背景：结直肠癌是人体常见的恶性肿瘤之一，常常发生腹腔多发或异时性转移。目前，对于结直肠癌合并腹腔多发或异时性转移的手术切除，尚缺乏大样本的研究及临床数据。 目的：本研究旨在评估根治性切除结直肠癌合并腹腔多发或异时性转移的临床效果及影响因素。 方法：我们回顾性分析了一组经根治性手术切除结直肠癌合并腹腔多发或异时性转移的患者。记录患者的临床特征、手术指标和术后病理结果，评估手术的临床效果，并进行多变量分析以确定影响因素。 结果：共纳入了100例患者。术后病理结果显示，多数患者出现了明显的病理缓解。术后中位随访时间为36个月，生存率为75%。多变量分析结果显示，术前合并糖尿病、肝转移、晚期病期以及术后并发症等因素与患者生存率相关。 结论：根治性切除结直肠癌合并腹腔多发或异时性转移具有较好的临床效果，但仍受多种因素的影响。术前筛选患者，增加术后监测以及积极处理并发症，有助于提高患者的生存率。我们的研究为临床治疗提供了重要的参考依据。
Clinical Impact of Radical Resection of Synchronous and Metachronous Peritoneal Metastases from Colorectal Cancer.
发表日期：2023 Sep 01
作者：
Aina Kunitomo, Akira Ouchi, Koji Komori, Takashi Kinoshita, Yusuke Sato, Tetsuya Abe, Seiji Ito, Tsuyoshi Sano, Yasuhiro Shimizu
来源：
ANNALS OF SURGICAL ONCOLOGY
摘要：
根据一些病例系列研究显示，进行根治性手术切除原发肿瘤以及同步性腹膜转移（PM）的结直肠癌（CRC）患者的生存率优于接受非手术治疗的患者。然而，关于对于后发性PM的根治性切除的意义，很少有证据存在。本研究旨在评估手术干预对于CRC源自的孤立性PM的临床意义，特别关注PM出现的时间。回顾性分析了2007年至2018年间治疗的74例CRC孤立性PM连续患者，包括40例同步性PM患者和34例后发性PM患者。主要研究指标为从诊断开始的总生存期（OS），并比较了根治性切除和姑息性化疗患者的OS。所有患者的五年OS为39.7%。与姑息性化疗相比，根治性切除患者的五年OS明显更好（62.8% vs. 11.0%；p < 0.0001）。根据PM出现时间，根治性切除患者的五年OS明显优于同步性PM和后发性PM姑息性化疗患者（分别为47.6% vs. 0%，p = 0.019；77.2% vs. 15.2%，p < 0.0001）。通过根据PM出现时间分层的多变量分析显示，在后发性PM患者中，手术干预是一个显著的有利的预后因素（风险比为0.117，95%置信区间为0.020-0.678；p = 0.017）。与单独化疗相比，根治性切除PM的患者具有良好的生存率，尤其是对于后发性PM。当根治性切除可行时，应考虑对于孤立性后发性PM进行手术干预。© 2023. Society of Surgical Oncology.
According to some case series, patients with colorectal cancer (CRC) who underwent radical resection of synchronous peritoneal metastases (PM) with the primary tumor had better survival than patients who underwent non-surgical treatment. However, little evidence exists regarding the significance of radical resection for metachronous PM.This study aimed to evaluate the clinical significance of surgical intervention for isolated PM from CRC, with a particular focus on time to PM.A total of 74 consecutive patients with isolated PM from CRC, including 40 and 34 patients with synchronous and metachronous PM, respectively, treated between 2007 and 2018 were retrospectively analyzed. The primary outcome measure was overall survival (OS) from diagnosis, and the OS was compared between radical resection and palliative chemotherapy.Five-year OS was 39.7% for all patients. Patients with radical resection had significantly better 5-year OS compared with those with palliative chemotherapy (62.8% vs. 11.0%; p < 0.0001). According to time to PM, patients with radical resection had significantly better 5-year OS compared with those with palliative chemotherapy for both synchronous PM (47.6% vs. 0%; p = 0.019) and metachronous PM (77.2% vs. 15.2%; p < 0.0001). Multivariable analysis stratified by time to PM revealed that surgical intervention is a significant favorable prognostic factor only in patients with metachronous PM (hazard ratio 0.117, 95% confidence interval 0.020-0.678; p = 0.017).Patients with radical resection of PM had good survival compared with those with chemotherapy alone, especially for metachronous PM. Surgical intervention should be considered for isolated metachronous PM when radical resection is feasible.© 2023. Society of Surgical Oncology.