Adjuvant chemo: hints of benefit in isolated synchronous colorectal peritoneal metastases

  • Rovers KP & al.
  • JAMA Oncol
  • 16 Jul 2020

  • curated by Jim Kling
  • Univadis Clinical Summaries
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Takeaway

  • Adjuvant systemic chemotherapy is associated with improved survival compared with active surveillance after cytoreductive surgery with hyperthermic intraperitoneal chemotherapy for isolated synchronous colorectal peritoneal metastases.

Why this matters

  • The data are the first to address adjuvant systemic chemotherapy in this population.

Study design

  • Propensity score-matched analysis (n=284; 142 treated with adjuvant systemic chemotherapy and 142 active surveillance).
  • Funding: None disclosed.

Key results

  • After propensity score matching, there were some imbalances between the 2 groups (adjuvant vs active surveillance):
    • Period of diagnosis 2014-2017: 46% vs 54%;
      • Standardized difference [SD], −0.17.
    • Primary tumor location, rectum: 5% vs 3%;
      • SD, 0.11.
    • Signet ring cell adenocarcinoma: 8% vs 4%;
      • SD, 0.15.
    • Initial length of hospital stay >21 days: 4% vs 11%;
      • SD, −0.27.
  • Adjuvant systemic chemotherapy was associated with better OS (adjusted [a]HR, 0.64; P=.003).
  • The association held even after exclusion of patients who died within 6 months of surgery, patients who started systemic chemotherapy with targeted therapy within 3 months of surgery, and those who started systemic chemotherapy 3-4 months after surgery (aHR, 0.70; P=.03).
  • Adjustment for major postoperative morbidity did not change the association (aHR, 0.71; 95% CI, 0.53-0.95).

Limitations

  • Retrospective.