PROPHYLOCHIP: no benefit of second-look surgery plus HIPEC for colorectal peritoneal metastases

Moran, Brendan

doi:10.1016/s1470-2045(20)30338-7

Cited by 9 publications

(7 citation statements)

References 7 publications

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“…Historically, the PCI (a tumor burden surrogate) and completeness of cytoreduction (a score of surgical radicality) have been used as selection and prognostic criteria. 7,[46][47][48][49][50][51][52][53][54][55][56][57][58] Our results clearly showed the independent role of PCI (HR 1.03 per increasing point) and completeness of surgery (CC score) (HR, 2.8 for complete vs suboptimal cytoreduction) in predicting survival and disease relapse. Indeed, patients with a PCI lower than 15 have a median survival twice as long as patients with a higher PCI (55.0 vs 25.1 months).…”

Section: Overall Survivalsupporting

confidence: 61%

“…Addition of HIPEC to CRS has been questioned during the last few years, after results of randomized controlled trials in a proactive/prophylactic (patients at risk for the development of PM) 53,54 or curative (''adjuvant'' treatment after surgery) setting. 9 Of relevance, reported results of a still unpublished PRODIGE 7 randomized trial showed a notable median OS survival in both arms, but failed to demonstrate a survival advantage of CRS?HIPEC with oxaliplatin over CRS alone, reporting a higher rate of complication in the HIPEC arm.…”

Section: Discussionmentioning

confidence: 99%

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Microsatellite and RAS/RAF Mutational Status as Prognostic Factors in Colorectal Peritoneal Metastases Treated with Cytoreductive Surgery and Hyperthermic Intraperitoneal Chemotherapy (HIPEC)

et al. 2021

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Background. Cytoreductive surgery (CRS) with hyperthermic intraperitoneal chemotherapy (HIPEC) leads to prolonged survival for selected patients with colorectal (CRC) peritoneal metastases (PM). This study aimed to analyze the prognostic role of micro-satellite (MS) status and RAS/RAF mutations for patients treated with CRS. Methods. Data were collected from 13 Italian centers with PM expertise within a collaborative group of the Italian Society of Surgical Oncology. Clinical and pathologic variables and KRAS/NRAS/BRAF mutational and MS status were correlated with overall survival (OS) and disease-free survival (DFS).Results. The study enrolled 437 patients treated with CRS-HIPEC. The median OS was 42.3 months [95% confidence interval (CI), 33.4-51.2 months], and the median DFS was 13.6 months (95% CI, 12.3-14.9 months).

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Section: Overall Survivalsupporting

confidence: 61%

Section: Discussionmentioning

confidence: 99%

Microsatellite and RAS/RAF Mutational Status as Prognostic Factors in Colorectal Peritoneal Metastases Treated with Cytoreductive Surgery and Hyperthermic Intraperitoneal Chemotherapy (HIPEC)

et al. 2021

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“…Accumulating evidence from observational studies promoted the spread of CRS and HIPEC for PSMs, and now, the treatment is considered the standard of care for primary peritoneal malignancies despite the absence of level 1 evidence due to lack of an effective alternative treatment [ 5 ]. However, certain recent high-quality RCTs, such as PRODIGE7, COLOPEC, CYTO-CHIP, and PROFILOCHIP presented conflicting data and questioned whether HIPEC regimens currently in use are helpful for peritoneal metastases [ 6 , 7 , 8 , 9 ]. Thus, this study aimed to investigate and present our 10-year experience with this controversial method, CRS and HIPEC, for PSMs in a single tertiary center in a Baltic country.…”

Section: Introductionmentioning

confidence: 99%

Initial Experience of Cytoreductive Surgery (CRS) and Hyperthermic Intraperitoneal Chemotherapy (HIPEC) in Baltic Country Center

