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Fugazzola P, Moroni A, Agnoletti V, Catena F, Cobianchi L, Corallo S, Dal Mas F, Frassini S, Maestri M, Magnone S, Pagani A, Pedrazzoli P, Rigamonti A, Santandrea G, Tomasoni M, Vallicelli C, Viganò J, Ansaloni L. Should we exclude patients with peritoneal carcinosis of colorectal origin and high PCI from CRS + HIPEC? Updates Surg 2023; 75:1819-1825. [PMID: 37423956 DOI: 10.1007/s13304-023-01579-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2023] [Accepted: 07/03/2023] [Indexed: 07/11/2023]
Abstract
International guidelines exclude from surgery patients with peritoneal carcinosis of colorectal origin and a peritoneal cancer index (PCI) ≥ 16. This study aims to analyze the outcomes of patients with colorectal peritoneal carcinosis and PCI greater or equal to 16 treated with cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) (CRS + HIPEC). We retrospectively performed a multicenter observational study involving three Italian institutions, namely the IRCCS Policlinico San Matteo in Pavia, the M. Bufalini Hospital in Cesena, and the ASST Papa Giovanni XXIII Hospital in Bergamo. The study included all patients undergoing CRS + HIPEC for peritoneal carcinosis from colorectal origin from November 2011 to June 2022. The study included 71 patients: 56 with PCI < 16 and 15 with PCI ≥ 16. Patients with higher PCI had longer operative times and a statistically significant higher rate of not complete cytoreduction, with a Completeness of Cytoreduction score (CC) 1 (microscopical disease) of 30.8% (p = 0.004). The 2-year OS was 81% for PCI < 16 and 37% for PCI ≥ 16 (p < 0.001). The 2-years DFS was 29% for PCI < 16 and 0% for PCI ≥ 16 (p < 0.001). The 2-year peritoneal DFS for patients with PCI < 16 was 48%, and for patients with PCI ≥ 16 was 57% (p = 0.783). CRS and HIPEC provide reasonable local disease control for patients with carcinosis of colorectal origin and PCI ≥ 16. Such results form the basis for new studies to reassess the exclusion of these patients, as set out in the current guidelines, from CRS and HIPEC. This therapy, combined with new therapeutical strategies, i.e., pressurized intraperitoneal aerosol chemotherapy (PIPAC), could offer reasonable local control of the disease, preventing local complications. As a result, it increases the patient's chances of receiving chemotherapy to improve the systemic control of the disease.
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Affiliation(s)
- Paola Fugazzola
- General Surgery I, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy.
- Department of Clinical, Diagnostic and Pediatric Sciences, University of Pavia, Via Alessandro Brambilla, 74, 27100, Pavia, PV, Italy.
| | - Alessandro Moroni
- General Surgery I, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Vanni Agnoletti
- Intensive Care Unit, M. Bufalini Hospital, AUSL Romagna, Cesena, Italy
| | - Fausto Catena
- General Surgery, M. Bufalini Hospital, AUSL Romagna, Cesena, Italy
| | - Lorenzo Cobianchi
- General Surgery I, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
- Department of Clinical, Diagnostic and Pediatric Sciences, University of Pavia, Via Alessandro Brambilla, 74, 27100, Pavia, PV, Italy
| | - Salvatore Corallo
- Medical Oncology Unit, Fondazione IRCCS Policlinico San Matteo, 27100, Pavia, Italy
| | - Francesca Dal Mas
- Department of Management, Ca' Foscari University of Venice, Venice, Italy
| | - Simone Frassini
- General Surgery I, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Marcello Maestri
- General Surgery I, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Stefano Magnone
- General Surgery, ASST Papa Giovanni XXIII Hospital, Bergamo, Italy
| | - Anna Pagani
- Medical Oncology Unit, Fondazione IRCCS Policlinico San Matteo, 27100, Pavia, Italy
| | - Paolo Pedrazzoli
- Medical Oncology Unit, Fondazione IRCCS Policlinico San Matteo, 27100, Pavia, Italy
- Department of Internal Medicine and Medical Therapy, University of Pavia, 27100, Pavia, Italy
| | - Andrea Rigamonti
- General Surgery, ASST Papa Giovanni XXIII Hospital, Bergamo, Italy
| | | | - Matteo Tomasoni
- General Surgery I, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Carlo Vallicelli
- General Surgery, M. Bufalini Hospital, AUSL Romagna, Cesena, Italy
| | - Jacopo Viganò
- General Surgery I, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Luca Ansaloni
- General Surgery I, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
- Department of Clinical, Diagnostic and Pediatric Sciences, University of Pavia, Via Alessandro Brambilla, 74, 27100, Pavia, PV, Italy
