Ma R, Li X B, Yan F C, Lin Y L, Li Y
Department of Peritoneal Cancer Surgery, Beijing Shijitan Hospital, Capital Medical University, Beijing 100038, China.
Department of Pathology, Beijing Shijitan Hospital, Capital Medical University, Beijing 100038, China.
Beijing Da Xue Xue Bao Yi Xue Ban. 2020 Apr 18;52(2):240-246. doi: 10.19723/j.issn.1671-167X.2020.02.008.
To evaluate the effect of tumor-stroma ratio (TSR) on disease progression and prognosis of pseudomyxoma peritonei (PMP) from the appendix.
The study included 30 PMP patients with complete individual patient data, who underwent cytoreductive surgery (CRS) plus hyperthermic intraperitoneal chemotherapy (HIPEC) in Beijing Shijitan Hospital. Image-Pro Plus was used to quantitatively analyze the proportion of tumor and stromal areas in hematoxylin-eosin staining pathological images, from which TSR was derived. Correlation studies were conducted to evaluate the relationships between TSR and clinicopathological features, immunohistochemical characteristics, and prognosis of PMP.
Among 30 PMP patients, there were 16 males (53.3%) and 14 females (46.7%), with the mean age of (54.9±2.3) years. There were 15 cases (50.0%) of low-grade mucinous carcinoma peritonei (LMCP) and high-grade mucinous carcinoma peritonei (HMCP), respectively, with vascular tumor emboli occurring in 4 cases (13.3%), nerve invasion occurring in 3 cases (10.0%), and lymphatic metastasis occurring in 4 cases (13.3%). The median peritoneal cancer index (PCI) score was 36 (range: 3-39). The median TSR was 8% (range: 2%-24%), with TSR≤10% in 19 cases (63.3%) and TSR>10% in 11 cases (36.7%). Immunohistochemistry showed that 16 cases (53.3%) had Ki67 label index ≤ 50% and 14 cases (46.7%) > 50%. The mutation rate of p53 was 56.7% and the loss rate of MMR protein was 11.8%. In addition, the expression rates of MUC2, MUC5AC, CDX2, CK7, and CK20 were 66.7%, 100.0%, 82.6%, 56.0%, and 92.3%, respectively. There were significant correlations between TSR and histopathological types, nerve invasion, Ki67 label index, and p53 mutation (P<0.05 for all). At the end of the last follow-up, 21 patients (70.0%) died and 9 patients (30.0%) survived, including 6 patients survived with tumor. The median overall survival (OS) was 12.7 months (95%CI: 10.4-11.5 months), and the 1-, 2-, and 3-year survival rates were 60.5%, 32.3%, and 27.7%, respectively. The median OS was 19.4 months (95%CI: 3.0-35.9 months) in the TSR≤10% group, versus 12.6 months (95%CI: 0.7-24.5 months) in the TSR>10% group (χ=3.996, P=0.046).
TSR is correlated with histopathological types, tumor proliferation, invasion behaviors and prognosis of PMP, thus could be a new prognostic indicator for PMP.
评估肿瘤-间质比（TSR）对阑尾来源的腹膜假黏液瘤（PMP）疾病进展及预后的影响。
本研究纳入30例具有完整个体患者数据的PMP患者，这些患者在北京世纪坛医院接受了减瘤手术（CRS）加腹腔热灌注化疗（HIPEC）。采用Image-Pro Plus软件对苏木精-伊红染色病理图像中的肿瘤和间质区域比例进行定量分析，进而得出TSR。进行相关性研究以评估TSR与PMP的临床病理特征、免疫组化特征及预后之间的关系。
30例PMP患者中，男性16例（53.3%），女性14例（46.7%），平均年龄（54.9±2.3）岁。腹膜低级别黏液性癌（LMCP）和高级别黏液性癌（HMCP）各15例（50.0%），4例（13.3%）出现血管内肿瘤栓子，3例（10.0%）出现神经侵犯,4例（13.3%）出现淋巴结转移。腹膜癌指数（PCI）评分中位数为36分（范围：3 - 39分）。TSR中位数为8%（范围：2% - 24%），TSR≤10%者19例（63.3%），TSR>10%者11例（36.7%）。免疫组化显示，Ki67标记指数≤50%者16例（53.3%），>50%者14例（46.7%）。p53突变率为56.7%，错配修复蛋白缺失率为11.8%。此外，MUC2、MUC5AC、CDX2、CK7和CK20的表达率分别为66.7%、100.0%、82.6%、56.0%和92.3%。TSR与组织病理学类型、神经侵犯、Ki67标记指数及p53突变均存在显著相关性（均P<0.05）。末次随访结束时，21例患者（70.0%）死亡，9例患者（30.0%）存活，其中6例带瘤存活。总生存（OS）期中位数为12.7个月（95%CI：10.4 - 11.5个月），1年、2年和3年生存率分别为60.5%、32.3%和27.7%。TSR≤10%组OS期中位数为19.4个月（95%CI：3.0 - 35.9个月），TSR>10%组为12.6个月（95%CI：0.7 - 24.5个月）（χ=3.996，P=0.046）。
TSR与PMP的组织病理学类型、肿瘤增殖、侵袭行为及预后相关，可作为PMP的一项新的预后指标。
