Perioperative chemotherapy in colorectal cancer with peritoneal metastases: A global propensity score matched study

Peter H Cashin; Jesus Esquivel; Stein G Larsen; Winston Liauw; Nayef A Alzahrani; David L Morris; Vahan Kepenekian; Isabelle Sourrouille; Frédéric Dumont; Jean-Jacques Tuech; Cécilia Ceribelli; Beranger Doussot; Olivia Sgarbura; Francois Quenet; Olivier Glehen; Oliver M Fisher; Peritoneal Surface Oncology Group International (PSOGI); Nordic Peritoneal Oncology Group (NPOG); American Society for Peritoneal Surface Malignancy (ASPSM); BIG-RENAPE Groups

doi:10.1016/j.eclinm.2022.101746

Perioperative chemotherapy in colorectal cancer with peritoneal metastases: A global propensity score matched study

EClinicalMedicine. 2022 Nov 24:55:101746. doi: 10.1016/j.eclinm.2022.101746. eCollection 2023 Jan.

Authors

Peter H Cashin¹, Jesus Esquivel², Stein G Larsen³, Winston Liauw^{4

5}, Nayef A Alzahrani⁶, David L Morris⁶, Vahan Kepenekian^{7

8}, Isabelle Sourrouille⁹, Frédéric Dumont¹⁰, Jean-Jacques Tuech¹¹, Cécilia Ceribelli¹², Beranger Doussot¹³, Olivia Sgarbura¹⁴, Francois Quenet¹⁴, Olivier Glehen^{7

8}, Oliver M Fisher^{5

6

15}; Peritoneal Surface Oncology Group International (PSOGI); Nordic Peritoneal Oncology Group (NPOG); American Society for Peritoneal Surface Malignancy (ASPSM); BIG-RENAPE Groups

Affiliations

¹ Department of Surgical Sciences, Section of Surgery, Uppsala University, Akademiska Sjukhuset, Uppsala 75185, Sweden.
² Division of Surgical Oncology, Beebe Healthcare, Lewes, DE, United States of America.
³ Section of Surgical Oncology, Department of Gastroenterological Surgery, Oslo University Hospital, Sognsvannsveien 20, Oslo 0372, Norway.
⁴ St George & Sutherland Clinical School, UNSW Australia, Sydney, Australia.
⁵ Department of Medical Oncology, St George Hospital, Sydney, Australia.
⁶ Department of Surgery, St George Hospital, Sydney, Australia.
⁷ Hôspital Lyon Sud, Hospices Civils de Lyon, Lyon, France.
⁸ CICLY, Université Lyon 1, Lyon, France.
⁹ Department of Surgery, Institut Gustave Roussy, Villejuif, France.
¹⁰ Department of Oncological Surgery, Institut de Cancérologie de l'Ouest, St Herblain, France.
¹¹ Department of Digestive Surgery, Centre Hospitalo-Universitaire de Rouen, Rouen, France.
¹² Department of Surgery, Centre Hospitalo-Universitaire de l'Archet II, Nice, France.
¹³ Department of Digestive Surgery, Centre Hospitalo Universitaire Dijon Bourgogne, Dijon, France.
¹⁴ Department of Surgical Oncology, Cancer Institute of Montpellier, University of Montpellier, Montpellier, France.
¹⁵ Notre Dame University School of Medicine, Sydney, Australia.

Abstract

Background: There is a paucity of studies evaluating perioperative systemic chemotherapy in conjunction with cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) in patients with colorectal cancer peritoneal metastases (CRCPM). The aim was to evaluate neoadjuvant and/or adjuvant systemic therapy in CRCPM.

Methods: Patients with CRCPM from 39 treatment centres globally from January 1, 1991, to December 31, 2018, who underwent CRS+HIPEC were identified and stratified according to neoadjuvant/adjuvant use. Crude data analysis, propensity score matching (PSM) and Cox-proportional hazard modelling was performed.

Findings: Of 2093 patients, 1613 were included in neoadjuvant crude evaluation with 708 in the PSM cohort (354 patients/arm). In the adjuvant evaluation, 1176 patients were included in the crude cohort with 778 in the PSM cohort (389 patients/arm). The median overall survival (OS) in the PSM cohort receiving no neoadjuvant vs neoadjuvant therapy was 37.0 months (95% CI: 32.6-42.7) vs 34.7 months (95% CI: 31.2-38.8, HR 1.08 95% CI: 0.88-1.32, p = 0.46). The median OS in the PSM cohort receiving no adjuvant therapy vs adjuvant therapy was 37.0 months (95% CI: 32.9-41.8) vs 45.7 months (95% CI: 38.8-56.2, HR 0.79 95% CI: 0.64-0.97, p = 0.022). Recurrence-free survival did not differ in the neoadjuvant evaluation but differed in the adjuvant evaluation - HR 1.04 (95% CI: 0.87-1.25, p = 0.66) and 0.83 (95% CI: 0.70-0.98, p = 0.03), respectively. Multivariable Cox-proportional hazard modelling in the crude cohorts showed hazard ratio 1.08 (95% CI: 0.92-1.26, p = 0.37) for administering neoadjuvant therapy and 0.86 (95% CI: 0.72-1.03, p = 0.095) for administering adjuvant therapy.

Interpretation: Neoadjuvant therapy did not confer a benefit to patients undergoing CRS+HIPEC for CRCPM, whereas adjuvant therapy was associated with a benefit in this retrospective setting.

Funding: None.

Keywords: Adjuvant chemotherapy; Colorectal cancer; Cytoreductive surgery; Hyperthermic intraperitoneal chemotherapy; Neoadjuvant chemotherapy; Peritoneal metastases.