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Perianesthesia Care of the Oncologic Patients Undergoing Cytoreductive Surgery with Hyperthermic Intraperitoneal Chemotherapy: A Retrospective Study. J Perianesth Nurs 2021; 36:543-552. [PMID: 34303613 DOI: 10.1016/j.jopan.2020.10.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2020] [Revised: 10/23/2020] [Accepted: 10/23/2020] [Indexed: 11/21/2022]
Abstract
PURPOSE This study was to understand the perianesthesia care for patients undergoing cytoreductive surgery and hyperthermic intraperitoneal chemotherapy (CRS + HIPEC). METHOD This is a retrospective study. DESIGN The perioperative electronic medical records of 189 CRS + HIPEC surgical cases at a hospital of Western Pennsylvania from 2012 to 2018 were analyzed to study the characteristics of perianesthesia care for CRS + HIPEC surgery. FINDINGS The patients' median age was 57 (range 21-83) years, and 60% were men. The mean anesthesia time was 10.47 ± 2.54 hours. Most tumors were appendix or colorectal in origin, and the mean peritoneal cancer index score was 16.19 ± 8.76. The mean estimated blood loss was 623 ± 582 mL. The mean total intravenous crystalloid administered was 8,377 ± 4,100 mL. Fifty-two patients received packed red blood cells during surgery. Postoperatively, 100% of the patients were transferred to the intensive care unit. A majority (52%) of patients were extubated in the operating room. Median lengths of hospital and intensive care unit stays were 13 and 2 days, respectively. A majority (73%) of patients had 1 or more postoperative complications and 29% of patients experienced major postoperative complications (Clavien-Dindo grade III or higher) during the hospital stay. Prolonged hospitalization was owing to gastrointestinal dysfunctions and respiratory failure related to atelectasis and pleural effusion. CONCLUSIONS CRS + HIPEC is a major surgery with numerous challenges to the perianesthesia care team regarding hemodynamic adjustment, pain control, and postoperative complications, which demand training and future studies from the perianesthesia care team.
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Sun T, Li K, Xu G, Zhu K, Wang Q, Dang C, Yuan D. Postoperative oxaliplatin-based hyperthermic intraperitoneal chemotherapy: an effective and safe palliative treatment option for colorectal cancer with peritoneal metastasis. World J Surg Oncol 2021; 19:200. [PMID: 34229721 PMCID: PMC8262040 DOI: 10.1186/s12957-021-02320-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Accepted: 06/25/2021] [Indexed: 12/13/2022] Open
Abstract
Background The prognosis of patients with colorectal cancer and peritoneal metastasis (CRC-PM) after incomplete cytoreductive surgery (CRS) or palliative surgery is poor. Novel and effective therapies are urgently needed. This study aimed to assess the effects of palliative postoperative hyperthermic intraperitoneal chemotherapy (HIPEC) in patients with CRC-PM. Methods This retrospective study included patients with CRC-PM at the First Affiliated Hospital of Xi’an Jiaotong University in 05/2014–05/2019. Observation indicators included overall survival (OS), ascites-free survival, peritoneal cancer index (PCI), and completeness of cytoreduction (CC). Kaplan-Meier survival curves and multivariable Cox regression models were used to determine the factors associated with OS and ascites-free survival. The ascites-specific quality of life (QoL) was measured using the Functional Assessment of Chronic Illness Therapy-Ascites Index (FACIT-AI). Results Eighty-two patients were included, including 37 and 45 in the HIPEC and non-HIPEC groups, respectively. Mean OS was 10.3±3.7 (95% CI 9.5–11.2) months. Multivariable Cox proportional hazard regression suggested that PCI (HR=6.086, 95% CI 3.187–11.620, P < 0.0001) was independently associated with OS. The degree of ascites (HR=2.059, 95% CI 1.412–3.005, P < 0.0001), PCI (HR=6.504, 95% CI 2.844–14.875, P < 0.0001), and HIPEC (HR=0.328, 95% CI 0.191–0.562, P < 0.0001) were independently associated with ascites-free survival. In patients with survival >6 months, postoperative ascites-specific QoL was significantly improved after HIPEC compared with the non-HIPEC group (P < 0.001). Oxaliplatin-based HIPEC significantly increased the rates of neutropenia and peripheral neurotoxicity (both P < 0.05). Conclusion These data indicate that postoperative oxaliplatin-based HIPEC might help increase ascites-free survival in CRC-PM patients after incomplete CRS or palliative surgery, with improved QoL after 6 months of follow-up.
