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425. Survival prognostic factors in patients with colorectal peritoneal carcinomatosis treated with cytoreductive surgery and intraoperative hyperthermic intraperitoneal chemotherapy: A single institution experience
ABSTRACTS
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Poster Session: Peritoneal Surface Oncology 425. Survival prognostic factors in patients with colorectal peritoneal carcinomatosis treated with cytoreductive surgery and intraoperative hyperthermic intraperitoneal chemotherapy: A single institution experience S. Nikolic1, Z.M. Zegarac1, M.A. Martinovic1, I.D.J. Djurisic1, M.K. Kocic1, I.M. Markovic1 1 Institute of Oncology and Radiology, Surgery, Belgrade, Serbia Purpose: The aim of this research was to examine overall (OS) and disease-free survival (DFS) in patients with colorectal peritoneal carcinomatosis (CRC-PC), treated with cytoreductive surgery (CRS) and intraoperative hyperthermic intraperitoneal chemotherapy (HIPEC), as well as to analyse factors of prognostic significance. Methods: We included 61 patients with pathological/ and computerized tomography (CT) confirmation of CRC-PC, treated with CRS+HIPEC from 2005 to 2012. Peritoneal Cancer Index (PCI) score was used for quantitative assessment of the CRC-PC extent. We performed CRS following the Sugarbaker’s principles in all patients with PCI 20 and only in 3/61 (4.92%) patients with PCI >20. HIPEC (oxaliplatin 410 mg/m2 in 2000mL isotonic solution and 41 C) was performed using RanD PerformerÒ HT perfusion system during 30e60 min. Cox proportional hazard regression was used to determine significant factors for OS and DFS. Results: The follow-up ranged from 1 to 83 months (median 22). Median OS was 51 months (95% confidence interval/CI 22+). Median DFS for patients without residual disease (57/61, 93.44%) was 23 months (95% CI 16+). One-, 2- and 6-year OS (DFS) were 78.6% (68.3%), 58.7% (46.7%) and 50.5% (38.1%), respectively. By the end of the study, 55.74% of the patients were still alive. Cox multivariate analysis indicated PCI score as a parameter of highly prognostic significance for patients treated with CRS+HIPEC (p < 0.001). Patients with PCI <13 (vs PCI 13) had significantly longer OS and DFS (p < 0.001), also confirmed for PCI subcategories (PCI < 7 vs 7 PCI < 13 vs PCI13). All patients with PCI <7 are still alive. Conclusion: Our study indicates that CRS+HIPEC significantly improves the survival of CRC-PC patients. This treatment modality should be considered as the most suitable in well-selected patients with this disease. No conflict of interest. http://dx.doi.org/10.1016/j.ejso.2014.08.415 426. Incidence of free colorectal cancer cells in peritoneal cavity and correlation with clinicopathologic variables: An analysis of 275 patients undergoing curative intent resection for colorectal cancer W. Suwanthanma1, C. Euanorasetr1, P. Lertsithichai1, A. Pongtippan2, E. Sirachainan3, N. Poprom1 1 Ramathibodi Hospital, Surgery, Bangkok, Thailand 2 Ramathibodi Hospital, Pathology, Bangkok, Thailand 3 Ramathibodi Hospital, Medicine, Bangkok, Thailand Background: This study was conducted to investigate the incidence of free cancer cells in the peritoneal lavage cytology of patients who had undergone curative resection for colorectal cancer. Material and methods: From January 2006-December 2012, intraoperative peritoneal lavage cytology was performed in 275 patients who underwent curative resection for colorectal cancer. Immediately after exploration of abdomen, 100 ml of normal saline solution was instilled into peritoneal cavity over the tumor site. Peritoneal lavage was then aspirated and sent for cytological examination. Results: Six (2.18%) of 275 patients examined were found to have positive peritoneal lavage cytology. Demographic variables, site of tumor,
degree of differentiation, mucinous component, perineural invasion, angiolymphatic invasion, depth of tumor penetration, staging and level of serum CEA were found not to affect the incidence of free cancer cells. Positive nodal status was the only factors found to be associated with incidence of positive peritoneal cytology (p ¼ 0.04). Conclusion: Overall, our study demonstrates low incidence of positive free colorectal cancer cell in lavage fluid obtained before resection in patients underwent curative intent resection for colorectal cancer. Factors associated with positive peritoneal cytology are lymph node involvement. No conflict of interest. http://dx.doi.org/10.1016/j.ejso.2014.08.416
