Prognostic Analysis of Prophylactic Hyperthermic Intraperitoneal Chemotherapy for Advanced Colorectal Cancer: A Propensity Score Matching Analysis

目的：探究对进展期结直肠癌(Colorectal Cancer, CRC)患者术后预防性腹腔热灌注化疗(Hyperthermic Intraperitoneal Chemotherapy)的安全性、有效性以及对生存情况的影响。方法：回顾性分析2018至2020年于青岛大学附属医院接受根治性手术进展期结直肠癌患者的临床资料，其中HIPEC组135例，对照组165例，经过1:1比例进行倾向评分匹配(propensity score matching, PSM)后将252例患者按是否接受HIPEC干预分为两组：HIPEC组(n = 126)与对照组(n = 126)。对入组患者进行围术期安全性分析及术后长期随访。结果：HIPEC组总生存期为(36.25 ± 0.780)个月；对照组为(32.97 ± 1.065)个月，两组3年总生存率(83.3% vs. 73.8%)差异具有统计学意义(P = 0.044)。HIPEC组3年无复发生存率为85.7%，对照组为75.4%，组间差异具有统计学意义(P = 0.027)。两组术后严重并发症方面无明显统计学差异(P > 0.05)。血管侵犯、pT分期以及预防性HIPEC治疗是影响患者术后DFS的独立危险因素：血管侵犯(HR = 1.893, 95% CI 1.080~3.318, P = 0.026)与pT分期(HR = 2.439, 95% CI 1.385~4.295, P = 0.002)与复发风险显著相关。而预防性HIPEC可降低术后复发风险(HR = 0.465, 95% CI 0.258~0.835, P = 0.010)。结论：预防性腹腔热灌注化疗(HIPEC)可以有效降低发生腹膜转移的风险并使进展期结直肠癌患者的生存获益，同时预防性HIPEC并未显著增加术后并发症的发生率，这说明预防性HIPEC是一种安全、可行的治疗手段，而血管侵犯和pT4分期是肿瘤复发的重要危险因素。Objective: To investigate the safety, efficacy, and impact on survival outcomes of prophylactic hyperthermic intraperitoneal chemotherapy (HIPEC) for patients with advanced colorectal cancer (CRC) after surgery. Methods: We retrospectively analyzed clinical data from advanced CRC patients who underwent radical surgery at the Affiliated Hospital of Qingdao University from 2018 to 2020, including 135 cases in the HIPEC group and 165 cases in the control group. After 1:1 propensity score matching (PSM), 252 patients were divided into two groups based on HIPEC intervention: the HIPEC group (n = 126) and the control group (n = 126). Perioperative safety analysis and long-term postoperative follow-up were conducted. Results: The overall survival (OS) was (36.25 ± 0.780) months in the HIPEC group versus (32.97 ± 1.065) months in the control group. The 3-year OS rates (83.3% vs. 73.8%) showed a statistically significant difference (P = 0.044). The 3-year recurrence-free survival rate was 85.7% in the HIPEC group and 75.4% in the control group, with a statistically significant difference between the groups (P = 0.027). No significant difference in severe postoperative complications was observed (P > 0.05). Vascular invasion, pT stage, and prophylactic HIPEC were independent risk factors for postoperative DFS: vascular invasion (HR = 1.893, 95% CI 1.080~3.318, P = 0.026) and pT stage (HR = 2.439, 95% CI 1.385~4.295, P = 0.002) significantly correlated with recurrence risk. Prophylactic HIPEC reduced recurrence risk (HR = 0.465, 95% CI 0.258~0.835, P = 0.010). Conclusion: Prophylactic HIPEC effectively reduces peritoneal metastasis risk and improves survival in advanced CRC patients without significantly increasing postoperative complications, demonstrating its safety and feasibility. Vascular invasion and pT4 stage are significant risk factors for tumor recurrence.