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Affiliation(s)
- Tuanhe Sun
- Department of Surgical Oncology, First Affiliated Hospital of Xi'an Jiaotong University, Yanta west street No.277, Xi'an, 710061, Shaanxi, China
| | - Kang Li
- Department of Surgical Oncology, First Affiliated Hospital of Xi'an Jiaotong University, Yanta west street No.277, Xi'an, 710061, Shaanxi, China
| | - Gang Xu
- Department of Surgical Oncology, First Affiliated Hospital of Xi'an Jiaotong University, Yanta west street No.277, Xi'an, 710061, Shaanxi, China
| | - Kun Zhu
- Department of Surgical Oncology, First Affiliated Hospital of Xi'an Jiaotong University, Yanta west street No.277, Xi'an, 710061, Shaanxi, China
| | - Qiong Wang
- Department of Surgical Oncology, First Affiliated Hospital of Xi'an Jiaotong University, Yanta west street No.277, Xi'an, 710061, Shaanxi, China
| | - Chengxue Dang
- Department of Surgical Oncology, First Affiliated Hospital of Xi'an Jiaotong University, Yanta west street No.277, Xi'an, 710061, Shaanxi, China
| | - Dawei Yuan
- Department of Surgical Oncology, First Affiliated Hospital of Xi'an Jiaotong University, Yanta west street No.277, Xi'an, 710061, Shaanxi, China.
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A mouse model for peritoneal metastases of colorectal origin recapitulates patient heterogeneity. J Transl Med 2020; 100:1465-1474. [PMID: 32504005 DOI: 10.1038/s41374-020-0448-x] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2020] [Revised: 05/13/2020] [Accepted: 05/20/2020] [Indexed: 12/24/2022] Open
Abstract
The peritoneum is a common site of dissemination in patients with colorectal cancer. In order to identify high-risk patients and improve therapeutic strategies, a better understanding of the peritoneal dissemination process and the reasons behind the high heterogeneity that is observed between patients is required. We aimed to create a murine model to further elucidate the process of peritoneal dissemination and to provide an experimental platform for further studies. We developed an in vivo model to assess patterns of peritoneal dissemination of 15 colorectal cancer cell lines. Immune deficient mice were intraperitoneally injected with 10,000 human colorectal cancer cells. Ten weeks after injection, or earlier in case of severe discomfort, the mice were sacrificed followed by dissection including assessment of the outgrowth and localization of peritoneal metastases. Furthermore, using a color-based clonal tracing method, the clonal dynamics of peritoneal nodules were observed. The different cell lines showed great variation in the extent of peritoneal outgrowth, ranging from no outgrowth to localized or widespread outgrowth of cells. An association between KRAS pathway activation and the formation of peritoneal metastases was identified. Also, cell line specific tumor location preferences were observed, with similar patterns of outgrowth in anatomically related areas. Furthermore, different patterns regarding clonal dynamics were found, varying from monoclonal or polyclonal outgrowth to extensively dispersed polyclonal lesions. The established murine model recapitulates heterogeneity as observed in human peritoneal metastases, which makes it a suitable platform for future (intervention) studies.