427. Progress classification of the synchronous peritoneal metastases of colorectal cancer e Discussion from a prognosis H. Sato1, Y. Koide1, M. Shiota1, S. Matsuoka1, K. Hatta1, M. Mizuno1, K. Maeda1 1 Fujita Health University, Department of Surgery, Toyoake, Japan Background: It is important to evaluate the degree of peritoneal metastases (PM) objectively, to conduct a comparison and the collaborative investigation between institutions. We examined a simple classification with the reproducibility to become the index of the treatment strategy in the PM of colorectal cancer (CRC). Patients and methods: This study comprised 67 patients with PM of CRC. We have resected as possible the local disseminated lesion with tumor resection as far as overall status permitted it, and performed chemotherapy postoperatively. Sixty-three patients showed distant metastasis at the same time, and palliative operation was performed in 17. The patients were classified according to the greatest size of the disseminated lesion (5 mm, 5e20 mm, 20 mm), the number of the disseminated lesion (3, 4), and the regional number with the disseminated lesion, and oncological results were compared. Results: The 3-year survival rate (3ySR) was significantly better in the primary tumor resection case (27.8%) than a non-resected case (18.5%). There were no significant differences in 3ySR among the groups according to the greatest size of the disseminated lesion (5 mm: 11.9%, 5e20 mm: 34.9%, 20 mm: 28.6%). The prognosis was significantly better in the patients with 3 disseminated lesions (3ySR: 45.2%) than in 4 disseminated lesions (3ySR:12.2%). The prognosis was significantly better in the patients whom disseminated lesion confined in 1 region (3ySR: 31.6%) than in the patients whom disseminated lesion was present in 2 or more regions (3ySR: 3.4%). The prognosis was significantly better in the patients who had 3 the disseminated lesion or whom disseminated lesion limited to 1 region (localized group: 3ySR; 45.6%) than in others (non-localized group: 3ySR;12.2%). The resection rate of primary tumor was significantly higher in localized group (89.3%) than in non-localized group (64.1%). In non-localized group, the prognosis was significantly better in the patients with primary tumor resection (8.8%) than without primary tumor resection. Conclusion: The number of the disseminated lesion, and the regional number with the disseminated lesion were useful for a prognostic prediction in the synchronous PM of CRC, and it was considered to be proper to classify in two groups (localized group and non-localized group), and it was suggested that the primary tumor resection contributed to the prognostic improvement of the synchronous PM case. No conflict of interest. http://dx.doi.org/10.1016/j.ejso.2014.08.417
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Poster Session: Peritoneal Surface Oncology 425. Survival prognostic factors in patients with colorectal peritoneal carcinomatosis treated with cytoreductive surgery and intraoperative hyperthermic intraperitoneal chemotherapy: A single institution experience S. Nikolic1, Z.M. Zegarac1, M.A. Martinovic1, I.D.J. Djurisic1, M.K. Kocic1, I.M. Markovic1 1 Institute of Oncology and Radiology, Surgery, Belgrade, Serbia Purpose: The aim of this research was to examine overall (OS) and disease-free survival (DFS) in patients with colorectal peritoneal carcinomatosis (CRC-PC), treated with cytoreductive surgery (CRS) and intraoperative hyperthermic intraperitoneal chemotherapy (HIPEC), as well as to analyse factors of prognostic significance. Methods: We included 61 patients with pathological/ and computerized tomography (CT) confirmation of CRC-PC, treated with CRS+HIPEC from 2005 to 2012. Peritoneal Cancer Index (PCI) score was used for quantitative assessment of the CRC-PC extent. We performed CRS following the Sugarbaker’s principles in all patients with PCI 20 and only in 3/61 (4.92%) patients with PCI >20. HIPEC (oxaliplatin 410 mg/m2 in 2000mL isotonic solution and 41 C) was performed using RanD PerformerÒ HT perfusion system during 30e60 min. Cox proportional hazard regression was used to determine significant factors for OS and DFS. Results: The follow-up ranged from 1 to 83 months (median 22). Median OS was 51 months (95% confidence interval/CI 22+). Median DFS for patients without residual disease (57/61, 93.44%) was 23 months (95% CI 16+). One-, 2- and 6-year OS (DFS) were 78.6% (68.3%), 58.7% (46.7%) and 50.5% (38.1%), respectively. By the end of the study, 55.74% of the patients were still alive. Cox multivariate analysis indicated PCI score as a parameter of highly prognostic significance for patients treated with CRS+HIPEC (p < 0.001). Patients with PCI <13 (vs PCI 13) had significantly longer OS and DFS (p < 0.001), also confirmed for PCI subcategories (PCI < 7 vs 7 PCI < 13 vs PCI13). All patients with PCI <7 are still alive. Conclusion: Our study indicates that CRS+HIPEC significantly improves the survival of CRC-PC patients. This treatment modality should be considered