Clinical and Histopathologic Features of 35 Patients Treated for Colorectal Peritoneal Metastases Who Survived 5 Years. 

 -  2023 
<br/><br/> BACKGROUND: Currently, patients with a limited extent of peritoneal metastases from colon and rectal cancer are treated by cytoreductive surgery combined with perioperative chemotherapy performed at experienced centers.  CARACTERSTICAS CLNICAS E HISTOPATOLGICAS EN PACIENTES TRATADOS POR METASTASIS PERITONEALES DE ORGEN COLORECTAL Y QUE SOBREVIVIERON AOS: ANTECEDENTES:Actualmente, los pacientes con extension limitada de metastasis peritoneales de origen colorectal son tratados mediante cirugia citorreductora asociada con una quimioterapia peri-peratoria realizadas en centros experimentados.OBJETIVO:Estudio y evaluacion estadistica de las caracteristicas que puedan impactar en la sobrevida de los pacientes a 5 anos o mas. Se utilizaron estos datos en el analisis de riesgo /beneficio realizados por un equipo multidisciplinario.DISENO:Revision retrospectiva de una base de datos prospectiva.AJUSTES:Estudio realizado en una sola institucion academica.PACIENTES:Todos aquellos que presentaban metastasis peritoneales de origen colorectal, comprobadas por biopsia y tratadas con quimioterapia sistemica, cirugia peri-operatoria y citorreductora completas.MEDIDAS DE RESULTADO PRINCIPALES:Las medidads de resultados primarios fueron las caracteristicas clinicas, histologicas y relacionadas con el tratamiento que tuvieron un impacto en la sobrevida a 5 anos. RESULTADOS:De 131 pacientes que tuvieron una cirugia de citorreduccion completa, 35 pacientes (26, 7%) fueron identificados como sobrevivientes a 5 anos. La mediana de sobrevida fue de 27 meses. Se identificarion 16 varones. La mediana de edad fue de 50, 5 anos con un rango de 25 a 80 anos. Segun analisis univariante, la ausencia de compromiso de los ganglios linfaticos en el momento de la reseccion del cancer colorrectal primario (HR 1,899 (1,064, 3,388) p = 0,03), la respuesta completa o casi completa al tratamiento neoadyuvante con quimioterapia (HR 0,251 (0,092, 0,684) p = 0,007), el indice de cancer peritoneal <=17 (HR 0,509 (0,329, 0,788) p = 0,002), la reseccion completa y visible de la enfermedad indicada por la puntuacion de citorreduccion de 0 (HR 0,412 (0,224), 0,756) p = 0,004) y los tumores bien diferenciados (HR 0,34 (0,157, 0,737) p = 0,006) se asociaron significativamente con 5 o mas anos de sobrevida.LIMITACIONES:El estudio se encontro limitado por su naturaleza retrospectiva, por la no medida de factores de confusion y por los datos provenientes de una sola institucion. CONCLUSION ES:La biologia tumoral demostrada segun el estado de los ganglios linfaticos y la diferenciacion tumoral, agregada a la extension de la enfermedad medida por la respuesta a la quimioterapia neoadyuvante, el indice de cancer peritoneal y la ausencia visible de enfermedad residual, demostraron un resultado favorable. Consulte Video Resumen en http://links.lww.com/DCR/C62(Traduccion-Dr. Xavier Delgadillo ). Copyright © The ASCRS 2022.  CONCLUSIONS: The tumor biology as revealed by lymph node status and tumor differentiation plus extent of disease as measured by the response to neoadjuvant chemotherapy, peritoneal cancer index, and no visible residual disease indicated a favorable outcome. See Video Abstract at http://links.lww.com/DCR/C62 .  DESIGN: This was a retrospective review of a prospective database.  LIMITATIONS: Limitations include its retrospective nature, unmeasured confounders, and data from a single institution.  MAIN OUTCOME MEASURES: The primary outcomes measured were the clinical-, histologic-, and treatment-related features that had an impact on 5-year survival.  OBJECTIVE: To statistically evaluate features that may impact survival of >=5 years. These data are used in the risk/benefit analyses performed by the multidisciplinary team.  PATIENTS: All patients who had biopsy-proven colon or rectal peritoneal metastases treated by systemic chemotherapy, complete cytoreductive surgery, and perioperative surgery were included.  RESULTS: From 131 patients who had complete cytoreduction, 35 patients (26.7%) were identified as 5-year survivors. The median survival time was 27 months. The median age was 50.5 (range, 25-80) years. By univariant analysis, an absence of lymph node involvement at the time of primary colorectal cancer resection (HR 1.899 [95% CI, 1.064-3.388]; p = 0.03), complete or near-complete response to neoadjuvant chemotherapy (HR 0.251 [95% CI, 0.092-0.684]; p = 0.007), peritoneal cancer index <=17 (HR 0.509 [95% CI, 0.329-0.788]; p = 0.002), complete visible resection of disease indicated by the completeness of cytoreduction score of 0 (HR 0.412 [95% CI, 0.224-0.756]; p = 0.004), and well-differentiated tumor (HR 0.34 [95% CI, 0.157-0.737]; p = 0.006) were significantly associated with >=5 years survival.  SETTINGS: This single-institution study was conducted at an academic center. 
<br/><br/><br/>English 
<br/><br/><label>ISSN: </label>0012-3706 
<br/><br/><label>Standard No.: </label>00003453-202310000-00009 [pii] 10.1097/DCR.0000000000002448 [doi] 
<br/><br/><label>Subjects--Topical Terms: </label><br/>*Colorectal Neoplasms<br/>*Hyperthermia, Induced<br/>*Peritoneal Neoplasms<br/>Adult<br/>Aged<br/>Aged, 80 and over<br/>Colorectal Neoplasms/su [Surgery]<br/>Combined Modality Therapy<br/>Cytoreduction Surgical Procedures/ae [Adverse Effects]<br/>Humans<br/>Hyperthermia, Induced/ae [Adverse Effects]<br/>Middle Aged<br/>Peritoneal Neoplasms/sc [Secondary]<br/>Peritoneum/pa [Pathology]<br/>Peritoneum/su [Surgery]<br/>Prognosis<br/>Retrospective Studies<br/>Survival Rate--Curated
<br/><br/><label>Subjects--Geographic Terms: </label><br/>MedStar Health Research Institute<br/>Washington Cancer Institute
<br/><br/><label>Index Terms--Occupation: </label><br/>MedStar General Surgery Residency<br/>MedStar Georgetown University Hospital/MedStar Washington Hospital Center
<br/><br/><label>Index Terms--Function: </label><br/>Journal Article<br/>Video-Audio Media