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Kubi B, Gunn J, Fackche N, Cloyd JM, Abdel-Misih S, Grotz T, Leiting J, Fournier K, Lee AJ, Dineen S, Dessureault S, Veerapong J, Baumgartner JM, Clarke C, Mogal H, Patel SH, Dhar V, Lambert L, Hendrix RJ, Abbott DE, Pokrzywa C, Raoof M, Lee B, Maithel SK, Staley CA, Johnston FM, Wang NY, Greer JB. Predictors of Non-home Discharge after Cytoreductive Surgery and Hyperthermic Intraperitoneal Chemotherapy. J Surg Res 2020; 255:475-485. [PMID: 32622162 DOI: 10.1016/j.jss.2020.05.085] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2020] [Revised: 05/11/2020] [Accepted: 05/24/2020] [Indexed: 12/21/2022]
Abstract
BACKGROUND Using a national database of cytoreductive surgery and hyperthermic intraperitoneal chemotherapy (CRS/HIPEC) recipients, we sought to determine risk factors for nonhome discharge (NHD) in a cohort of patients. METHODS Patients undergoing CRS/HIPEC at any one of 12 participating sites between 2000 and 2017 were identified. Univariate analysis was used to compare the characteristics, operative variables, and postoperative complications of patients discharged home and patients with NHD. Multivariate logistic regression was used to identify independent risk factors of NHD. RESULTS The cohort included 1593 patients, of which 70 (4.4%) had an NHD. The median [range] peritoneal cancer index in our cohort was 14 [0-39]. Significant predictors of NHD identified in our regression analysis were advanced age (odds ratio [OR], 1.09; 95% confidence interval [CI], 1.05-1.12; P < 0.001), an American Society of Anesthesiologists (ASA) score of 4 (OR, 2.87; 95% CI, 1.21-6.83; P = 0.017), appendiceal histology (OR, 3.14; 95% CI 1.57-6.28; P = 0.001), smoking history (OR, 3.22; 95% CI, 1.70-6.12; P < 0.001), postoperative total parenteral nutrition (OR, 3.14; 95% CI, 1.70-5.81; P < 0.001), respiratory complications (OR, 7.40; 95% CI, 3.36-16.31; P < 0.001), wound site infections (OR, 3.12; 95% CI, 1.58-6.17; P = 0.001), preoperative hemoglobin (OR, 0.81; 95% CI, 0.70-0.94; P = 0.006), and total number of complications (OR, 1.41; 95% CI, 1.16-1.73; P < 0.001). CONCLUSIONS Early identification of patients at high risk for NHD after CRS/HIPEC is key for preoperative and postoperative counseling and resource allocation, as well as minimizing hospital-acquired conditions and associated health care costs.
