Huang Yeqian, Alzahrani Nayef A, Chua Terence C, Morris David L
1 Department of Surgery, University of New South Wales, St. George Hospital, New South Wales, Australia 2 College of Medicine, Imam Muhammad ibn Saud Islamic University, Riyadh, Saudi Arabia 3 Department of Gastrointestinal Surgery, Royal North Shore Hospital, St Leonards, New South Wales, Australia.
Dis Colon Rectum. 2017 Apr;60(4):360-367. doi: 10.1097/DCR.0000000000000719.
BACKGROUND: It has been increasingly recognized that appendiceal mucinous neoplasm with peritoneal dissemination is not a homogenous disease. OBJECTIVE: This study aimed to examine the impact of different histological subtypes on survival of a large cohort of patients with appendiceal mucinous neoplasms uniformly treated by cytoreductive surgery and intraperitoneal chemotherapy. DESIGN: This was a retrospective study of prospectively collected data of patients with peritoneal dissemination of appendiceal neoplasm who underwent cytoreductive surgery and intraperitoneal chemotherapy. SETTING: The study was conducted by 1 surgical team at St. George Hospital. PATIENTS: A total of 444 patients formed the cohort of this study. MAIN OUTCOME MEASURES: Histological diagnoses were categorized based on Carr criteria to include acellular mucin, disseminated peritoneal adenomucinosis, peritoneal mucinous neoplasms without signet ring cells, and peritoneal mucinous carcinomatosis with signet cells. RESULTS: Patients with low-grade appendiceal mucinous neoplasms with neoplastic epithelium absent tended to have lower CEA, CA19-9, and CA125 levels preoperatively (p = 0.109, 0.008, and 0.034). Factor analysis showed that histological diagnosis was an independent prognostic factor for survival outcomes (HR = 3.13 (95% CI, 2.34-4.39); p < 0.001), adjusted for peritoneal cancer index >20, completeness of cytoreductive score ≥2, use of early postoperative intraperitoneal chemotherapy, transfusion units, CEA >7.0 mg/L, CA19-9 >24.0 U/mL, and CA125 >24 U/mL. LIMITATIONS: This study was limited by its retrospective nature, lack of uniform classifications of appendiceal mucinous neoplasms in early years, and the heterogeneity of this study cohort given the long study period. CONCLUSIONS: Histological subtype remains a significant prognostic factor for survival outcomes in patients with appendiceal mucinous neoplasms. It should be taken into account when selecting patients for cytoreductive surgery, tailoring appropriate adjuvant therapies and follow-up surveillance plan.
背景：人们越来越认识到，伴有腹膜播散的阑尾黏液性肿瘤并非一种同质疾病。 目的：本研究旨在探讨不同组织学亚型对一大群接受细胞减灭术和腹腔内化疗的阑尾黏液性肿瘤患者生存情况的影响。 设计：这是一项对前瞻性收集的接受细胞减灭术和腹腔内化疗的阑尾肿瘤腹膜播散患者数据的回顾性研究。 地点：该研究由圣乔治医院的1个外科团队进行。 患者：共有444例患者构成了本研究队列。 主要观察指标：根据卡尔标准对组织学诊断进行分类，包括无细胞黏液、播散性腹膜腺黏液瘤病、无印戒细胞的腹膜黏液性肿瘤以及有印戒细胞的腹膜黏液癌。 结果：肿瘤上皮缺失的低级别阑尾黏液性肿瘤患者术前CEA、CA19-9和CA125水平往往较低（p = 0.109、0.008和0.034）。因素分析表明，在调整了腹膜癌指数>20、细胞减灭评分完整性≥2、术后早期腹腔内化疗的使用、输血量、CEA>7.0mg/L、CA19-9>24.0U/mL和CA125>24U/mL后，组织学诊断是生存结局的独立预后因素（HR = 3.13（95%CI，2.34 - 4.39）；p < 0.001）。 局限性：本研究受其回顾性性质、早年阑尾黏液性肿瘤缺乏统一分类以及鉴于研究周期长本研究队列存在异质性的限制。 结论：组织学亚型仍然是阑尾黏液性肿瘤患者生存结局的重要预后因素。在选择进行细胞减灭术的患者、制定合适的辅助治疗方案和随访监测计划时应予以考虑。
Zotero 插件