European journal of surgical oncology : the journal of the European Society of Surgical Oncology and the British Association of Surgical Oncology · 2026
Real-world survival scenarios for patients with colorectal cancer and synchronous peritoneal metastases.
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Kerkhoff Teun Me, Hamers Patricia Ah, Koopman Miriam, Kok Niels Fm, Lemmens Valery Epp, de Hingh Ignace Hjt, van Erning Felice N
Аннотация
INTRODUCTION: Peritoneal metastases are present in nearly twenty-five percent of patients with synchronous metastatic colorectal cancer (mCRC). Treatment related overall survival (OS) outcomes within a real-world mCRC cohort, unstratified by metastatic site, have shown controversial results compared with corresponding trials, underlining the importance of evaluating survival scenarios within a real-world population. Therefore, the current study quantified real-world survival scenarios for patients with synchronous peritoneal metastatic colorectal cancer (sCPM) for each treatment.
MATERIALS AND METHODS: This population-based cohort study included all patients diagnosed with sCPM between 2011 and 2020. Patients were stratified based on therapeutic approach: Cytoreductive Surgery and Hyperthermic Intraperitoneal Chemotherapy (CRS-HIPEC), Primary Tumor Resection (PTR) with or without palliative systemic therapy, Palliative Systemic Therapy (PST) and Best-Supportive Care (BSC). Primary outcomes were best, upper-typical, median, lower-typical and worst-case survival scenarios for each treatment, calculated from survival curve percentiles.
RESULTS: Of 7038 patients, 12% underwent CRS-HIPEC, 27% underwent PTR, 30% received PST and 2200 (31%) received BSC. For CRS-HIPEC, the best, upper-typical, median, lower-typical and worst-case scenarios were: not-reached, 68, 35, 20 and 11 months. For PTR, these scenarios were 51, 26, 13, 5.9 and 1.8 months, while for PST these were 28, 17, 10, 5.3 and 2.6 months. For BSC these scenarios were 7.1, 3.4, 1.5, 0.6 and 0.2 months.
CONCLUSIONS: Real-world treatment related OS scenarios demonstrate a considerable heterogeneity across, and within treatment modalities for patients with synchronous CPM. These findings provide more tailored treatment related expected OS. Moreover, OS outcomes are inferior to those reported in corresponding trials, emphasizing constraints of external validity in mCRC trials.
MATERIALS AND METHODS: This population-based cohort study included all patients diagnosed with sCPM between 2011 and 2020. Patients were stratified based on therapeutic approach: Cytoreductive Surgery and Hyperthermic Intraperitoneal Chemotherapy (CRS-HIPEC), Primary Tumor Resection (PTR) with or without palliative systemic therapy, Palliative Systemic Therapy (PST) and Best-Supportive Care (BSC). Primary outcomes were best, upper-typical, median, lower-typical and worst-case survival scenarios for each treatment, calculated from survival curve percentiles.
RESULTS: Of 7038 patients, 12% underwent CRS-HIPEC, 27% underwent PTR, 30% received PST and 2200 (31%) received BSC. For CRS-HIPEC, the best, upper-typical, median, lower-typical and worst-case scenarios were: not-reached, 68, 35, 20 and 11 months. For PTR, these scenarios were 51, 26, 13, 5.9 and 1.8 months, while for PST these were 28, 17, 10, 5.3 and 2.6 months. For BSC these scenarios were 7.1, 3.4, 1.5, 0.6 and 0.2 months.
CONCLUSIONS: Real-world treatment related OS scenarios demonstrate a considerable heterogeneity across, and within treatment modalities for patients with synchronous CPM. These findings provide more tailored treatment related expected OS. Moreover, OS outcomes are inferior to those reported in corresponding trials, emphasizing constraints of external validity in mCRC trials.