Department of General and Digestive Surgery, Hautepierre Hospital, Strasbourg University Hospital, Strasbourg, France.
Department of Public Health, Strasbourg University Hospital, Strasbourg, France.
Br J Surg. 2018 May;105(6):668-676. doi: 10.1002/bjs.10716. Epub 2018 Feb 7.
The prognostic value of the primary neoplasm responsible for pseudomyxoma peritonei (PMP) remains poorly studied. The aim of this study was to determine the prognosis for patients with extra-appendicular PMP (EA-PMP) treated optimally with complete cytoreductive surgery (CCRS) and hyperthermic intraperitoneal chemotherapy (HIPEC).
All patients treated for PMP with CCRS and HIPEC between 1994 and 2016 were selected retrospectively from a French multicentre database. Patients with EA-PMP had pathologically confirmed non-neoplastic appendices and were matched in a 1 : 4 ratio with patients treated for appendicular PMP (A-PMP), based on a propensity score.
Some 726 patients were identified, of which 61 (EA-PMP group) were matched with 244 patients (A-PMP group). The origins of primary tumours in the EA-PMP group included the ovary (45 patients), colon (4), urachus (4), small bowel (1), pancreas (1) and unknown (6). The median peritoneal carcinomatosis index was comparable in EA-PMP and A-PMP groups (15·5 versus 18 respectively; P = 0·315). In-hospital mortality (3 versus 2·9 per cent; P = 1·000) and major morbidity 26 versus 25·0 per cent; P = 0·869) were also similar between the two groups. Median follow-up was 66·9 months. The 5-year overall survival rate was 87·8 (95 per cent c.i. 83·2 to 92·5) per cent in the A-PMP group and 87 (77 to 96) per cent in the EA-PMP group. The 5-year disease-free survival rate was 66·0 (58·7 to 73·4) per cent and 70 (53 to 83) per cent respectively.
Overall and disease-free survival following treatment with CCRS and HIPEC is similar in patients with pseudomyxoma peritonei of appendicular or extra-appendicular origin.
原发肿瘤对假性黏液瘤腹膜癌（PMP）的预后价值仍研究甚少。本研究旨在明确接受最佳完全细胞减灭术（CCRS）和腹腔热灌注化疗（HIPEC）治疗的非阑尾来源的 PMP（EA-PMP）患者的预后。
从法国多中心数据库中回顾性选择 1994 年至 2016 年间接受 CCRS 和 HIPEC 治疗的所有 PMP 患者。EA-PMP 患者经病理证实阑尾无肿瘤，并根据倾向评分与阑尾来源 PMP（A-PMP）患者以 1：4 比例匹配。
共纳入 726 例患者，其中 61 例（EA-PMP 组）与 244 例患者（A-PMP 组）相匹配。EA-PMP 组的原发肿瘤来源包括卵巢（45 例）、结肠（4 例）、脐尿管（4 例）、小肠（1 例）、胰腺（1 例）和未知（6 例）。EA-PMP 组和 A-PMP 组的腹膜肿瘤指数中位数分别为 15.5 和 18（P=0.315）。两组患者的院内死亡率（3%比 2.9%，P=1.000）和主要并发症发生率（26%比 25.0%，P=0.869）相似。中位随访时间为 66.9 个月。A-PMP 组的 5 年总生存率为 87.8%（95%可信区间为 83.2%至 92.5%），EA-PMP 组为 87.0%（77.0%至 96.0%）。5 年无疾病生存率分别为 66.0%（58.7%至 73.4%）和 70.0%（53.0%至 83.0%）。
接受 CCRS 和 HIPEC 治疗的阑尾来源和非阑尾来源的 PMP 患者的总生存率和无病生存率相似。