as the most suitable in well-selected patients with this disease. No conflict of interest. http://dx.doi.org/10.1016/j.ejso.2014.08.415 426. Incidence of free colorectal cancer cells in peritoneal cavity and correlation with clinicopathologic variables: An analysis of 275 patients undergoing curative intent resection for colorectal cancer W. Suwanthanma1, C. Euanorasetr1, P. Lertsithichai1, A. Pongtippan2, E. Sirachainan3, N. Poprom1 1 Ramathibodi Hospital, Surgery, Bangkok, Thailand 2 Ramathibodi Hospital, Pathology, Bangkok, Thailand 3 Ramathibodi Hospital, Medicine, Bangkok, Thailand Background: This study was conducted to investigate the incidence of free cancer cells in the peritoneal lavage cytology of patients who had undergone curative resection for colorectal cancer. Material and methods: From January 2006-December 2012, intraoperative peritoneal lavage cytology was performed in 275 patients who underwent curative resection for colorectal cancer. Immediately after exploration of abdomen, 100 ml of normal saline solution was instilled into peritoneal cavity over the tumor site. Peritoneal lavage was then aspirated and sent for cytological examination. Results: Six (2.18%) of 275 patients examined were found to have positive peritoneal lavage cytology. Demographic variables, site of tumor,
degree of differentiation, mucinous component, perineural invasion, angiolymphatic invasion, depth of tumor penetration, staging and level of serum CEA were found not to affect the incidence of free cancer cells. Positive nodal status was the only factors found to be associated with incidence of positive peritoneal cytology (p ¼ 0.04). Conclusion: Overall, our study demonstrates low incidence of positive free colorectal cancer cell in lavage fluid obtained before resection in patients underwent curative intent resection for colorectal cancer. Factors associated with positive peritoneal cytology are lymph node involvement. No conflict of interest. http://dx.doi.org/10.1016/j.ejso.2014.08.416
427. Progress classification of the synchronous peritoneal metastases of colorectal cancer e Discussion from a prognosis H. Sato1, Y. Koide1, M. Shiota1, S. Matsuoka1, K. Hatta1, M. Mizuno1, K. Maeda1 1 Fujita Health University, Department of Surgery, Toyoake, Japan Background: It is important to evaluate the degree of peritoneal metastases (PM) objectively, to conduct a comparison and the collaborative investigation between institutions. We examined a simple classification with the reproducibility to become the index of the treatment strategy in the PM of colorectal cancer (CRC). Patients and methods: This study comprised 67 patients with PM of CRC. We have resected as possible the local disseminated lesion with tumor resection as far as overall status permitted it, and performed chemotherapy postoperatively. Sixty-three patients showed distant metastasis at the same time, and palliative operation was performed in 17. The patients were classified according to the greatest size of the disseminated lesion (5 mm, 5e20 mm, 20 mm), the number of the disseminated lesion (3, 4), and the regional number with the disseminated lesion, and oncological results were compared. Results: The 3-year survival rate (3ySR) was significantly better in the primary tumor resection case (27.8%) than a non-resected case (18.5%). There were no significant differences in 3ySR among the groups according to the greatest size of the disseminated lesion (5 mm: 11.9%, 5e20 mm: 34.9%, 20 mm: 28.6%). The prognosis was significantly better in the patients with 3 disseminated lesions (3ySR: 45.2%) than in 4 disseminated lesions (3ySR:12.2%). The prognosis was significantly better in the patients whom disseminated lesion confined in 1 region (3ySR: 31.6%) than in the patients whom disseminated lesion was present in 2 or more regions (3ySR: 3.4%). The prognosis was significantly better in the patients who had 3 the disseminated lesion or whom disseminated lesion limited to 1 region (localized group: 3ySR; 45.6%) than in others (non-localized group: 3ySR;12.2%). The resection rate of primary tumor was significantly higher in localized group (89.3%) than in non-localized group (64.1%). In non-localized group, the prognosis was significantly better in the patients with primary tumor resection (8.8%) than without primary tumor resection. Conclusion: The number of the disseminated lesion, and the regional number with the disseminated lesion were useful for a prognostic prediction in the synchronous PM of CRC, and it was considered to be proper to classify in two groups (localized group and non-localized group), and it was suggested that the primary tumor resection contributed to the prognostic improvement of the synchronous PM case. No conflict of interest. http://dx.doi.org/10.1016/j.ejso.2014.08.417