Department of Surgery, Moores Cancer Center, University of California, San Diego, 3855 Health Sciences Dr. #0987, La Jolla, CA, 92093-0987, USA.
Department of Pathology, Moores Cancer Center, University of California, San Diego, La Jolla, CA, USA.
Ann Surg Oncol. 2018 Mar;25(3):702-708. doi: 10.1245/s10434-017-6310-8. Epub 2017 Dec 27.
Mucinous appendiceal tumors (MAT) are rare neoplasms that can metastasize to the peritoneum and often are treated with cytoreductive surgery (CRS) and HIPEC. Pathologic classification and outcomes vary, but standardized histologic definitions are emerging. We sought to evaluate outcomes in this disease after CRS/HIPEC using standardized pathologic criteria.
Outcomes of MAT with peritoneal metastases (PM) after CRS/HIPEC from 2007 to 2015 were reviewed at our institution. Standardized histologic categories per WHO and consensus definitions were used: low-grade appendiceal mucinous neoplasm (LAMN), low-grade adenocarcinoma (LGAC), or high-grade adenocarcinoma (HGAC) primary tumors; and acellular mucin (AM), low-grade mucinous carcinoma peritonei (LGMCP), or high-grade mucinous carcinoma peritonei (HGMCP) peritoneal metastases. Cox proportional hazards model was used identify predictors of progression-free survival (PFS) by univariate and multivariate analyses.
A total of 183 patients undergoing 197 CRS/HIPECs were included. Among 75 patients with primary histology review, there were 33 (44.0%) LAMNs, 28 (37.3%) LGACs, and 14 (18.7%) HGACs. Peritoneal histology was benign in 6 (3.0%), AM in 33 (16.8%), LGMCP in 114 (57.9%), and HGMCP in 44 (22.3%). PFS was not reached for AM, 34.3 months for LGMCP, and 16.8 months for HGMCP (p < 0.001). Peritoneal histology predicted PFS on multivariate analysis (hazard ratio 9.82 and 24.60 for LGMCP and HGMCP, respectively, vs. AM, p < 0.001). Among the LGMCP group, CEA and completeness of cytoreduction (CC score) predicted PFS on multivariate analysis.
Standardized peritoneal histology in patients with PM from MAT predicts PFS and patients with low-grade histology can be further discriminated by CEA and CC score.
黏液性阑尾肿瘤（MAT）是一种罕见的肿瘤，可转移至腹膜，并经常采用细胞减灭术（CRS）和腹腔热灌注化疗（HIPEC）进行治疗。病理分类和结果有所不同，但标准化的组织学定义正在出现。我们试图使用标准化的病理标准来评估 CRS/HIPEC 后这种疾病的结果。
在我们的机构中，回顾了 2007 年至 2015 年间，经 CRS/HIPEC 治疗的具有腹膜转移（PM）的 MAT 患者的结果。使用世界卫生组织（WHO）和共识定义的标准化组织学类别：低级别阑尾黏液性肿瘤（LAMN）、低级别腺癌（LGAC）或高级别腺癌（HGAC）原发肿瘤；以及无细胞黏液（AM）、低级别腹膜黏液癌（LGMCP）或高级别腹膜黏液癌（HGMCP）腹膜转移。采用 Cox 比例风险模型进行单因素和多因素分析，以确定无进展生存期（PFS）的预测因素。
共纳入 183 例患者，行 197 例 CRS/HIPEC 治疗。在对 75 例患者进行的原发组织学复查中，有 33 例（44.0%）为 LAMN，28 例（37.3%）为 LGAC，14 例（18.7%）为 HGAC。腹膜组织学良性 6 例（3.0%），AM 33 例（16.8%），LGMCP 114 例（57.9%），HGMCP 44 例（22.3%）。AM 的 PFS 未达到，LGMCP 为 34.3 个月，HGMCP 为 16.8 个月（p<0.001）。腹膜组织学在多因素分析中预测 PFS（LGMCP 和 HGMCP 的风险比分别为 9.82 和 24.60，与 AM 相比，p<0.001）。在 LGMCP 组中，CEA 和细胞减灭术的完全程度（CC 评分）在多因素分析中预测 PFS。
MAT 伴腹膜转移患者的标准化腹膜组织学预测 PFS，低级别组织学患者可进一步通过 CEA 和 CC 评分进行区分。
