JAMA Oncology: Comparison of the efficacy of systemic assisted chemotherapy and active monitoring after early permission after early excision of isolated permission in the same period of colorectal cancer.

According to statistics, about a quarter of patients with isolated permission of colorectal cancer in about 430 treatment centers worldwide received cell reduction and celiac thermal perfusion chemotherapy (CRS-HIPEC) during the same period.
follow-up of patients with CRS-HIPEC, an internationally controversial topic was whether patients with isolated peritometrial metastasis with colorectal cancer should receive systemic assisted chemotherapy.
to fill this gap in evidence, a new study published in JAMA Oncology assessed the relationship between systemic assisted chemotherapy and total survival time in patients with isolated periary membrane metastasis in colorectal cancer over the same period.
the isolated permissive metastasis of colorectal cancer during the same period should receive systemic assisted chemotherapy? The latest research gives evidence! For patients with isolated permission of colorectal cancer who underwent surgical excision, can postoperative systemic assisted chemotherapy improve total survival? Some experts and guidelines recommend the routine use of systemic assisted chemotherapy, some experts and guidelines recommend systemic assisted chemotherapy only if lymph nodes are positive, and others and guidelines only indicate that systemic assisted chemotherapy can be considered, and these inconsistent recommendations reflect the lack of data on the association between systemic assisted chemotherapy and total survival time in this particular population.
In the current population-based observational queue study, the researchers used national data from the Dutch Cancer Registry (cases confirmed between 1 January 2005 and 31 December 2017, followed up until 31 January 2019).
study included 393 patients with isolated periductal metastasis with colorectal cancer who survived 3 months after undergoing surgery and celiac fever perfusion chemotherapy.
patients were assigned to the auxiliary systemic chemotherapy group and the active monitoring group (1:1) based on synergetic variables such as individual condition, tumor condition and treatment level.
The patient is assigned to a systemic assisted chemotherapy group if the patient does not undergo targeted treatment within 3 months of surgery (fluorouracil combined with oxaliplyplatin, fluorouracil monotherapy or nonse specific chemotherapy programmes).
All other patients were assigned to active monitoring groups, including those who received targeted treatment within 3 months of surgery or started systemic chemotherapy within 3 months of surgery, as these treatments were considered palliative care rather than complementary treatment.
the current study's main study endpoint is total survival time (OS), defined as the time between the CRS-HIPEC date and the date of death or the date of the last follow-up of the patient under examination.
follow-up until 31 January 2019.
compared to active monitoring, assisted systemic chemotherapy was positively associated with overall survival improvement, with a total of 393 patients (average age, 61 years of age; 181 cases of men) in the initially identified 930 patients.
, 172 (44%) were assigned to the systemic assisted chemotherapy group.
172 patients had an average time of 8 weeks between the start of CRS-HIPEC and systemic assisted chemotherapy.
the medium duration of patient-assisted treatment in 102 patients with data was 21 weeks (four-part pitch (IQR), 14-22 weeks).
the positive tendency score, 142 patients in the systemic assisted chemotherapy group matched 142 patients in the active monitoring group.
, there were differences between the systemic assisted chemotherapy group and the active monitoring group in terms of diagnosis time, primary tumor location and initial hospitalization time.
the preference score match, there is no statistical difference on the baseline between the matching groups.
tendency score match, the systemic assisted chemotherapy group and the active monitoring group had residual imbalances in the following areas: diagnosis time (e.g., 2014-2017: 65 (46 per cent) vs 77 (54 per cent), standard deviation -0.17); (e.g. rectum: 7 (5 per cent) vs 4 (3 per cent), standard deviation 0.11); histological characteristics (e.g. 11 (8 per cent) vs 6 (4 per cent), standard deviation 0.15); initial hospital stay (e.g. 21 days: 6 (4 percent) vs 16 (11 percent), standard deviation -0.27).
the total matching population, the medium follow-up time was 25.9 months (IQR 15.7-46.8 months) and 186 deaths (65%). the
follow-up time in the whole-body assisted chemotherapy group was 35.9 months (IQR 20.8-51.5 months), 91 deaths (64%), while the average follow-up time in the active monitoring group was 21.3 months (IQR 12.5-34.7 months), and 95 patients died (67%).
the total survival period was 35.2 months (IQR 18.0-64.9 months) for the entire matching population, 39.2 months (IQR 21.1-111.1 months) in the systemic assisted chemotherapy group and 24.8 months (IQR 15.0-58.4 months).
overall survival rate was 86 per cent (1 year), 49 per cent (3 years) and 29 per cent (5 years) for the entire matching population.
the total systemic assisted chemotherapy group was 92 per cent (1 year), 55 per cent (3 years) and 35 per cent (5 years);
compared to active monitoring, assisted systemic chemotherapy was positively associated with improved overall survival (HR 0.64,95% CI 0.48-0.86, P s 0.003; aHR 0.66, 95% CI 0.49-0.88, P s 0.006).
the association remains consistent in excluding 13 patients who died within 6 months of surgery (aHR 0.68, 95% CI 0.50-0.93, P s 0.02) and 4 patients who started targeted therapy with combined systemic chemotherapy within 3 months of surgery (a) HR 0.68,95% CI 0.50-0.91, P s 0.01), excluding 13 patients who started systemic chemotherapy between 3 and 4 months after surgery (aHR 0.65, 95% CI 0.48-0.87, P s 0.004), excluding all three groups of patients (aHR 0.70, 95% CI 0.50-0.97, P s 0.03).
adjusted for measurable conferring due to significant postoperative complications and failed to eliminate the association between complementary systemic chemotherapy and total survival improvement (aHR 0.71, 95% CI, 0.53-0.95).
the results of the current study suggest that systemic-assisted chemotherapy may be positively associated with improved total survival time in patients with isolated periconal metastasis in colorectal cancer undergoing pre-removal surgery.
the potential mix of factors in the study, more large randomized studies are needed in the future to confirm the current findings.
the results of the current study are significant or could be used as a reference for future clinical decisions in patients with isolated pericina metastasis in colorectal cancer at the same time.
.