Site of Recurrence and Survival After Surgery for Colorectal Peritoneal Metastasis

Abstract Background Multimodal treatment, including systemic treatment and surgery, improved the prognosis of peritoneal metastasis (PM). Despite all efforts, recurrence rates remain high, and little data are available about clinical behavior or molecular patterns of PM in comparison to hematogenous...

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Published in:JNCI : Journal of the National Cancer Institute 2021-08, Vol.113 (8), p.1027-1035
Main Authors: Breuer, Eva, Hebeisen, Monika, Schneider, Marcel André, Roth, Lilian, Pauli, Chantal, Frischer-Ordu, Katharina, Eden, Janina, Pache, Basile, Steffen, Thomas, Hübner, Martin, Villeneuve, Laurent, Kepenekian, Vahan, Passot, Guillaume, Gertsch, Philippe, Gupta, Anurag, Glehen, Olivier, Lehmann, Kuno
Format: Article
Language:English
Subjects:
Antineoplastic Combined Chemotherapy Protocols - therapeutic use
Cancer
Chemotherapy
Colorectal cancer
Colorectal carcinoma
Colorectal Neoplasms - pathology
Combined Modality Therapy
Confidence intervals
Cytoreduction Surgical Procedures
Gastric cancer
Health services
Heterogeneity
Humans
Hyperthermia, Induced
Medical prognosis
Metastases
Metastasis
Patients
Peritoneal Neoplasms - therapy
Peritoneum
Peritoneum - pathology
Prognosis
Regression analysis
Retrospective Studies
Statistical analysis
Surgery
Survival
Survival Rate
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Summary:Abstract Background Multimodal treatment, including systemic treatment and surgery, improved the prognosis of peritoneal metastasis (PM). Despite all efforts, recurrence rates remain high, and little data are available about clinical behavior or molecular patterns of PM in comparison to hematogenous metastasis. Here, we aimed to analyze recurrence patterns after multimodal treatment for PM from colorectal cancer. Methods Patients with colorectal PM undergoing multimodal treatment including systemic chemotherapy and cytoreductive surgery plus hyperthermic intraperitoneal chemotherapy (CRS/HIPEC) between 2005 and 2017 at 4 centers were analyzed retrospectively. Results A total of 505 patients undergoing CRS/HIPEC were analyzed. Of the patients, 82.1% received preoperative chemotherapy. Median peritoneal cancer index was 6 (interquartile range = 3-11). Median disease-free and overall survival was 12 (95% confidence interval [CI] = 11 to 14) months and 51 (95% CI = 43 to 62) months, respectively. Disease recurred in 361 (71.5%) patients, presenting as isolated peritoneal recurrence in 24.6%, isolated hematogenous recurrence in 28.3%, and mixed recurrence in 13.9% of patients. Recurrence to the peritoneum was associated with an impaired time from recurrence to death of 21 (95% CI = 18 to 31) months for isolated peritoneal and 22 (95% CI = 16 to 30) months for mixed recurrence, compared with 43 (95% CI = 31 to >121) months for hematogenous recurrence (hazard ratio [HR] = 1.79, 95% CI = 1.27 to 2.53; P = .001; and HR = 2.44, 95% CI = 1.61 to 3.79; P 
ISSN:0027-8874
1460-2105
DOI:10.1093/jnci/djab001