Laboratoire d'Anatomie et Cytologie Pathologiques, Institut de Pathologie Multisite, Centre de Biologie Sud, Centre Hospitalier Sud, Hospices Civils de Lyon, Pierre-Bénite, France.
EMR 3738, Université Lyon 1, Lyon, France.
Histopathology. 2020 Oct;77(4):548-559. doi: 10.1111/his.14092. Epub 2020 Sep 10.
The peritoneal regression grading score (PRGS) and peritoneal cytology (PC) assess response to chemotherapy in peritoneal metastasis (PM) in a setting of palliative treatment by pressurized intraperitoneal aerosol chemotherapy (PIPAC). Progression has been defined as an increase of PRGS between first and third PIPAC procedures (iPRGS). iPRGSand positive peritoneal cytology were not associated with prognostic impact. These results may be explained by a lack of statistical power. Also, it is not known whether the mean or the highest PRGS among taken peritoneal biopsies bears the highest clinical value. We therefore conducted the largest prospective study to investigate the prognostic impact of PGRS, PC, and their combination, designated as combined progression index (CPI).
Patients with PM who underwent >3 PIPAC (n = 112) between December 2016 and February 2019 were prospectively included. A significant difference in OS and PFS according to CPI (used highest value of PRGS) was found (OS: CPI-, 83.3, 95% CI [49.8; NA] vs. CPI+, 48.1, 95% CI [38.5; 66.4] months; and PFS (respectively, 59.7, 95% CI [43.0; 96.0] vs. 33.7, 95% CI [30.4; 44.2] months). PRGS or PC had no independent prognostic impact. CPI+ was an independent predictor of worse prognosis, in OS (HR = 5.24, 95% CI [2.07; 13.26]), and PFS (HR = 4.41, 95% CI [1.40; 13.88]).
The CPI based on highest PRGS and PC was found to be independently associated with a worse prognosis for OS and for PFS in the setting of peritoneal metastasis. These results indicate that it should be of interest to systematically take peritoneal fluid for cytological examination and to implement the CPI in the therapeutic decision-making process in the context of PIPAC.
腹膜回归分级评分（PRGS）和腹膜细胞学（PC）通过加压腹腔内气溶胶化疗（PIPAC）评估姑息治疗中腹膜转移（PM）对化疗的反应。进展被定义为首次和第三次 PIPAC 程序之间 PRGS 的增加（iPRGS）。iPRGS 和阳性腹膜细胞学与预后影响无关。这些结果可能是由于统计效力不足造成的。此外，尚不清楚在采集的腹膜活检中，平均值或最高 PRGS 具有最高的临床价值。因此，我们进行了最大的前瞻性研究，以调查 PGRS、PC 及其组合（称为联合进展指数（CPI））的预后影响。
2016 年 12 月至 2019 年 2 月期间，前瞻性纳入了接受>3 次 PIPAC（n=112）的 PM 患者。根据 CPI（使用最高 PRGS 值）发现 OS 和 PFS 存在显著差异（OS：CPI-，83.3，95%CI [49.8；NA] 与 CPI+，48.1，95%CI [38.5；66.4] 个月；和 PFS（分别为 59.7，95%CI [43.0；96.0] 与 33.7，95%CI [30.4；44.2] 个月）。PRGS 或 PC 对预后无独立影响。CPI+是 OS（HR=5.24，95%CI [2.07；13.26]）和 PFS（HR=4.41，95%CI [1.40；13.88]）预后较差的独立预测因子。
基于最高 PRGS 和 PC 的 CPI 被发现与腹膜转移中 OS 和 PFS 的预后独立相关。这些结果表明，系统地采集腹膜液进行细胞学检查并在 PIPAC 背景下将 CPI 纳入治疗决策过程中可能具有重要意义。
