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. 2021 Dec;28(13):9073-9083.
doi: 10.1245/s10434-021-10190-z. Epub 2021 Jun 2.

Treatment Strategies and Prognosis of Patients With Synchronous or Metachronous Colorectal Peritoneal Metastases: A Population-Based Study

C Bakkers #  1 , R J Lurvink #  1   2 , A Rijken  1 , S W Nienhuijs  1 , N F Kok  3 , G J Creemers  4 , C Verhoef  5 , V E Lemmens  2 , F N van Erning  2 , I H De Hingh  6   7   8
Affiliations

Treatment Strategies and Prognosis of Patients With Synchronous or Metachronous Colorectal Peritoneal Metastases: A Population-Based Study

C Bakkers et al. Ann Surg Oncol. 2021 Dec.

Abstract

Background: This study aimed to compare treatment strategies and survival of patients with synchronous colorectal peritoneal metastases (CPM) and patients with metachronous CPM in a nationwide cohort.

Methods: All patients from the Netherlands Cancer Registry with synchronous or metachronous CPM whose primary colorectal cancer (CRC) was diagnosed between 1 January and 30 June 2015 were included in the study. Treatments were categorized as (A) cytoreductive surgery and hyperthermic intraperitoneal chemotherapy [CRS-HIPEC]; (B) palliative treatment; or (C) best supportive care. Overall survival (OS) for all the patients and disease-free survival (DFS) for those who underwent CRS-HIPEC were compared between the two groups.

Results: Of 7233 patients, 743 had a diagnosis of CPM, including 409 patients with synchronous CPM and 334 patients with metachronous CPM. The median OS was 8.1 months for the patients with synchronous CPM versus 12 months for the patients with metachronous CPM (p = 0.003). After multivariable correction, OS no longer differed between the patients with synchronous CPM and those with metachronous CPM (HR 1.03 [0.83-1.27]). The patients with metachronous CPM more often underwent CRS-HIPEC than the patients with synchronous CPM (16 % vs 8 %; p = 0.001). The two groups did not differ statistically in terms of DFS and OS (median DFS, 21.5 vs 14.1 months, respectively; p = 0.094; median OS, 37.8 vs. 35.8 months, respectively; p = 0.553).

Conclusion: This population-based study showed that survival for the patients with synchronous CPM and patients with metachronous CPM did not significantly differ. This suggests that a similar prognosis may be expected for patients selected for treatment regardless of the onset of CPM.

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Conflict of interest statement

I. H. De Hingh reports an unrestricted research grant from RanD/QPS and Roche paid to the institute outside the submitted work. The remaining authors have no conflicts of interest.

Figures

Fig. 1.
Fig. 1.
Treatment strategies for patients with synchronous or metachronous colorectal peritoneal metastases.
Fig. 2.
Fig. 2.
Disease-free survival of patients with synchronous or metachronous colorectal peritoneal metastases after cytoreductive surgery and hyperthermic intraperitoneal chemotherapy (CRS-HIPEC).
Fig. 3.
Fig. 3.
Sites of first recurrent disease after cytoreductive surgery and hyperthermic intraperitoneal chemotherapy (CRS-HIPEC) in patients with synchronous or metachronous colorectal peritoneal metastases.
Fig. 4.
Fig. 4.
Overall survival of patients with synchronous or metachronous colorectal peritoneal metastases. a All the patients in the study. b All the patients who underwent cytoreductive surgery and hyperthermic intraperitoneal chemotherapy (CRS-HIPEC). c All the patients who underwent palliative treatment. d All the patients who received best supportive care.
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References

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