The Characteristics of 206 Long-Term Survivors with Peritoneal Metastases from Colorectal Cancer Treated with Curative Intent Surgery: A Multi-Center Cohort from PSOGI.

Yasuyuki Kamada,Mitsuhiro Morikawa,Takanori Goi,Yutaka Yonemura,Shadin Ghabra,Pompiliu Piso,Koji Murono,Kanji Katayama,Miklos Acs,Hiroshi Nagata,Koya Hida,Aditi Bhatt,Paul H Sugarbaker,Beate Rau,Emel Canbay,Soichiro Ishihara,Federico Coccolini,Pierre-Emmanuel Bonnot ,Mao Chih Hsieh ,Olivier Gléhen

doi:10.3390/cancers13122964

Abstract

Simple SummaryCytoreductive surgery (CRS) combined with hyperthermic intraperitoneal chemotherapy improves survival in selected patients with peritoneal metastases from colorectal cancer (CRC). However, the characteristics of long-term survivors are not well documented. This study set out to investigate the patient characteristics associated with the long-term survival of peritoneal metastases from CRC. We retrospectively analyzed 206 long-term survivors who underwent CRS for peritoneal metastases from CRC. We found that most long-term survivors showed low peritoneal cancer index (PCI), low PCI of small bowel subsets, and complete cytoreduction (CC-0), while some exhibited characteristics considered associated with poor prognosis.Background: We conducted this study to review the patient characteristics associated with long-term survival in patients with peritoneal metastases from colorectal cancer who underwent cytoreductive surgery (CRS). Methods: We retrospectively investigated patients with peritoneal metastases from CRC treated with curative intent surgery with or without hyperthermic intraperitoneal chemotherapy at 13 institutions worldwide between January 1985 and April 2015 and survived longer than five years after the first CRS for peritoneal metastases. Clinical and oncological features and therapeutic parameters were described and analyzed. Results: Two hundred six long-term survivors were available for study. The median peritoneal cancer index (PCI) of this cohort was 4 (interquartile range (IQR), 2–7), and the median score of the small bowel regions of the PCI (SB-PCI) was 0 (IQR, 0–2). Complete cytoreduction (CC-0) was achieved in 180 (87.4%) patients. Recurrence was observed in 122 (59.2%) patients at a median of 1.8 (IQR, 1.2–2.6) years. Conclusions: While most long-term survivors showed low PCI/SB-PCI and CCR-0, some had characteristics considered associated with poor prognosis. Curative intent treatments may be considered in well-informed and fit patients showing negative factors affecting survival outcome.

Highlights

In colorectal cancer (CRC) patients, peritoneal metastases are observed in 5–10% at the time of treatment for primary cancer and in15–30% of the follow-up after primary cancer surgery [1,2,3]
Many centers worldwide adopt cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) for peritoneal metastases, there is room for debate about this combined treatment. One criticism for these procedures is the uncertainty about the effectiveness of HIPEC for peritoneal metastases from CRC; the PRODIGE-7 trial questioned the role of HIPEC with oxaliplatin in the clinical management of peritoneal metastases from CRC [23]
Whether CRS and HIPEC may add to long-term survival as compared to CRS alone cannot be determined from our data

Summary

Introduction

In colorectal cancer (CRC) patients, peritoneal metastases are observed in 5–10% at the time of treatment for primary cancer (i.e., synchronous peritoneal metastases) and in15–30% of the follow-up after primary cancer surgery (i.e., metachronous peritoneal metastases) [1,2,3]. For more than two decades, the combination of cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC). The aim of HIPEC is to eradicate any residual disease with the administration of heated chemotherapy after completing cytoreduction With these treatments, the number of patients with peritoneal metastasis from CRC who achieve long-term survival has increased over the past decade [14,15]. We conducted this study to review the patient characteristics associated with long-term survival in patients with peritoneal metastases from colorectal cancer who underwent cytoreductive surgery (CRS). Methods: We retrospectively investigated patients with peritoneal metastases from CRC treated with curative intent surgery with or without hyperthermic intraperitoneal chemotherapy at 13 institutions worldwide between January 1985 and April 2015 and survived longer than five years after the first CRS for peritoneal metastases. Curative intent treatments may be considered in well-informed and fit patients showing negative factors affecting survival outcome

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