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中国癌症防治杂志

中国癌症防治杂志 ›› 2025, Vol. 17 ›› Issue (2): 195-200.doi: 10.3969/j.issn.1674-5671.2025.02.10

• 论著 • 上一篇    下一篇

CRS联合HIPEC治疗结直肠癌腹膜转移：原发肿瘤位置与临床结局的相关性

  

  1. 广西医科大学附属肿瘤医院实验研究部；溶瘤纳米体系开发广西高校工程研究中心；区域性高发肿瘤早期防治研究教育部重点实验室（广西医科大学）；广西医科大学第一附属医院肿瘤内科
  • 出版日期:2025-04-25 发布日期:2025-05-15
  • 通讯作者: 周迈 E-mail：wuming19830202@163.com

CRS combined with HIPEC for peritoneal metastasis in colorectal cancer: correlation between primary tumor location and clinical outcomes

  • Online:2025-04-25 Published:2025-05-15
  • Supported by:
    中国癌症基金会北京希望马拉松专项基金（LC2022L01）

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摘要： 目的 探讨原发肿瘤位置对接受细胞减灭术（cytoreductive surgery,CRS）联合腹腔热灌注化疗（hyperthermic intraperitoneal chemotherapy, HIPEC）的结直肠癌腹膜转移（peritoneal metastasis,PM）患者围手术期结局与远期预后的影响。方法 回顾性收集2017年6月至2022年12月在中国医学科学院北京协和医学院肿瘤医院结直肠外科行CRS联合HIPEC治疗的结直肠癌PM患者的基线资料、临床病理特征、围手术期资料及预后信息。采用Kaplan⁃Meier法绘制生存曲线并采用Log⁃rank对组间生存差异进行比较。采用单因素及多因素Cox回归分析探讨接受CRS联合HIPEC治疗结直肠癌PM患者总生存期（overall survival, OS）的影响因素。结果 共142例患者纳入研究，结肠癌组104例，直肠癌组38例。相较于结肠癌PM患者，直肠癌PM患者行CRS+HIPEC治疗后3~4级并发症发生率更高（19.2% vs 36.8%，P=0.029），且3年OS率更低（47.9% vs 22.7%，P=0.003）。原发肿瘤位于直肠（HR=2.07，95%CI：1.07~4.42，P=0.042）和CC评分为2~3分（HR=2.31，95%CI：1.04~5.22，P=0.038）是影响结直肠癌PM患者行CRS+HIPEC后不良OS的独立危险因素。结论 CRS+HIPEC治疗后直肠癌PM患者比结肠癌PM患者更倾向于出现3~4级并发症，且生存结局不理想。

关键词: 结直肠癌, 腹膜转移, 细胞减灭术, 腹腔热灌注化疗, 预后

Abstract: Objective To investigate the effect of primary tumor location on perioperative complications and long⁃term prognosis in colorectal cancer patients with peritoneal metastasis (PM) undergoing cytoreductive surgery (CRS) combined with hyperthermic intraperitoneal chemotherapy (HIPEC). Methods Baseline data, clinicopathological characteristics, perioperative data, and prognosis were retrospectively collected from patients with colorectal cancer PM treated CRS combined with HIPEC at the Department of Colorectal Surgery, Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College between June 2017 and December 2022. Kaplan⁃Meier method was used to draw the survival curve, and Log⁃rank was used to compare the survival differences between groups. Univariable and multivariable Cox regression analysis were used to analyze the influencing factors of overall survival (OS) in patients with colorectal cancer PM treated with CRS combined with HIPEC. Results A total of 142 patients were enrolled, with 104 in the colon cancer group and 38 in the rectal cancer group. Compared with colon cancer PM patients, rectal cancer PM patients demonstrated higher incidence of grade 3-4 complications (19.2% vs 36.8%, P=0.029), and worse 3⁃year OS (47.9% vs 22.7%, P=0.003) after CRS+HIPEC. The location of the primary tumor in the rectum (HR=2.07, 95%CI: 1.07-4.42, P=0.042) and CC score of 2-3 (HR=2.31, 95%CI: 1.04-5.22, P=0.038) were the independent prognostic factors of reduced OS in colorectal cancer PM patients after CRS+HIPEC. Conclusions Rectal cancer PM patients demonstrate increased susceptibility to grade 3-4 complications and inferior survival outcomes compared to colon cancer PM patients after CRS+HIPEC, and the survival outcome is not ideal.

Key words: Colorectal cancer, Peritoneal metastasis, Cytoreductive surgery, Hyperthermic intraperitoneal chemotherapy, Prognosis

中图分类号: 

  • R735.3+5