for aggressive cytoreductive surgery.

引用

页数：13

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