Division of Surgical Oncology, University of Pittsburgh Medical Center, Pittsburgh, PA, USA.
The University of Pittsburgh Cancer Institute Biostatistics Facility, Pittsburgh, PA, USA.
Ann Surg Oncol. 2019 May;26(5):1429-1436. doi: 10.1245/s10434-018-07091-z. Epub 2019 Jan 8.
The aim of this study was to identify factors associated with pleuropulmonary disease recurrence following cytoreductive surgery with hyperthermic intraperitoneal chemoperfusion (CRS/HIPEC) for appendiceal pseudomyxoma peritonei (PMP) and to evaluate the oncologic impact of pleuropulmonary disease recurrence compared with isolated peritoneal recurrence.
From a prospective database, we identified patients who developed pleuropulmonary recurrence, isolated peritoneal recurrence, or no recurrence following CRS/HIPEC for appendiceal PMP. Clinicopathologic, perioperative, and oncologic data associated with the index CRS/HIPEC procedure were reviewed. The Kaplan-Meier method was used to estimate survival. Multivariate analyses identified associations with recurrence and survival.
Of 382 patients undergoing CRS/HIPEC, 61 (16%) developed pleuropulmonary recurrence. Patients who developed a pleuropulmonary recurrence were more likely to have high-grade (American Joint Committee on Cancer [AJCC] grade 2/3) tumors (74% vs. 56%, p = 0.02) and increased operative blood loss (1651 vs. 1201 ml, p = 0.05) and were more likely to have undergone diaphragm stripping/resection (79% vs. 48%, p < 0.01) compared with patients with an abdominal recurrence. In a multivariate analysis, pleuropulmonary recurrence after CRS/HIPEC was associated with diaphragm stripping/resection, incomplete cytoreduction, and higher AJCC tumor grade. There was a trend towards reduced survival in patients with pleuropulmonary recurrence compared with patients with isolated peritoneal recurrence (median overall survival 45 vs. 53 months, p = 0.87).
Pleuropulmonary recurrence of appendiceal PMP following CRS/HIPEC is common and may negatively impact survival. Formal protocols for surveillance and therapeutic intervention need to be studied and implemented to improve oncologic outcomes.
本研究旨在确定行细胞减灭术联合腹腔热灌注化疗（CRS/HIPEC）治疗阑尾黏液性肿瘤（PMP）后并发胸膜肺疾病复发的相关因素，并评估与单纯腹膜复发相比，胸膜肺疾病复发的肿瘤学影响。
我们从前瞻性数据库中确定了在接受 CRS/HIPEC 治疗阑尾 PMP 后发生胸膜肺复发、单纯腹膜复发或无复发的患者。回顾了与指数 CRS/HIPEC 手术相关的临床病理、围手术期和肿瘤学数据。采用 Kaplan-Meier 法估计生存。多变量分析确定了与复发和生存相关的因素。
在 382 例接受 CRS/HIPEC 的患者中，有 61 例（16%）发生了胸膜肺复发。发生胸膜肺复发的患者更有可能患有高级别（美国癌症联合委员会 [AJCC] 分级 2/3）肿瘤（74%比 56%，p=0.02）和更多的手术失血量（1651 比 1201 ml，p=0.05），并且更有可能接受膈肌剥离/切除术（79%比 48%，p<0.01）。在多变量分析中，CRS/HIPEC 后胸膜肺复发与膈肌剥离/切除术、不完全细胞减灭术和更高的 AJCC 肿瘤分级相关。与单纯腹膜复发的患者相比，胸膜肺复发的患者生存时间有缩短的趋势（中位总生存时间 45 比 53 个月，p=0.87）。
CRS/HIPEC 治疗阑尾 PMP 后并发胸膜肺复发较为常见，可能对生存产生负面影响。需要研究和实施规范的监测和治疗干预方案，以改善肿瘤学结果。
