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Purpose <p>We evaluated the role of complete cytoreductive surgery (CRS) for locoregional disease control in patients with colorectal cancer with peritoneal metastases (CRC-PM) and concurrent extraperitoneal metastases (EPM).</p> Methods <p>Institutional data identified patients with CC-0/1 CRS for CRC-PM. Patients with peritoneal disease only (PDO) were compared with those with concomitant EPM. Co-primary outcomes were progression-free survival (PFS) and peritoneal progression-free survival (p-PFS). The secondary outcome was overall survival (OS). Covariate imbalance was addressed using entropy balancing. Survival was analyzed using a weighted Cox proportional hazards model. Subgroup analyses were performed to identify favorable prognostic groups.</p> Results <p>In total, 83 patients were included: 31 (37.4%) had EPM. Baseline characteristics were comparable. Within the EPM cohort, liver-only metastases were most common (58%), followed by lung-only metastases (26%). EPM were managed at index CRS in 61%, before CRS in 19%, and deferred or untreated in 19% of patients. Unadjusted analyses demonstrated comparable median OS (PDO vs. EPM: 39 vs. 34 months, <i>p </i>= 0.551) and median p-PFS (PDO vs. EPM: 17 vs. 15 months, <i>p </i>= 0.346) but longer median PFS in the PDO group (14 vs. 5 months, p&lt;0.001). After entropy balancing, patients with EPM had worse OS (31.6 vs. 38.7 months; hazard ratio [HR] 2.12; 95% confidence interval [CI] 1.02–4.37; <i>p </i>&lt; 0.05) and PFS (5.0 vs.12.8 months; HR 2.7; 95% CI 1.58–4.5; <i>p </i>&lt; 0.001) but similar p-PFS (13.4 vs.14.9 months; HR 1.10; 95% CI 0.58–1.77; <i>p </i>= 0.622). Subgroup analyses demonstrated comparable OS and p-PFS for patients with PDO and those with single-site liver or lung EPM.</p> Conclusion <p>Complete CRS provides durable locoregional disease control in patients with EPM.</p>

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Locoregional Control from Complete Peritoneal Cytoreduction in Patients with Extraperitoneal Colorectal Cancer Metastases: An Entropy Balanced Analysis

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2026年5月11日

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  • M. Daniyal Tanweer,
  • Isaac B. Paz,
  • Thinzar Lwin,
  • Laleh Melstrom,
  • Yuman Fong,
  • Gagandeep Brar,
  • Dani Castillo,
  • Pashtoon Kasi,
  • Marwan Fakih,
  • Mustafa Raoof

摘要

Purpose

We evaluated the role of complete cytoreductive surgery (CRS) for locoregional disease control in patients with colorectal cancer with peritoneal metastases (CRC-PM) and concurrent extraperitoneal metastases (EPM).

Methods

Institutional data identified patients with CC-0/1 CRS for CRC-PM. Patients with peritoneal disease only (PDO) were compared with those with concomitant EPM. Co-primary outcomes were progression-free survival (PFS) and peritoneal progression-free survival (p-PFS). The secondary outcome was overall survival (OS). Covariate imbalance was addressed using entropy balancing. Survival was analyzed using a weighted Cox proportional hazards model. Subgroup analyses were performed to identify favorable prognostic groups.

Results

In total, 83 patients were included: 31 (37.4%) had EPM. Baseline characteristics were comparable. Within the EPM cohort, liver-only metastases were most common (58%), followed by lung-only metastases (26%). EPM were managed at index CRS in 61%, before CRS in 19%, and deferred or untreated in 19% of patients. Unadjusted analyses demonstrated comparable median OS (PDO vs. EPM: 39 vs. 34 months, p = 0.551) and median p-PFS (PDO vs. EPM: 17 vs. 15 months, p = 0.346) but longer median PFS in the PDO group (14 vs. 5 months, p<0.001). After entropy balancing, patients with EPM had worse OS (31.6 vs. 38.7 months; hazard ratio [HR] 2.12; 95% confidence interval [CI] 1.02–4.37; p < 0.05) and PFS (5.0 vs.12.8 months; HR 2.7; 95% CI 1.58–4.5; p < 0.001) but similar p-PFS (13.4 vs.14.9 months; HR 1.10; 95% CI 0.58–1.77; p = 0.622). Subgroup analyses demonstrated comparable OS and p-PFS for patients with PDO and those with single-site liver or lung EPM.

Conclusion

Complete CRS provides durable locoregional disease control in patients with EPM.