Yonemura Yutaka, Canbay Emel, Wakama Satoshi, Sako Shouzou, Ishibashi Haruaki, Hirano Masamitsu, Motoi Shunsuke, Mizumoto Akiyoshi, Takao Nobuyuki, Ichinose Masumi, Noguchi Kousuke, Liu Yang, Fushida Sachio, Li Yan
NPO to Support Peritoneal Surface Malignancy Treatment.
Gan To Kagaku Ryoho. 2019 Feb;46(2):251-258.
Treatment failure after complete cytoreduction for appendiceal mucinous carcinoma peritonei (AMCP)has not been fully investigated. The present study was performed to clarify the risk factor for recurrence after complete cytoreduction for AMCP.
A total of 400 patients with AMCP who underwent complete cytoreductive surgery combined with perioperative chemotherapy were investigated.
Documented recurrence was developed in 135 (33.8%)patients. The 5- and 10-year progression-free survival was 51% and 49%, respectively. By multivariate analysis, histological subtype of peritoneal disease(high-grade AMCP[AMCP-H]and AMCP-H with signet ring cells), serum CA19- 9 level, and PCIB20 were significantly associated with reduced progression-free survival. In contrast, histologic subtype of mucin without epithelial cells(MWEC)showed the lowest risk for recurrence. Eighty-six patients had localized intra-abdominal recurrence, and 42 patients had diffuse peritoneal recurrence. Recurrence was found in the various peritoneal sectors. Eighty-one patients underwent complete cytoreduction for the recurrence, and the overall survival 5-year survival rate after secondary cytoreduction was 49%.
Risk factors for recurrence were histologic subtype, PCI cutoff level, and serum CA19-9 levels. Aggressive second attempt of cytoreduction in patients with localized recurrence improved the survival.
阑尾黏液性癌腹膜转移（AMCP）完全减瘤术后的治疗失败情况尚未得到充分研究。本研究旨在明确AMCP完全减瘤术后复发的危险因素。
共调查了400例行完全减瘤手术联合围手术期化疗的AMCP患者。
135例（33.8%）患者出现有记录的复发。5年和10年无进展生存率分别为51%和49%。多因素分析显示，腹膜疾病的组织学亚型（高级别AMCP[AMCP-H]和伴有印戒细胞的AMCP-H）、血清CA19-9水平和PCIB20与无进展生存率降低显著相关。相比之下，无上皮细胞黏液的组织学亚型（MWEC）复发风险最低。86例患者出现局限性腹腔内复发，42例患者出现弥漫性腹膜复发。复发见于各个腹膜区域。81例患者因复发接受了再次完全减瘤，二次减瘤后5年总生存率为49%。
复发的危险因素为组织学亚型、PCI临界值水平和血清CA19-9水平。对局限性复发患者积极进行二次减瘤尝试可提高生存率。
