Traitement des carcinoses péritonéales d'origine colo-rectale. Quoi ...

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Original Article extent of PC, and previous treatment with systemic chemotherapy. The extent of PC was assessed intraoperatively. Institutions used 2 different tools, the Gilly classification 15 and the Sugarbaker Peritoneal Cancer Index (PCI), 16 to assess the extent of PC. By using the Gilly classification, carcinomatosis was classified into 5 stages: stage 0, positive peritoneal cytology; stage I, malignant tumor nodules 2 cm in greatest dimension). For the descriptive analysis, 4 subgroups according to the PCI score were created: 1 to 6, 7 to 12, 13 to 19, and >19. Information recorded about the combined procedure included the date, the completeness of cytoreductive surgery, the simultaneous resection of primary tumor or of liver metastases, the presence or absence of lymph node metastases, the type of perioperative intraperitoneal chemotherapy (HIPEC or EPIC) and its modalities (drugs used, ‘‘closed’’ or ‘‘open’’ HIPEC, temperatures, duration), and treatment with adjuvant systemic chemotherapy. The assessment of the completeness of the cancer resection (CCR) by cytoreductive surgery was performed by the surgeon at the end of the procedure and was classified in 3 categories 4 : CCR-0 (no macroscopic residual cancer remaining), CCR-1 (no residual nodule >2.5 mm), and CCR-2 (residual nodules >2.5 mm in greatest dimension). The institutions were classified regarding their length of experience with performing cytoreductive surgery at the time of the procedure (0-3 years, 3-7 years, 7-11 years, and >11 years). Four groups also were analyzed regarding the period of the procedure (before 1997, between 1997 and 1999, between 2000 and 2002, between 2003 and 2004, and after 2005). Information was obtained regarding the postoperative course, including postoperative death (within 30 postoperative days) and its cause, major complications (grade 3 and 4 complications according to the National Cancer Institute’s Common Toxicity Criteria), and reoperations. Follow-up data recorded included the date of the most recent followup, the status of the patient (alive with disease, alive without disease, dead with disease, or dead without disease), the site of initial recurrence, and all other subsequent sites of recurrence. Statistical Analysis The descriptive analyses of the patients who were included in the registry and the survival analyses were performed on a patient basis (1 record per patient). However, all procedures were considered for the analyses of postoperative morbidity or mortality events (death or major complications that occurred within 30 days after surgery). Categorical variables are described in terms of frequency and percentages. The distributions of continuous variables are described as the mean, standard error, median, and first and third quartiles. The influence of patient, disease, and treatment characteristics was related to the risk of postoperative morbidity or mortality events using univariate and multivariate logistic regression models that were adjusted by institution. The analysis of long-term mortality censored information after the cutoff date of December 31, 2006, because an active enquiry was performed in all institutions to collect the status (dead/alive) of the patients at that date. There were 72 patients included after the cutoff date, 4 patients had an unknown date of death, and 46 patients were lost to follow-up (the last follow-up before the cutoff date). The analysis of total mortality considered the interval from the first procedure to the date of death, the date of last follow-up, or the cutoff date, whichever came first. The analysis of recurrence or death was based on the interval from the first procedure to the date of first recurrence, the date of death, the date of last follow-up, or the cutoff date, whichever came first. When the date of recurrence was unknown in patients who died, the date of death was used instead. For this analysis, 32 patients were lost to follow-up. Kaplan-Meier survival estimates were calculated and compared between strata with the log-rank test. The influence of baseline risk factors on the hazard of death was assessed using a multiple proportional hazards regression model stratified by institution. Stratification was justified by a large heterogeneity of hazards between institutions and by a strong potential confounding effect on other risk factors. In all multivariate analyses, age and PCI were entered as continuous variables. Completeness of cytoreduction (4 categories) also was entered as a continuous variable when justified by a linear trend across categories. Risk factors with a significance degree .10 were retained in the final model. SAS statistical software for Windows (version 9.1; SAS Institute, Inc., Cary, NC) was used for all analyses. RESULTS Twenty-5 institutions treated 1290 patients who underwent 1344 procedures. One institution recorded >403 patients, 3 institutions recorded 100 to 300 patients, 3 institutions recorded 50 to 100 patients, 4 institutions 5610 Cancer December 15, 2010
Table 1. Origin of Carcinomatosis in Patients Who Underwent Cytoreductive Surgery Combined With Perioperative Intraperitoneal Chemotherapy Etiology No. of Patients Colorectal cancer 523 40.5 Pseudomyxoma peritonei 301 23.3 Gastric cancer 159 12.3 Peritoneal mesothelioma 88 6.8 Appendiceal adenocarcinoma 50 3.9 Small bowel adenocarcinoma 45 3.5 Primary peritoneal serous carcinoma 30 2.3 Peritoneal sarcomatosis 28 2.2 Others 66 5.1 Uterine adenocarcinoma 13 Unknown primary adenocarcinoma 8 Biliary 7 Small bowel carcinoid 7 Urachal fold 4 Uterine epidermoid carcinoma 4 Appendiceal carcinoid 3 Desmoplastic tumor (small round cell) 3 Adrenal 3 GIST 3 Hepatocellular carcinoma 2 Kidney 2 Breast 2 Malignant teratoma 2 Bladder 1 Pheochromacytoma 1 Esophagus 1 Total 1290 GIST indicates gastrointestinal stromal tumor. recorded 20 to 50 patients, 5 institutions recorded 10 to 20 patients, and 9 institutions recorded
Page 1 and 2: SOMMAIRE Modérateurs : D. ELIAS (V
Page 3: The primary peritoneal malignancies
Page 7 and 8: Figure 3. Overall survival rates ar
Page 9 and 10: Table 6. Prognostic Impact of Clini
Page 11 and 12: CCR-1 resection (residual tumor nod
Page 13 and 14: QUOI DE NEUF DANS LA LITTERATURE SU
Page 15 and 16: Références 1. Elias D, Gilly F, B
Page 17 and 18: CHIMIOTHERAPIE INTRAPERITONEALE PER
Page 19 and 20: et/ou de réparer les dommages à l
Page 21 and 22: d’anthracycline comme la doxorubi
Page 23 and 24: Références 1. Benoit L, Cheynel N
Page 25 and 26: 25. Shah DK, Veith J, Bernacki RJ,
Page 27 and 28: péritonectomies sélectives, réal
Page 29 and 30: zones atteintes de maladie macrosco
Page 31 and 32: Une équipe grecque a proposé apr
Page 33 and 34: Il peut donc être utile, en cas de
Page 35 and 36: Le second look chirurgical a été
Page 37 and 38: a) patients présentant une carcino
Page 39 and 40: CHIP: LES ESSAIS THERAPEUTIQUES EN

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