|
1
|
Cashin PH, Esquivel J, Larsen SG, Liauw W, Alzahrani NA, Morris DL, Kepenekian V, Sourrouille I, Dumont F, Tuech JJ, Ceribelli C, Doussot B, Sgarbura O, Quenet F, Glehen O, Fisher OM. Perioperative chemotherapy in colorectal cancer with peritoneal metastases: A global propensity score matched study. EClinicalMedicine 2023; 55:101746. [PMID: 36457647 PMCID: PMC9706515 DOI: 10.1016/j.eclinm.2022.101746] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2022] [Revised: 10/28/2022] [Accepted: 10/28/2022] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND There is a paucity of studies evaluating perioperative systemic chemotherapy in conjunction with cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) in patients with colorectal cancer peritoneal metastases (CRCPM). The aim was to evaluate neoadjuvant and/or adjuvant systemic therapy in CRCPM. METHODS Patients with CRCPM from 39 treatment centres globally from January 1, 1991, to December 31, 2018, who underwent CRS+HIPEC were identified and stratified according to neoadjuvant/adjuvant use. Crude data analysis, propensity score matching (PSM) and Cox-proportional hazard modelling was performed. FINDINGS Of 2093 patients, 1613 were included in neoadjuvant crude evaluation with 708 in the PSM cohort (354 patients/arm). In the adjuvant evaluation, 1176 patients were included in the crude cohort with 778 in the PSM cohort (389 patients/arm). The median overall survival (OS) in the PSM cohort receiving no neoadjuvant vs neoadjuvant therapy was 37.0 months (95% CI: 32.6-42.7) vs 34.7 months (95% CI: 31.2-38.8, HR 1.08 95% CI: 0.88-1.32, p = 0.46). The median OS in the PSM cohort receiving no adjuvant therapy vs adjuvant therapy was 37.0 months (95% CI: 32.9-41.8) vs 45.7 months (95% CI: 38.8-56.2, HR 0.79 95% CI: 0.64-0.97, p = 0.022). Recurrence-free survival did not differ in the neoadjuvant evaluation but differed in the adjuvant evaluation - HR 1.04 (95% CI: 0.87-1.25, p = 0.66) and 0.83 (95% CI: 0.70-0.98, p = 0.03), respectively. Multivariable Cox-proportional hazard modelling in the crude cohorts showed hazard ratio 1.08 (95% CI: 0.92-1.26, p = 0.37) for administering neoadjuvant therapy and 0.86 (95% CI: 0.72-1.03, p = 0.095) for administering adjuvant therapy. INTERPRETATION Neoadjuvant therapy did not confer a benefit to patients undergoing CRS+HIPEC for CRCPM, whereas adjuvant therapy was associated with a benefit in this retrospective setting. FUNDING None.
Collapse
Affiliation(s)
- Peter H. Cashin
- Department of Surgical Sciences, Section of Surgery, Uppsala University, Akademiska Sjukhuset, Uppsala 75185, Sweden
- Corresponding author. Associate Professor of Surgery, Residency Director of Surgery, Department of Surgery, HIPEC Team, Section of Colorectal Surgery, Uppsala University Hospital, Akademiska Sjukhuset, Uppsala, Sweden.
| | - Jesus Esquivel
- Division of Surgical Oncology, Beebe Healthcare, Lewes, DE, United States of America
| | - Stein G. Larsen
- Section of Surgical Oncology, Department of Gastroenterological Surgery, Oslo University Hospital, Sognsvannsveien 20, Oslo 0372, Norway
| | - Winston Liauw
- St George & Sutherland Clinical School, UNSW Australia, Sydney, Australia
- Department of Medical Oncology, St George Hospital, Sydney, Australia
| | | | - David L. Morris
- Department of Surgery, St George Hospital, Sydney, Australia
| | - Vahan Kepenekian
- Hôspital Lyon Sud, Hospices Civils de Lyon, Lyon, France
- CICLY, Université Lyon 1, Lyon, France
| | | | - Frédéric Dumont
- Department of Oncological Surgery, Institut de Cancérologie de l’Ouest, St Herblain, France
| | - Jean-Jacques Tuech
- Department of Digestive Surgery, Centre Hospitalo-Universitaire de Rouen, Rouen, France
| | - Cécilia Ceribelli
- Department of Surgery, Centre Hospitalo-Universitaire de l’Archet II, Nice, France
| | - Beranger Doussot
- Department of Digestive Surgery, Centre Hospitalo Universitaire Dijon Bourgogne, Dijon, France
| | - Olivia Sgarbura
- Department of Surgical Oncology, Cancer Institute of Montpellier, University of Montpellier, Montpellier, France
| | - Francois Quenet
- Department of Surgical Oncology, Cancer Institute of Montpellier, University of Montpellier, Montpellier, France
| | - Olivier Glehen
- Hôspital Lyon Sud, Hospices Civils de Lyon, Lyon, France
- CICLY, Université Lyon 1, Lyon, France
| | - Oliver M. Fisher
- Department of Medical Oncology, St George Hospital, Sydney, Australia
- Department of Surgery, St George Hospital, Sydney, Australia
- Notre Dame University School of Medicine, Sydney, Australia
| | | | | | | | | |
Collapse
|