Peritoneal Malignancy Institute, Basingstoke, North Hampshire Hospital, Aldermaston Road, Basingstoke, Hampshire, RG24 9NA, UK.
Peritoneal Malignancy Institute, Basingstoke, North Hampshire Hospital, Aldermaston Road, Basingstoke, Hampshire, RG24 9NA, UK.
Eur J Surg Oncol. 2018 Sep;44(9):1371-1377. doi: 10.1016/j.ejso.2018.06.023. Epub 2018 Jul 6.
Pseudomyxoma peritonei (PMP) is an uncommon malignancy, generally originating from a ruptured epithelial tumour of the appendix. Despite successful cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC), some patients recur. Currently there are no guidelines on the methods, frequency and intensity of follow-up.
Between 1994 and 2016, 1070 patients underwent surgery for a perforated epithelial tumour of the appendix, predominantly with PMP. Overall (OS) and Disease Free Survival (DFS) were documented by annual CT scanning and evaluated according to the Kaplan-Meier method. The influence of histological differentiation was investigated.
Overall, 775/1070 (72%) had complete cytoreductive surgery (CCRS) and HIPEC. Histological classification was low grade PMP in 615 (79.4%), high grade PMP in 134 (17.3%) and adenocarcinoma in 26 (3.4%). DFS and OS were significantly worse for high grade disease, with the steepest decline for both in the first three years. DFS curves, for low as well as high grade PMP, levelled off at year 6 at approximately 60% and 20% respectively. Thereafter there were few recurrences in either group.
Annual CT of the abdomen and pelvis in the first six years appears to be adequate follow-up for low grade PMP. In high grade PMP, additional imaging of the chest and more frequent surveillance, during the first three years postoperatively, may detect recurrent disease earlier. From year 6 on, reduced frequency of follow-up is proposed, independent of the histology. This long-term follow-up in a large number of patients gives insight into tumour behavior after CCRS and HIPEC for PMP and guides intensity of surveillance.
假性黏液瘤（PMP）是一种罕见的恶性肿瘤，通常起源于阑尾破裂的上皮性肿瘤。尽管成功进行了细胞减灭术（CRS）和腹腔内热化疗（HIPEC），但一些患者仍会复发。目前，尚无关于随访方法、频率和强度的指南。
1994 年至 2016 年，1070 例因阑尾穿孔上皮性肿瘤接受手术治疗，主要为 PMP。通过每年 CT 扫描记录总生存期（OS）和无病生存期（DFS），并根据 Kaplan-Meier 方法进行评估。研究了组织学分化的影响。
总体而言，1070 例中有 775 例（72%）接受了完全细胞减灭术（CCRS）和 HIPEC。组织学分类为低级别 PMP 615 例（79.4%），高级别 PMP 134 例（17.3%），腺癌 26 例（3.4%）。高级别疾病的 DFS 和 OS 明显更差，前三年两者下降最快。低级别和高级别 PMP 的 DFS 曲线在第 6 年左右分别稳定在 60%和 20%左右。此后，两组均很少复发。
在最初的六年中，每年对腹部和骨盆进行 CT 检查似乎足以随访低级别 PMP。在高级别 PMP 中，在手术后的前三年，可能需要对胸部进行额外的影像学检查，并更频繁地进行监测，以更早发现复发病灶。从第 6 年开始，建议减少随访频率，无论组织学如何。对大量患者进行的这种长期随访为 CRS 和 HIPEC 治疗 PMP 后的肿瘤行为提供了深入了解，并指导了监测强度。
