Cytoreductive surgery plus hyperthermic intraperitoneal chemotherapy improves survival of patients with peritoneal carcinomatosis from colorectal cancer: a case-control study from a Chinese center

Abstract

Background: Advanced colorectal cancer (CRC) is prone to developing peritoneal carcinomatosis (PC). This case-control study was to compare the efficacy and safety of cytoreductive surgery (CRS) versus CRS plus hyperthermic intraperitoneal chemotherapy (HIPEC) in Chinese patients with CRC PC.

Methods: The 62 consecutive PC patients were treated with CRS (Control group, n = 29) or CRS + HIPEC (Study group, n = 33). The primary end point was overall survival (OS), the secondary end points were perioperative safety profiles.

Results: For the comparison of Control versus Study groups, the peritoneal cancer index (PCI) ≤20 was 13 (44.8%) versus 16 (48.5%) patients (P = 0.78), complete cytoreduction (CC0-1) was achieved in 9 (31.0%) versus 14 (42.4%) cases (P = 0.36). At the median OS was 8.5 (95% confidence interval [CI] 4.7-12.4) versus 13.7 (95% CI 10.0-16.5) months (P = 0.02), the 1-, 2-, and 3-year survival rates were 27.5% versus 63.6%, 12.0% versus 20.0%, and 0.0% versus 16.0%, respectively. Serious adverse events in postoperative 30 days were 9.4% versus 28.6% (P = 0.11). Multivariate analysis revealed that CRS + HIPEC, CC0-1, adjuvant chemotherapy ≥6 cycles were independent factors for OS benefit.

Conclusion: CRS + HIPEC could improve OS for CRC PC patients, with acceptable perioperative safety.

Keywords: colorectal cancer; cytoreductive surgery; hyperthermic intraperitoneal chemotherapy; peritoneal carcinomatosis.

Fig 1

The overall survival in patients with peritoneal carcinomatosis from colorectal cancer treated by CRS + HIPEC regimen compared with Control group. Mo, months.

Fig 2

a: the patients with synchronous PC in Study group are superior survival to metachronous PC; b: compared with the PCI >20, the PCI ≤20 have a significant survival advantage in Control group. Mo, months; SPC, synchronous PC; MPC, metachronous PC.

Fig 3

Either Control group (a) or Study group (b), patients with CC0-1 cytoreduction had better survival advantage; Similarly, in both groups(c,d), postoperative chemotherapy ≥6 cycles provided far better survival advantage than <6 cycles, particularly in Study group (d). Mo, months; PCC, postoperative chemotherapy cycles.