University of New South Wales, St George Hospital, Sydney, Australia.
J Clin Oncol. 2012 Jul 10;30(20):2449-56. doi: 10.1200/JCO.2011.39.7166. Epub 2012 May 21.
Pseudomyxoma peritonei (PMP) originating from an appendiceal mucinous neoplasm remains a biologically heterogeneous disease. The purpose of our study was to evaluate outcome and long-term survival after cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) consolidated through an international registry study.
A retrospective multi-institutional registry was established through collaborative efforts of participating units affiliated with the Peritoneal Surface Oncology Group International.
Two thousand two hundred ninety-eight patients from 16 specialized units underwent CRS for PMP. Treatment-related mortality was 2% and major operative complications occurred in 24% of patients. The median survival rate was 196 months (16.3 years) and the median progression-free survival rate was 98 months (8.2 years), with 10- and 15-year survival rates of 63% and 59%, respectively. Multivariate analysis identified prior chemotherapy treatment (P < .001), peritoneal mucinous carcinomatosis (PMCA) histopathologic subtype (P < .001), major postoperative complications (P = .008), high peritoneal cancer index (P = .013), debulking surgery (completeness of cytoreduction [CCR], 2 or 3; P < .001), and not using HIPEC (P = .030) as independent predictors for a poorer progression-free survival. Older age (P = .006), major postoperative complications (P < .001), debulking surgery (CCR 2 or 3; P < .001), prior chemotherapy treatment (P = .001), and PMCA histopathologic subtype (P < .001) were independent predictors of a poorer overall survival.
The combined modality strategy for PMP may be performed safely with acceptable morbidity and mortality in a specialized unit setting with 63% of patients surviving beyond 10 years. Minimizing nondefinitive operative and systemic chemotherapy treatments before definitive cytoreduction may facilitate the feasibility and improve the outcome of this therapy to achieve long-term survival. Optimal cytoreduction achieves the best outcomes.
阑尾黏液性肿瘤（PMP）源于一种生物学异质性疾病。我们研究的目的是通过腹膜表面肿瘤国际组织（PSOGI）参与单位的合作，评估细胞减灭术（CRS）和腹腔内热灌注化疗（HIPEC）联合治疗后的结果和长期生存。
通过参与腹膜表面肿瘤国际组织（PSOGI）的合作单位的协作，建立了一个回顾性多机构登记处。
16 个专门单位的 2298 名患者接受了 PMP 的 CRS。治疗相关死亡率为 2%，24%的患者发生了重大手术并发症。中位生存时间为 196 个月（16.3 年），无进展中位生存时间为 98 个月（8.2 年），10 年和 15 年生存率分别为 63%和 59%。多因素分析确定了先前的化疗治疗（P <.001）、腹膜黏液性癌（PMCA）组织病理学亚型（P <.001）、主要术后并发症（P =.008）、高腹膜癌指数（P =.013）、减瘤手术（完全性细胞减灭术[CCR]，2 或 3；P <.001）和未使用 HIPEC（P =.030）是无进展生存较差的独立预测因素。年龄较大（P =.006）、主要术后并发症（P <.001）、减瘤手术（CCR 2 或 3；P <.001）、先前的化疗治疗（P =.001）和 PMCA 组织病理学亚型（P <.001）是总生存较差的独立预测因素。
在专门单位中，以腹膜表面肿瘤国际组织（PSOGI）参与单位为背景，采用这种联合治疗模式，可安全地进行，发病率和死亡率可接受，63%的患者生存时间超过 10 年。在进行确定性细胞减灭术之前，尽量减少非确定性手术和全身性化疗治疗，可能有助于实现这种治疗的可行性，并改善其结果，以实现长期生存。最佳的细胞减灭术可获得最佳结果。
