Surgical Oncology, Mercy Medical Center, Baltimore, MD, USA.
Ann Surg Oncol. 2012 Jan;19(1):122-5. doi: 10.1245/s10434-011-1903-0. Epub 2011 Jul 12.
In treating high-grade appendiceal cancer, appropriate patient selection for cytoreductive surgery and heated intraperitoneal chemotherapy (CRS/HIPEC) is essential. The effect of lymph node (LN) status on survival is not clear. We hypothesize that LN metastases negatively affect long-term survival.
Retrospective analysis of peritoneal mucinous carcinomatosis (PMCA) patients from a prospective database was conducted. Using Kaplan-Meier survival curves and Cox proportional hazards ratio analysis, the effect of LN status, completeness of cytoreduction (CC), and peritoneal cancer index (PCI) was studied.
Of 134 patients with appendiceal cancer who underwent CRS/HIPEC, 77 (57%) had PMCA. Mean follow-up was 22 (range, 3-90) months. Overall survival (OS) was 88, 56, and 40% for 1, 3, and 5-year, respectively. Thirty-four patients (44%) had LN metastases, 23 of whom (68%) had CC, whereas in LN negative patients 35 of 43 (81%) had CC (p = 0.191). PCI ≥ 20 was seen in 23 of 34 patients (68%) with LN metastases and 29 of 43 (67%) without metastases (p = 0.191). Five-year OS for patients with LN metastases was 11% compared with 76% for LN negative (p < 0.001). Among patients with complete cytoreduction, 5-year OS for LN positive vs. negative was 21 and 73%, respectively (p = 0.002). On multivariate regression analysis of LN status, CC score and PCI, the following hazard ratios were obtained: 3.4 (95% confidence interval (CI), 1.3-9.0), 2.6 (95% CI, 1.03-6.7), and 2.8 (95% CI, 0.8-10.4), respectively.
Patient selection for CRS/HIPEC should take into consideration LN status, but it should not be a contraindication if preoperative evaluation revealed a high likelihood of complete cytoreduction.
在治疗高级阑尾癌时，选择合适的患者进行细胞减灭术和腹腔热灌注化疗（CRS/HIPEC）至关重要。淋巴结（LN）状态对生存的影响尚不清楚。我们假设 LN 转移会对长期生存产生负面影响。
对前瞻性数据库中的腹膜黏液性癌（PMCA）患者进行回顾性分析。使用 Kaplan-Meier 生存曲线和 Cox 比例风险比分析，研究 LN 状态、细胞减灭术的完整性（CC）和腹膜癌指数（PCI）的影响。
在 134 例接受 CRS/HIPEC 的阑尾癌患者中，77 例（57%）患有 PMCA。平均随访时间为 22 个月（范围 3-90 个月）。总生存率（OS）分别为 1 年、3 年和 5 年的 88%、56%和 40%。34 例（44%）患者存在 LN 转移，其中 23 例（68%）CC 完整，而在 LN 阴性患者中，35 例（81%）CC 完整（p=0.191）。在 34 例 LN 转移患者中，23 例（68%）和 43 例无转移患者（67%）中 PCI≥20（p=0.191）。LN 转移患者的 5 年 OS 为 11%，而 LN 阴性患者的 5 年 OS 为 76%（p<0.001）。在完全细胞减灭的患者中，LN 阳性和阴性患者的 5 年 OS 分别为 21%和 73%（p=0.002）。在对 LN 状态、CC 评分和 PCI 的多因素回归分析中，获得了以下风险比：3.4（95%置信区间（CI），1.3-9.0）、2.6（95% CI，1.03-6.7）和 2.8（95% CI，0.8-10.4）。
在选择进行 CRS/HIPEC 的患者时，应考虑 LN 状态，但如果术前评估显示完全细胞减灭的可能性很高，则不应作为禁忌证。
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