G A Simkens1, L G Razenberg2, V E Lemmens3, H J Rutten4, G-J Creemers5, I H de Hingh6. 1. Department of Surgical Oncology, Catharina Hospital, PO Box 1350, 5602 ZA Eindhoven, The Netherlands. Electronic address: geert.simkens@catharinaziekenhuis.nl. 2. Department of Oncology, Catharina Hospital, PO Box 1350, 5602 ZA Eindhoven, The Netherlands; Netherlands Comprehensive Cancer Organization (IKNL), PO Box 19079, 3501 DB Utrecht, The Netherlands. 3. Netherlands Comprehensive Cancer Organization (IKNL), PO Box 19079, 3501 DB Utrecht, The Netherlands; Department of Public Health, Erasmus MC University Medical Centre, PO Box 2040, 3000 CA Rotterdam, The Netherlands. 4. Department of Surgical Oncology, Catharina Hospital, PO Box 1350, 5602 ZA Eindhoven, The Netherlands. 5. Department of Oncology, Catharina Hospital, PO Box 1350, 5602 ZA Eindhoven, The Netherlands. 6. Department of Surgical Oncology, Catharina Hospital, PO Box 1350, 5602 ZA Eindhoven, The Netherlands. Electronic address: ignace.d.hingh@catharinaziekenhuis.nl.
Abstract
BACKGROUND: Treatment possibilities for colorectal peritoneal metastases (PM) are increasing. It is however unclear how treatment choice and outcome are influenced by histological subtype and the presence of systemic metastases. Therefore, this study assessed the impact of histological subtype and systemic metastases on treatment choice and survival in patients with colorectal PM. METHODS: This population-based study included patients with synchronous PM originating from colorectal adenocarcinoma (AC), mucinous adenocarcinoma (MC), or signet ring cell carcinoma (SRCC). Data of patients diagnosed between 2005 and 2014 were extracted from the National Cancer Registry (IKNL) of the Netherlands. Treatment strategy and survival were analyzed with logistic regression and cox proportional hazard analyses. RESULTS: In total, 5516 patients were included, of whom 71.8% had an AC, 21.2% an MC, and 7.0% had an SRCC. The use of cytoreduction and hyperthermic intraperitoneal chemotherapy (HIPEC) was dependent on histological subtype and the presence of systemic metastases, and increased over time, especially in AC and MC patients. The relative survival gain of CRS + HIPEC, corrected for systemic metastases, was comparable in AC, MC, and SRCC patients (hazard ratio: 0.17, 0.21, and 0.13, respectively). Compared to supportive care only, the absolute survival gain was 30, 35, and 18 months, respectively. Systemic therapy improved survival in all histological subtypes. CONCLUSIONS: Histological subtype and the presence of systemic metastases strongly influenced treatment choice and survival in patients with synchronous colorectal PM. These results can be used to optimize treatment strategy for patients with synchronous colorectal PM.
BACKGROUND: Treatment possibilities for colorectal peritoneal metastases (PM) are increasing. It is however unclear how treatment choice and outcome are influenced by histological subtype and the presence of systemic metastases. Therefore, this study assessed the impact of histological subtype and systemic metastases on treatment choice and survival in patients with colorectal PM. METHODS: This population-based study included patients with synchronous PM originating from colorectal adenocarcinoma (AC), mucinous adenocarcinoma (MC), or signet ring cell carcinoma (SRCC). Data of patients diagnosed between 2005 and 2014 were extracted from the National Cancer Registry (IKNL) of the Netherlands. Treatment strategy and survival were analyzed with logistic regression and cox proportional hazard analyses. RESULTS: In total, 5516 patients were included, of whom 71.8% had an AC, 21.2% an MC, and 7.0% had an SRCC. The use of cytoreduction and hyperthermic intraperitoneal chemotherapy (HIPEC) was dependent on histological subtype and the presence of systemic metastases, and increased over time, especially in AC and MC patients. The relative survival gain of CRS + HIPEC, corrected for systemic metastases, was comparable in AC, MC, and SRCC patients (hazard ratio: 0.17, 0.21, and 0.13, respectively). Compared to supportive care only, the absolute survival gain was 30, 35, and 18 months, respectively. Systemic therapy improved survival in all histological subtypes. CONCLUSIONS: Histological subtype and the presence of systemic metastases strongly influenced treatment choice and survival in patients with synchronous colorectal PM. These results can be used to optimize treatment strategy for patients with synchronous colorectal PM.
Authors: Marco Tonello; Dario Baratti; Paolo Sammartino; Andrea Di Giorgio; Manuela Robella; Cinzia Sassaroli; Massimo Framarini; Mario Valle; Antonio Macrì; Luigina Graziosi; Federico Coccolini; Piero Vincenzo Lippolis; Roberta Gelmini; Marcello Deraco; Daniele Biacchi; Francesco Santullo; Marco Vaira; Katia Di Lauro; Fabrizio D'Acapito; Fabio Carboni; Giuseppe Giuffrè; Annibale Donini; Paola Fugazzola; Pinuccia Faviana; Lorena Sorrentino; Antonio Scapinello; Paola Del Bianco; Antonio Sommariva Journal: Ann Surg Oncol Date: 2021-11-16 Impact factor: 5.344