Winer Joshua, Zenati Mazen, Ramalingam Lekshmi, Jones Heather, Zureikat Amer, Holtzman Matthew, Lee Kenneth, Ahrendt Steven, Pingpank James, Zeh Herbert J, Bartlett David L, Choudry Haroon A
Division of Surgical Oncology, University of Pittsburgh, Pittsburgh, PA, USA.
Ann Surg Oncol. 2014 May;21(5):1456-62. doi: 10.1245/s10434-013-3328-4. Epub 2013 Nov 8.
Cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemoperfusion (HIPEC) for peritoneal carcinomatosis (PC) of colorectal origin increases survival (OS) compared to systemic chemotherapy alone. Signet ring histology demonstrates aggressive behavior with poor survival. We sought to determine whether CRS/HIPEC increases survival in this subset of patients.
We reviewed 67 patients with PC of appendiceal (AP, n = 37) or colorectal origin (CRC, n = 30) with signet cell histology from a prospective database between May 2001 and August 2011. Survival analysis and multivariate Cox regression were used to determine prognostic factors for survival.
Complete CRS (CC-0/1) was achieved in 77 % (CRC) and 73 % (AP) of patients. Progression-free survival (PFS) and OS were 9 and 12 months in CRC and 12 and 21 months in AP patients. In the CRC group, univariate predictors of poor survival included female gender, age, American Society of Anesthesiologists score, preoperative albumin, completeness of cytoreduction, and morbidity. In a multivariate Cox regression model, incomplete cytoreduction (CC-2/3) and female gender were joint significant predictors of poor survival. In the AP group, significant univariate predictors of poor survival included higher EBL and PCI score. In a multivariate Cox regression model, blood loss of >500 ml and a body mass index of <25 kg/m(2) were joint significant predictors of poor survival.
AP signet cell tumors demonstrate a more favorable outcome than CRC signet cell tumors after CRC/HIPEC for carcinomatosis, suggesting an underlying difference in biology. CRS/HIPEC does not confer survival benefit in colorectal signet ring carcinomatosis unless complete cytoreduction can be achieved, whereas appendiceal signet ring carcinomatosis may benefit, regardless of resectability.
与单纯全身化疗相比，细胞减灭术（CRS）联合热灌注化疗（HIPEC）治疗结直肠源性腹膜癌病（PC）可提高生存率（OS）。印戒组织学表现为侵袭性生物学行为，生存率低。我们旨在确定CRS/HIPEC是否能提高该亚组患者的生存率。
我们回顾了2001年5月至2011年8月前瞻性数据库中67例阑尾（AP，n = 37）或结直肠（CRC，n = 30）来源的印戒细胞组织学的PC患者。采用生存分析和多因素Cox回归确定生存的预后因素。
77%（CRC）和73%（AP）的患者实现了完全CRS（CC-0/1）。CRC患者的无进展生存期（PFS）和OS分别为9个月和12个月，AP患者分别为12个月和21个月。在CRC组中，生存不良的单因素预测因素包括女性、年龄、美国麻醉医师协会评分、术前白蛋白、细胞减灭的完整性和发病率。在多因素Cox回归模型中，细胞减灭不完全（CC-2/3）和女性是生存不良的联合显著预测因素。在AP组中，生存不良的显著单因素预测因素包括较高的术中出血量（EBL）和腹膜癌指数（PCI）评分。在多因素Cox回归模型中，出血量>500 ml和体重指数<25 kg/m²是生存不良的联合显著预测因素。
对于癌病，CRS/HIPEC术后，AP印戒细胞瘤比CRC印戒细胞瘤预后更佳，提示生物学存在潜在差异。除非能实现完全细胞减灭，CRS/HIPEC对结直肠印戒细胞癌病无生存获益，而阑尾印戒细胞癌病可能获益，无论是否可切除。
