低级别阑尾黏液性肿瘤切除术后腹膜复发的多机构研究。
A Multi-institutional Study of Peritoneal Recurrence Following Resection of Low-grade Appendiceal Mucinous Neoplasms.
机构信息
Department of Surgery, University of California San Diego, La Jolla, CA, USA.
Department of Pathology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
出版信息
Ann Surg Oncol. 2021 Aug;28(8):4685-4694. doi: 10.1245/s10434-020-09499-y. Epub 2021 Jan 7.
BACKGROUND
Peritoneal dissemination of low-grade appendiceal mucinous neoplasms (LAMNs), sometimes referred to as pseudomyxoma peritonei, can result in significant morbidity and mortality. Little is known about the natural history of localized (non-disseminated) LAMNs.
OBJECTIVE
The goal of this study was to evaluate the risk of peritoneal recurrence in patients with localized LAMNs.
METHODS
We performed a multi-institutional retrospective review of patients with pathologically confirmed localized LAMNs. Baseline characteristics, pathology, and follow-up data were collected. The primary endpoint was the rate of peritoneal recurrence.
RESULTS
We identified 217 patients with localized LAMNs. Median age was 59 years (11-95) and 131 (60%) patients were female. Surgical management included appendectomy for 124 (57.1%) patients, appendectomy with partial cecectomy for 26 (12.0%) patients, and colectomy for 67 (30.9%) patients. Pathology revealed perforation in 46 patients (37.7% of 122 patients with perforation status mentioned in the report), extra-appendiceal acellular mucin (EAM) in 49 (22.6%) patients, and extra-appendiceal neoplastic cells (EAC) in 13 (6.0%) patients. Median follow-up was 51.1 months (0-271). Seven (3.2%) patients developed a peritoneal recurrence, with a median time to recurrence of 14.4 months (2.5-47.0). Seven (15.2%) patients with histologic evidence of perforation had recurrence, versus no patients (0%) without perforation (p < 0.001); five (10.2%) patients with EAM versus two (1.2%) patients without EAM (p = 0.007), and one (7.7%) patient with EAC versus six (2.9%) patients without EAC (p = 0.355) had recurrence.
CONCLUSIONS
This multi-institutional study represents the largest reported series of patients with localized LAMNs. In the absence of perforation or extra-appendiceal mucin or cells, recurrence was extremely rare; however, patients with any of these pathologic findings require careful follow-up.
背景
低级别阑尾黏液性肿瘤（LAMN）的腹膜播散，有时也称为假性黏液瘤腹膜病，可导致显著的发病率和死亡率。对于局限性（非播散性）LAMN 的自然病史知之甚少。
目的
本研究旨在评估局限性 LAMN 患者腹膜复发的风险。
方法
我们对经病理证实为局限性 LAMN 的患者进行了多机构回顾性研究。收集了基线特征、病理和随访数据。主要终点是腹膜复发率。
结果
我们确定了 217 例局限性 LAMN 患者。中位年龄为 59 岁（11-95），131 例（60%）为女性。手术治疗包括阑尾切除术 124 例（57.1%），阑尾切除术加部分盲肠切除术 26 例（12.0%），结肠切除术 67 例（30.9%）。病理检查显示 46 例（提及穿孔状态的 122 例患者中的 37.7%）有穿孔，49 例（22.6%）有阑尾外无细胞黏液（EAM），13 例（6.0%）有阑尾外肿瘤细胞（EAC）。中位随访时间为 51.1 个月（0-271）。7 例（3.2%）患者发生腹膜复发，中位复发时间为 14.4 个月（2.5-47.0）。有组织学穿孔证据的 7 例（15.2%）患者复发，而无穿孔的 0 例（0%）患者（p<0.001）；5 例（10.2%）有 EAM 的患者与 2 例（1.2%）无 EAM 的患者（p=0.007），1 例（7.7%）有 EAC 的患者与 6 例（2.9%）无 EAC 的患者（p=0.355）复发。
结论
本多机构研究代表了迄今为止报道的最大系列局限性 LAMN 患者。在没有穿孔、阑尾外黏液或细胞的情况下，复发极为罕见；然而，有任何这些病理发现的患者需要密切随访。
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