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Intraperitoneal-Free Cancer Cells Represent a Major Prognostic Factor in Colorectal Peritoneal Carcinomatosis
B Trilling1, E Cotte, D Vaudoyer
11 Clinique de Chirurgie Viscérale et de l'Urgence, Grenoble Alpes, France 2 Département de Chirurgie Générale, Digestive et Cancérologique, Centre Hospitalier Lyon Sud, Hospices Civils de Lyon, Pierre Bénite, France 3 EMR 37-38 Université Lyon1, Lyon, France 4 Service d'Anatomie et Cytologie Pathologiques, CHU Lyon-Sud, Lyon, France 5 Centre de Pathologie Est, CHU Edouard Herriot, Lyon, France 6 Hospices Civils de Lyon, Pole IMER, Unité de Recherche Clinique, Lyon, France.
Background:
Intraperitoneal-free cancer cells are considered as an important prognostic tool in gastric and ovarian cancer. However, their significance in colorectal cancer remains more controversial.
Objective:
This study aimed to determine the role of intraperitoneal-free cancer cells as a prognostic tool in the outcome in colorectal peritoneal carcinomatosis treated with curative intent by complete cytoreductive surgery.
Design:
This study is an analysis of a prospectively maintained database.
Patients:
Between 1991 and 2012, all patients treated in a single institution for colorectal peritoneal carcinomatosis by complete cytoreductive surgery with peritoneal cytology available were evaluated. Peritoneal cytology was stained in the conventional way (May Grumwald Giemsa).
Results:
Among a population of 162 patients treated for colorectal peritoneal carcinomatosis by complete cytoreductive surgery, 38 presented positive intraperitoneal-free cancer cells (23.5%). Systemic chemotherapy was administered to 135 patients (85%) during the preoperative course. Median follow-up was 34.5 months. Median overall survival was 19 and 44 months for positive and negative intraperitoneal-free cancer cells (p = 0.018). In multivariate analysis, Peritoneal Carcinomatosis Index and positive intraperitoneal-free cancer cells were significant prognostic factors of overall survival (HR, 2.3 (1.18-4.52), p = 0.014; HR, 1.9 (1.08-3.38), p = 0.027).
Limitations:
Retrospective analysis and the long period were limitations of study.
Conclusion:
Along with the Peritoneal Carcinomatosis Index, intraperitoneal-free cancer cells are a strong prognostic factor for patients treated with curative intent for colorectal peritoneal carcinomatosis by complete cytoreductive surgery. The presence of intraperitoneal-free cancer cells should lead to the consideration of different treatment strategies such as extensive intraperitoneal lavage, targeted intraperitoneal therapies, or repeated intraperitoneal chemotherapy.
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