Surgical Oncology, Mercy Medical Center, Baltimore, MD, USA.
Ann Surg Oncol. 2012 Jan;19(1):110-4. doi: 10.1245/s10434-011-1840-y. Epub 2011 Jun 24.
Patients with peritoneal mucinous carcinomatosis (PMCA) of appendiceal origin and extensive disease are commonly advised against CRS/HIPEC. We hypothesize that CRS/HIPEC is a beneficial treatment for this group.
Retrospective analysis of 134 patients with appendiceal cancer treated with CRS/HIPEC was performed from a prospective database. Extent of disease, measured by peritoneal cancer index (PCI), was related to completeness of cytoreduction (CC), lymph node (LN) status, and prior surgery score (PSS). Overall survival (OS) was estimated by Kaplan-Meier curves. Test differences were calculated using log-rank test.
A total of 77 patients (57%) had PMCA. Mean follow-up was 22 months with a median of 18 months. OS was 88%, 56%, and 40% for 1, 3, and 5 years, respectively. 68% had PCI ≥ 20. LN metastasis was found in 44% of patients in PCI ≥ 20 and PCI < 20 groups. 73% and 60% of patients had PSS of 2 or 3 in PCI ≥ 20 and PCI < 20 groups, respectively (P = .196). Complete cytoreduction was achieved in 65% of PCI ≥ 20 group and 96% of PCI < 20 group (P = .004). With complete cytoreduction, the 5-year OS was 45% in PCI ≥ 20 group and 66% in PCI < 20 group (P = .139). 18 of 19 patients with incomplete cytoreduction had PCI ≥ 20, with 3- and 5-year OS of 27% and 0%. Hazard ratios (by Cox regression) were 2.8 (95% confidence interval [95% CI] 0.8-10.2) and 3.6 (95% CI 1.5-8.8) for PCI < 20 and complete cytoreduction, respectively.
Meaningful long-term survival could be achieved in patients with PMCA even with extensive peritoneal disease. PCI ≥ 20 should not be used as an exclusion criterion when selecting these patients for CRS/HIPEC, and every effort should be made to achieve complete cytoreduction.
阑尾来源的腹膜粘液性癌（PMCA）伴广泛疾病的患者通常不建议进行细胞减灭术/腹腔热灌注化疗（CRS/HIPEC）。我们假设 CRS/HIPEC 是治疗这类患者的有益方法。
对前瞻性数据库中 134 例接受 CRS/HIPEC 治疗的阑尾癌患者进行回顾性分析。通过腹膜肿瘤指数（PCI）来衡量疾病的严重程度，并与细胞减灭术的完全程度（CC）、淋巴结（LN）状态和术前手术评分（PSS）相关。通过 Kaplan-Meier 曲线估计总生存率（OS）。通过对数秩检验计算检验差异。
共有 77 例（57%）患者患有 PMCA。平均随访时间为 22 个月，中位数为 18 个月。1、3 和 5 年的 OS 分别为 88%、56%和 40%。68%的患者 PCI≥20。在 PCI≥20 和 PCI<20 组中，分别有 44%和 41%的患者存在 LN 转移。在 PCI≥20 和 PCI<20 组中，分别有 73%和 60%的患者 PSS 为 2 或 3（P=0.196）。在 PCI≥20 组中，完全细胞减灭术的比例为 65%，在 PCI<20 组中为 96%（P=0.004）。在完全细胞减灭术后，PCI≥20 组的 5 年 OS 为 45%，而 PCI<20 组为 66%（P=0.139）。19 例不完全细胞减灭术患者中，有 18 例 PCI≥20，其 3 年和 5 年 OS 分别为 27%和 0%。风险比（通过 Cox 回归）分别为 2.8（95%置信区间[95%CI]0.8-10.2）和 3.6（95%CI 1.5-8.8），分别代表 PCI<20 和完全细胞减灭术。
即使患有广泛腹膜疾病，PMCA 患者也能获得有意义的长期生存。在选择这些患者进行 CRS/HIPEC 时，不应将 PCI≥20 作为排除标准，应尽一切努力实现完全细胞减灭术。