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Affiliation(s)
- Boateng Kubi
- Department of Surgery, Johns Hopkins University, Baltimore, Maryland
| | - Jonathan Gunn
- Department of Surgery, Johns Hopkins University, Baltimore, Maryland
| | - Nadege Fackche
- Department of Surgery, Johns Hopkins University, Baltimore, Maryland
| | - Jordan M Cloyd
- Division of Surgical Oncology, Department of Surgery, The Ohio State University Wexner Medical Center, Columbus, Ohio
| | - Sherif Abdel-Misih
- Division of Surgical Oncology, Department of Surgery, The Ohio State University Wexner Medical Center, Columbus, Ohio
| | - Travis Grotz
- Division of Hepatobiliary and Pancreas Surgery, Mayo Clinic, Rochester, Minnesota
| | - Jennifer Leiting
- Division of Hepatobiliary and Pancreas Surgery, Mayo Clinic, Rochester, Minnesota
| | - Keith Fournier
- Department of Surgical Oncology, University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Andrew J Lee
- Department of Surgical Oncology, University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Sean Dineen
- Department of Gastrointestinal Oncology, Department of Oncologic Sciences, Moffitt Cancer Center, Morsani College of Medicine, Tampa, Florida
| | - Sophie Dessureault
- Department of Gastrointestinal Oncology, Department of Oncologic Sciences, Moffitt Cancer Center, Morsani College of Medicine, Tampa, Florida
| | - Jula Veerapong
- Division of Surgical Oncology, Department of Surgery, University of California- San Diego, San Diego, California
| | - Joel M Baumgartner
- Division of Surgical Oncology, Department of Surgery, University of California- San Diego, San Diego, California
| | - Callisia Clarke
- Division of Surgical Oncology, Department of Surgery, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Harveshp Mogal
- Division of Surgical Oncology, Department of Surgery, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Sameer H Patel
- Department of Surgery, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Vikrom Dhar
- Department of Surgery, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Laura Lambert
- Division of Surgical Oncology, Department of Surgery, University of Massachusetts Medical School, Worcester, Massachusetts
| | - Ryan J Hendrix
- Division of Surgical Oncology, Department of Surgery, University of Massachusetts Medical School, Worcester, Massachusetts
| | - Daniel E Abbott
- Division of Surgical Oncology, Department of Surgery, University of Wisconsin, Madison, Wisconsin
| | - Courtney Pokrzywa
- Division of Surgical Oncology, Department of Surgery, University of Wisconsin, Madison, Wisconsin
| | - Mustafa Raoof
- Division of Surgical Oncology, Department of Surgery, City of Hope National Medical Center, Duarte, California
| | - Byrne Lee
- Division of Surgical Oncology, Department of Surgery, City of Hope National Medical Center, Duarte, California
| | - Shishir K Maithel
- Division of Surgical Oncology, Winship Cancer Institute, Emory University, Atlanta, Georgia
| | - Charles A Staley
- Division of Surgical Oncology, Winship Cancer Institute, Emory University, Atlanta, Georgia
| | - Fabian M Johnston
- Department of Surgery, Johns Hopkins University, Baltimore, Maryland
| | - Nae-Yuh Wang
- Department of Medicine, Johns Hopkins University, Baltimore, Maryland; Department of Biostatistics and Epidemiology, Bloomberg School of Public Health, Baltimore, Maryland
| | - Jonathan B Greer
- Department of Surgery, Johns Hopkins University, Baltimore, Maryland.
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Kasumi E, Sato N. A ketogenic diet improves the prognosis in a mouse model of peritoneal dissemination without tumor regression. J Clin Biochem Nutr 2019; 64:201-208. [PMID: 31138953 PMCID: PMC6529699 DOI: 10.3164/jcbn.18-103] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2018] [Accepted: 12/12/2018] [Indexed: 12/16/2022] Open
Abstract
Peritoneal dissemination describes a state where tumor cells spread to the surface of the peritoneum and become engrafted. Peritoneal dissemination reduces the quality of life and prognosis of cancer patients. Currently, there are few effective therapies or preventative treatments for peritoneal dissemination. The aim of this study was to evaluate a ketogenic diet, characterized by high fat, moderate protein and low carbohydrate content, as a novel therapy in a mouse model of peritoneal dissemination. BALB/c mice were intraperitoneally inoculated with colon 26, a murine colon adenocarcinoma cell line, to induce experimental peritoneal dissemination. After tumor inoculation, mice were fed a regular or ketogenic diet. A longer survival time and better health status score, related to improved behavior, was observed in the ketogenic diet group compared with the regular diet group. In addition, the weight of ascites was significantly smaller and the anemia symptoms, number of red blood cell, hemoglobin and hematocrit, were improved in the ketogenic diet group compared with the regular diet group. However, the tumor weight was not significantly smaller in the ketogenic diet group compared with the regular diet group. These data suggest that a ketogenic diet might be a potential preventive therapy for peritoneal dissemination.
