Yu Hsin-Hsien, Yonemura Yutaka, Hsieh Mao-Chih, Mizumoto Akiyoshi, Wakama Satoshi, Lu Chang-Yun
Department of Surgery, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan.
Division of General Surgery, Department of Surgery, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan.
Cancer Manag Res. 2017 Oct 19;9:513-523. doi: 10.2147/CMAR.S147227. eCollection 2017.
Goblet cell carcinomas (GCCs) of the appendix are rare and aggressive malignancies with early peritoneal dissemination. The aim of the present article is to describe our experience in the management of GCCs with peritoneal carcinomatosis (PC) through cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) and to determine the impact of multiple clinical characteristics on the prognosis.
From a prospectively maintained database of patients receiving CRS and HIPEC for peritoneal surface malignancy, the data of 15 patients with GCC and PC were collected. Neo-adjuvant laparoscopic HIPEC was performed if indicated. CRS and HIPEC with mitomycin-C or 5-fluorouracil plus oxaliplatin were performed. Adjuvant chemotherapy was also arranged if suitable for the patient's condition.
Nine males and six females with a mean age of 52.4 years were enrolled. The estimated median survival after the diagnosis of GCC with PC and after definitive CRS-HIPEC was 28 and 17 months, respectively. The 1-, 2-, 3-, 4-year survival rates were 86%, 69%, 57%, and 24%, respectively. Log-rank test revealed that the significant independent risk factors for more favorable outcomes were age >50 years, peritoneal cancer index (PCI) <27, postoperative PCI <20, administration of HIPEC, and adjuvant chemotherapy. Multivariate analyses confirmed that administration of HIPEC played a crucial role in providing prognostic benefit.
The management of GCC with PC remains challenging. We recommend CRS and HIPEC, followed by adjuvant systemic chemotherapy, as a promising strategy to improve survival, especially in selected patients with low PCI and possibility to achieve complete cytoreduction.
阑尾杯状细胞癌（GCC）是一种罕见且侵袭性强的恶性肿瘤，早期即可发生腹膜播散。本文旨在描述我们通过细胞减灭术（CRS）和腹腔内热灌注化疗（HIPEC）治疗伴有腹膜癌转移（PC）的GCC的经验，并确定多种临床特征对预后的影响。
从一个前瞻性维护的接受CRS和HIPEC治疗腹膜表面恶性肿瘤患者的数据库中，收集了15例GCC伴PC患者的数据。如有指征则进行新辅助腹腔镜HIPEC。实施了CRS及使用丝裂霉素-C或5-氟尿嘧啶加奥沙利铂的HIPEC。若适合患者病情，也安排了辅助化疗。
纳入9例男性和6例女性，平均年龄52.4岁。诊断GCC伴PC后及确定性CRS-HIPEC后的估计中位生存期分别为28个月和17个月。1年、2年、3年、4年生存率分别为86%、69%、57%和24%。对数秩检验显示，更有利结局的显著独立危险因素为年龄>50岁、腹膜癌指数（PCI）<27、术后PCI<20、进行HIPEC及辅助化疗。多因素分析证实，进行HIPEC在提供预后益处方面起关键作用。
GCC伴PC的治疗仍然具有挑战性。我们推荐CRS和HIPEC，随后进行辅助全身化疗，作为一种有望提高生存率的策略，尤其是在PCI低且有可能实现完全细胞减灭的特定患者中。
