Department of Pathology, University of Pittsburgh Medical Center, Pittsburgh, PA, USA.
Department of Surgical Oncology, University of Pittsburgh Medical Center, Pittsburgh, PA, USA.
Histopathology. 2020 Nov;77(5):798-809. doi: 10.1111/his.14189. Epub 2020 Sep 27.
Peritoneal spread is the most common route of metastasis in appendiceal goblet cell adenocarcinoma. The aim of this study was to assess the prognostic significance of the World Health Organization (WHO) 5th edition grading criteria in peritoneal metastases of goblet cell adenocarcinoma.
We evaluated the clinicopathological features and survival of 63 patients with peritoneal metastasis of goblet cell adenocarcinoma who underwent cytoreductive surgery with hyperthermic intraperitoneal chemoperfusion (CRS-HIPEC), stratified according to the WHO 5th edition and the Tang et al. grading schemes. The patients were also compared with 120 patients with peritoneal metastasis of appendiceal mucinous neoplasia. Most (73%) peritoneal metastases of goblet cell adenocarcinoma were WHO Grade 3 (G3), there being fewer cases of Grade 2 (G2) (16%) and Grade 1 (G1) (11%) disease. No significant differences in overall survival were observed between WHO G1 and G2 tumours or between the three Tang grades. In the multivariable model of survival, WHO G3 [hazard ratio (HR) 2.81, 95% confidence interval (CI) 1.02-7.70] and the presence of >50% extracellular mucin (HR 2.30, 95% CI 1.09-4.88) were associated with reduced overall survival for patients with goblet cell adenocarcinoma. As compared with patients with peritoneal metastasis of mucinous neoplasia, patients with goblet cell adenocarcinoma had significantly reduced survival (median overall survival of 37 months versus 102 months, P < 0.001), which was attributed to the reduced survival of patients with G1/G2 goblet cell adenocarcinoma as compared with patients with G1 mucinous neoplasia (median survival of 98 months versus 204 months, P < 0.001).
Grade of peritoneal goblet cell adenocarcinoma determined according to the WHO 5th edition criteria is a clinically relevant measure that independently predicts survival in patients treated with CRS-HIPEC.
腹膜扩散是阑尾杯状细胞腺癌最常见的转移途径。本研究的目的是评估世界卫生组织（WHO）第 5 版分级标准在阑尾杯状细胞腺癌腹膜转移中的预后意义。
我们评估了 63 例接受细胞减灭术联合腹腔热灌注化疗（CRS-HIPEC）治疗的阑尾杯状细胞腺癌腹膜转移患者的临床病理特征和生存情况，这些患者根据 WHO 第 5 版和 Tang 等人的分级方案进行了分层。我们还将这些患者与 120 例阑尾粘液性肿瘤腹膜转移患者进行了比较。大多数（73%）阑尾杯状细胞腺癌的腹膜转移为 WHO 分级 3 级（G3），2 级（G2）（16%）和 1 级（G1）（11%）疾病较少。WHO G1 和 G2 肿瘤之间或 Tang 分级的三个等级之间的总生存率没有显著差异。在生存的多变量模型中，WHO G3[风险比（HR）2.81，95%置信区间（CI）1.02-7.70]和存在>50%细胞外粘蛋白（HR 2.30，95%CI 1.09-4.88）与阑尾杯状细胞腺癌患者的总生存率降低相关。与阑尾粘液性肿瘤腹膜转移患者相比，阑尾杯状细胞腺癌患者的生存时间明显缩短（中位总生存时间 37 个月与 102 个月，P<0.001），这归因于 G1/G2 阑尾杯状细胞腺癌患者的生存时间短于 G1 型粘液性肿瘤患者（中位生存时间 98 个月与 204 个月，P<0.001）。
根据 WHO 第 5 版标准确定的腹膜杯状细胞腺癌分级是一种临床相关的措施，可独立预测接受 CRS-HIPEC 治疗的患者的生存情况。
