Michael G White, Paula Marincola Smith, Neal Bhutiani, Beth Helmink, Norman Galbraith, Scott Kopetz, Michael Overman, Paul Mansfield, Keith Fournier, Abhineet Uppal
BACKGROUND: patients with peritoneal metastases (PM) from colorectal adenocarcinoma(CRC) benefit from cytoreductive surgery(CRS). The role of HIPEC, however, remains unclear. We studied associations between HIPEC, peritoneal disease-free survival (PDFS), and overall survival(OS) in CRC patients undergoing CRS.
STUDY DESIGN: All CRC patients undergoing CRS between 2008 and 2023 were retrospectively identified at our center. Patient clinicodemographic factors were determined by chart review. OS and PDFS were evaluated using the Kaplan-Meier method. Associations between clinical factors and survival were determined using Cox proportional hazard models.
RESULTS: One hundred forty-seven patients were identified with 24.5-month median follow-up. Most patients (111,75.5%) had a low PCI (<11), while 36 patients (24.5%) had high PCI(���11). Eighty-three (55.8%) patients had CRS alone. Sixty-four patients underwent CRS with HIPEC (42(66%) MMC, 19(30%) OX, 3(4.7%) CIS). Median OS was 59.8 (95%CI:41.7-83.0) months. Median PDFS was 13.3 (95%CI:10.4-18.5) months. OS was equivalent comparing HIPEC with MMC, HIPEC with OX (HR 0.49, 95%CI: 0.22-1.09, p=0.08), and CRS alone (HR 0.74, 95%CI:0.41-1.32, p=0.31). Multivariable analysis showed only PCI was associated with OS (HR 1.08, 95%CI:1.03-1.14, p=0.003). Low PCI patients had similar PDFS after CRS/HIPEC (HR 1.07, 95%CI:0.61-1.87, p=0.814) compared to CRS alone. High PCI patients had improved OS comparing CRS/HIPEC to CRS (MMC: HR 0.17, 95%CI:0.04-0.76, p=0.02; OX: HR 0.048, 95%CI:0.006-0.37, p=0.004).
CONCLUSION: HIPEC was not associated with OS or PDFS in patients with PCI���10 but was associated with improved OS and PDFS in patients with PCI���11. Use of HIPEC for high PCI may be warranted, though randomized prospective data is needed to confirm this.