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Affiliation(s)
- Eiji Kasumi
- EN Otsuka Pharmaceutical Co., Ltd., R&D Laboratories, 4-3-5 Nimaibashi, Hanamaki, Iwate 025-0312, Japan
| | - Norifumi Sato
- EN Otsuka Pharmaceutical Co., Ltd., R&D Laboratories, 4-3-5 Nimaibashi, Hanamaki, Iwate 025-0312, Japan
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Non-home Discharge and Prolonged Length of Stay After Cytoreductive Surgery and HIPEC. J Surg Res 2019; 233:360-367. [DOI: 10.1016/j.jss.2018.08.018] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2018] [Revised: 07/24/2018] [Accepted: 08/03/2018] [Indexed: 12/29/2022]
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Wu W, Yan S, Liao X, Xiao H, Fu Z, Chen L, Mou J, Yu H, Zhao L, Liu X. Curative versus palliative treatments for colorectal cancer with peritoneal carcinomatosis: a systematic review and meta-analysis. Oncotarget 2017; 8:113202-113212. [PMID: 29348899 PMCID: PMC5762584 DOI: 10.18632/oncotarget.21912] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2017] [Accepted: 10/05/2017] [Indexed: 12/12/2022] Open
Abstract
The objective of this study was to provide an up-to-date summary of the current evidence that may be useful for updating guidelines. We comprehensively searched the published literatures and conferences for studies that compared curative with palliative treatments in colorectal cancer patients with peritoneal metastasis. The primary outcomes considered in this study were three- and five-year overall survival rates. We pooled data across studies and estimated summary effect sizes. Overall, patients who received curative treatments had improved three-year survival (hazard ratio (HR), 2.19 [95% CI, 1.83 to 2.62]) and five-year survival (HR, 2.22 [95% CI, 1.83 to 2.69]) compared with those who received palliative treatments. Patients who received curative treatments had an increased risk of treatment-related morbidity (odds ratio (OR), 2.90 [95% CI, 2.02 to 4.17]), but there was no significant difference in treatment-related mortality between patients who received curative treatments and those who received palliative treatments (OR, 1.46 [CI, 0.62 to 3.47]). Curative treatments improved overall survival in colorectal cancer patients with peritoneal metastasis and did not increase the risk of treatment-related mortality. Curative treatments were associated with a higher risk of treatment-related morbidity. These data highlight the importance for further investigation aimed at prevention of treatment-associated morbidity.
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Affiliation(s)
- Wenqiong Wu
- Department of Radiation Oncology, Hunan Cancer Hospital-The Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University, Changsha, Hunan Province, China
| | - Shipeng Yan
- Department of Cancer Prevention and Control, Hunan Cancer Hospital-The Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University, Changsha, Hunan Province, China
| | - Xianzhen Liao
- Department of Cancer Prevention and Control, Hunan Cancer Hospital-The Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University, Changsha, Hunan Province, China
| | - Haifang Xiao
- Department of Cancer Prevention and Control, Hunan Cancer Hospital-The Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University, Changsha, Hunan Province, China
| | - Zhongxi Fu
- Department of Chronic Diseases Prevention and Control, Centers for Disease Control and Prevention of Hunan, Changsha, Hunan Province, China
| | - Lizhang Chen
- Department of Epidemiology and Health Statistics, School of Public Health, Central South University, Changsha, Hunan Province, China
| | - Jinsong Mou
- Department of Epidemiology and Health Statistics, Changsha Medical University, Changsha, Hunan Province, China
| | - Haibo Yu
- Department of Metabolism and Endocrinology, The Second Xiangya Hospital, Central South University, Changsha, Hunan Province, China
| | - Lian Zhao
- Department of Gastroenterology, The Third Xiangya Hospital, Central South University, Changsha, Hunan Province, China.,Hunan Key Laboratory of Nonresolving Inflammation and Cancer, Changsha, Hunan Province, China
| | - Xiangguo Liu
- Department of Cancer Prevention and Control, Hunan Cancer Hospital-The Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University, Changsha, Hunan Province, China
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