Peritoneal Carcinomatosis Unit, Department of General and Digestive Surgery, Hospital General Universitario Gregorio Marañón, Madrid, Spain.
Department of Surgery, School of Medicine, Universidad Complutense de Madrid, Madrid, Spain.
BJS Open. 2021 Jul 6;5(4). doi: 10.1093/bjsopen/zrab059.
Mucinous appendiceal neoplasms with peritoneal dissemination (PD) show a wide spectrum of clinical behaviour. Histological grade has been correlated with prognosis, but no universally accepted histological grading has been established. The aim of this systematic review was to provide historical insight to understand current grading classifications, basic histopathological features of each category, and to define which classification correlates best with prognosis.
MEDLINE and the Cochrane Library were searched for studies that reported survival across different pathological grades in patients with mucinous neoplasm of the appendix with PD treated with cytoreductive surgery and hyperthermic intraperitoneal chemotherapy. PRISMA guidelines were followed.
Thirty-eight studies were included. Ronnett's classification was the most common (9 studies). Classifications proposed by the Peritoneal Surface Oncology Group International (PSOGI) (6 studies) and the seventh or eighth edition of the AJCC (7 studies) are gaining in popularity. Nine studies supported a two-tier, 12 a three-tier, and two a four-tier classification system. Three studies demonstrated that acellular mucin had a better prognosis than low-grade pseudomyxoma peritonei in the PSOGI classification or M1bG1 in the eighth edition of the AJCC classification. Four studies demonstrated that the presence of signet ring cells was associated with a worse outcome than high-grade pseudomyxoma peritonei in the PSOGI classification and M1bG2 in the eighth edition of the AJCC.
There is a great need for a common language in describing mucinous neoplasms of the appendix with PD. Evolution in terminology as a result of pathological insight turns the four-tiered PSOGI classification system into a coherent classification option.
具有腹膜播散（PD）的黏液性阑尾肿瘤具有广泛的临床行为谱。组织学分级与预后相关，但尚未建立普遍接受的组织学分级标准。本系统评价的目的是提供历史见解，以了解当前的分级分类，每种类别的基本组织病理学特征，并确定哪种分类与预后相关性最好。
在 MEDLINE 和 Cochrane 图书馆中搜索了报道黏液性阑尾肿瘤伴 PD 患者接受细胞减灭术和腹腔内热化疗后不同病理分级生存情况的研究。遵循 PRISMA 指南。
共纳入 38 项研究。Ronnett 分类最常见（9 项研究）。腹膜表面肿瘤国际组织（PSOGI）提出的分类（6 项研究）和 AJCC 第 7 或第 8 版（7 项研究）越来越受欢迎。9 项研究支持两阶梯、12 项三阶梯和两项四阶梯分类系统。三项研究表明，在 PSOGI 分类中无细胞黏液比低级别腹膜假黏液瘤或 AJCC 第 8 版分类中的 M1bG1 具有更好的预后。四项研究表明，在 PSOGI 分类中，PSOGI 分类中存在印戒细胞比高级别腹膜假黏液瘤或 AJCC 第 8 版中的 M1bG2 预后更差。
需要一种通用语言来描述具有 PD 的黏液性阑尾肿瘤。由于病理见解的发展，术语的演变使四阶梯 PSOGI 分类系统成为一种连贯的分类选择。
