Esquivel Jesus, Garcia Susana Sanchez, Hicken Willima, Seibel Jeffrey, Shekitka Kris, Trout Richard
St. Agnes Hospital, Baltimore, Maryland.
J Surg Oncol. 2014 Nov;110(6):656-60. doi: 10.1002/jso.23679. Epub 2014 Jun 5.
Most classifications of mucinous appendiceal neoplasms (MAN) do not take into consideration the type of primary tumor or the burden of peritoneal disease.
We conducted a retrospective evaluation of 229 patients with MAN. The severity of their disease was analyzed with the Peritoneal Surface Disease Severity Score (PSDSS) on a five-point scale that included: (1) the primary appendiceal tumor, (2) the type of peritoneal dissemination, and (3) the burden of disease. Overall survival was analyzed according to five tiers of estimated disease severity based on the above parameters.
There were 19, 67, 59, 43, and 41 patients with PSDSS 0, I, II, III, and IV, respectively. One hundred seventy-three patients underwent cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC). Overall survival was 80.0 months in this group with 5-year survival of 100%, 79.2%, 23.3%, and 6.9% in patients with PSDSS I, II, III, and IV, respectively (P < 0.001). On multivariate analysis, sex and PSDSS stage were identified as independent predictors of survival.
The PSDSS appears to be an important prognostic indicator in patients with MANs with or without peritoneal dissemination and may improve selection of patients for appropriate therapy from the time of diagnosis.
大多数黏液性阑尾肿瘤（MAN）的分类未考虑原发性肿瘤的类型或腹膜疾病的负担。
我们对229例MAN患者进行了回顾性评估。采用腹膜表面疾病严重程度评分（PSDSS）对其疾病严重程度进行五点量表分析，该量表包括：（1）原发性阑尾肿瘤，（2）腹膜播散类型，（3）疾病负担。根据上述参数，依据估计的疾病严重程度的五个等级分析总生存期。
PSDSS 0、I、II、III和IV级的患者分别有19例、67例、59例、43例和41例。173例患者接受了细胞减灭术（CRS）和腹腔内热灌注化疗（HIPEC）。该组患者的总生存期为80.0个月，PSDSS I、II、III和IV级患者的5年生存率分别为100%、79.2%、23.3%和6.9%（P < 0.001）。多因素分析显示，性别和PSDSS分期是生存的独立预测因素。
PSDSS似乎是有或无腹膜播散的MAN患者的重要预后指标，并且可能从诊断时起改善对合适治疗患者的选择。