Račkauskas

Baušys

Jurgaitis

et al. 2022

JCM

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Background: Peritoneal surface malignancies (PSMs) are a heterogenous group of primary and metastatic cancers affecting the peritoneum. They are associated with poor long-term outcomes. Many centers around the world adopt cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) in routine clinical practice for these otherwise condemned patients despite a lack of high-level evidence from randomized control trials. This study aimed to investigate and present our 10-year experience with this controversial method, CRS and HIPEC, for PSM in a single tertiary center in a Baltic country. Methods: Patients who underwent CRS and HIPEC at Vilnius University Hospital Santaros Klinikos between 2011 and 2021 were included in this retrospective study. Overall survival was the primary study outcome. Secondary outcomes included postoperative morbidity and mortality, and local or systemic recurrence rates. Results: Sixty-nine patients who underwent CRS and HIPEC were included in the study. Most patients underwent treatment for peritoneal metastases from colorectal, ovarian, and appendiceal cancers. Six (8.7%) patients received CRS and HIPEC for primary peritoneal neoplasm—pseudomyxoma peritonei. The mean peritoneal carcinomatosis index score was 12 ± 7. Complete cytoreduction was achieved in 62 (89.9%) patients. The mean OS was 39 ± 29 months. The mean survival of patients with PSMs of different origin was as follows: 39 ± 25 (95% CI: 28–50) months for colorectal cancer, 44 ± 31 (95% CI: 30–58) months for ovarian cancer, 32 ± 21 (95% CI: 21–43) months for appendiceal cancer, 422 ± 1 (95% CI: 12–97) months for pseudomyxoma peritonei, and 7 months for gastric cancer. Conclusions: The current study demonstrated the results of the CRS and HIPEC program in a single Baltic country tertiary center. Patients who underwent CRS and HIPEC for PSMs achieved moderate survival rates with acceptable postoperative morbidity and mortality risk.

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“…(HIPEC) to improve overall and disease-free survival in patients with localized PM. [5][6][7][8] Similarly, randomized trials are underway to investigate the role of prophylactic second-look surgery and HIPEC. [9][10][11] The efficacy of these strategies depends on the extent of peritoneal disease, 12 therefore efforts should be made toward early identification of limited mPM or selection of patients at higher risk.…”

mentioning

confidence: 99%

Prediction of Metachronous Peritoneal Metastases After Radical Surgery for Colon Cancer: A Scoring System Obtained from an International Multicenter Cohort

et al. 2022

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Background Since novel strategies for prevention and treatment of metachronous peritoneal metastases (mPM) are under study, it appears crucial to identify their risk factors. Our aim is to establish the incidence of mPM after surgery for colon cancer (CC) and to build a statistical model to predict the risk of recurrence. Patients and Methods Retrospective analysis of consecutive pT3–4 CC operated at five referral centers (2014–2018). Patients who developed mPM were compared with patients who were PM-free at follow-up. A scoring system was built on the basis of a logistic regression model. Results Of the 1423 included patients, 74 (5.2%) developed mPM. Patients in the PM group presented higher preoperative carcinoembryonic antigen (CEA) [median (IQR): 4.5 (2.5–13.0) vs. 2.7 (1.5–5.9), P = 0.001] and CA 19-9 [median (IQR): 17.7 (12.0–37.0) vs. 10.8 (5.0–21.0), P = 0.001], advanced disease (pT4a 42.6% vs. 13.5%; pT4b 16.2% vs. 3.2%; P < 0.001), and negative pathological characteristics. Multivariate logistic regression identified CA 19-9, pT stage, pN stage, extent of lymphadenectomy, and lymphovascular invasion as significant predictors, and individual risk scores were calculated for each patient. The risk of recurrence increased remarkably with score values, and the model demonstrated a high negative predictive value (98.8%) and accuracy (83.9%) for scores below five. Conclusions Besides confirming incidence and risk factors for mPM, our study developed a useful clinical tool for prediction of mPM risk. After external validation, this scoring system may guide personalized decision-making for patients with locally advanced CC.

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PROPHYLOCHIP: no benefit of second-look surgery plus HIPEC for colorectal peritoneal metastases

Cited by 9 publications

References 7 publications

Microsatellite and RAS/RAF Mutational Status as Prognostic Factors in Colorectal Peritoneal Metastases Treated with Cytoreductive Surgery and Hyperthermic Intraperitoneal Chemotherapy (HIPEC)

Microsatellite and RAS/RAF Mutational Status as Prognostic Factors in Colorectal Peritoneal Metastases Treated with Cytoreductive Surgery and Hyperthermic Intraperitoneal Chemotherapy (HIPEC)

Initial Experience of Cytoreductive Surgery (CRS) and Hyperthermic Intraperitoneal Chemotherapy (HIPEC) in Baltic Country Center

Prediction of Metachronous Peritoneal Metastases After Radical Surgery for Colon Cancer: A Scoring System Obtained from an International Multicenter Cohort

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