Department of Peritoneal Cancer Surgery, Beijing Shijitan Hospital, Capital Medical University, No. 10 Tieyi Road, Yangfangdian Street, Haidian District, 100038, Beijing, China.
Department of Pathology, Beijing Shijitan Hospital, Capital Medical University, 100038, Beijing, China.
Diagn Pathol. 2021 Dec 13;16(1):116. doi: 10.1186/s13000-021-01177-1.
As a rare clinical tumor syndrome with an indolent clinical course and lack of pathognomonic symptoms, pseudomyxoma peritonei (PMP) is usually diagnosed at an advanced stage. In-depth pathological analysis is essential to assess tumor biological behaviors, assist treatment decision, and predict the clinical prognosis of PMP. The tumor-stroma ratio (TSR) is a promising prognostic parameter based on the tumor and stroma. This study explored the relationship between TSR and the pathological characteristics and prognosis of PMP.
PMP patients with complete data who underwent cytoreductive surgery plus hyperthermic intraperitoneal chemotherapy were enrolled. The TSR of postoperative pathological images was quantitatively analyzed by Image-Pro Plus. Then the relationship between TSR and the clinicopathological characteristics, immunohistochemical characteristics and prognosis of PMP was analyzed.
Among the 50 PMP patients included, there were 27 males (54.0%) and 23 females (46.0%), with a median age of 55 (range: 31-76) years. 25 (50.0%) patients were diagnosed with low-grade PMP (LG-PMP), and 25 (50.0%) were diagnosed with high-grade PMP (HG-PMP). There were 4 (8.0%) patients with vascular tumor emboli, 3 (6.0%) patients with nerve invasion, and 5 (10.0%) patients with lymph node metastasis. The immunohistochemical results showed that the Ki67 label index was < 25% in 18 cases (36.0%), 25 - 50% in 18 cases (36.0%) and > 50% in 14 cases (28.0%). The range of TSR was 2 - 24% (median: 8%). The cutoff value of TSR was 10% based on the receiver operating characteristic (ROC) curve and X-Tile analysis. There were 31 (62.0%) cases with TSR < 10% and 19 (38.0%) cases with TSR ≥ 10%. The TSR was closely related to histopathological type (P < 0.001) and Ki67 label index (P < 0.001). Univariate analysis showed that preoperative carcinoembryonic antigen (CEA), preoperative carbohydrate antigen 19-9, pathological type, vascular tumor emboli and TSR influenced the prognosis of PMP patients (P < 0.05). Multivariate analysis showed that preoperative CEA, vascular tumor emboli and the TSR were independent prognostic factors.
The TSR could be a new independent prognosticator for PMP.
假性黏液瘤（PMP）是一种罕见的临床肿瘤综合征，具有惰性的临床病程和缺乏特征性症状，通常在晚期诊断。深入的病理分析对于评估肿瘤的生物学行为、辅助治疗决策和预测 PMP 的临床预后至关重要。肿瘤-基质比（TSR）是基于肿瘤和基质的一种有前途的预后参数。本研究探讨了 TSR 与 PMP 的病理特征和预后之间的关系。
纳入了接受细胞减灭术加腹腔热灌注化疗的完整数据的 PMP 患者。通过 Image-Pro Plus 对术后病理图像的 TSR 进行定量分析。然后分析了 TSR 与 PMP 的临床病理特征、免疫组织化学特征和预后之间的关系。
在纳入的 50 名 PMP 患者中，有 27 名男性（54.0%）和 23 名女性（46.0%），中位年龄为 55 岁（范围：31-76 岁）。25 名（50.0%）患者被诊断为低级别 PMP（LG-PMP），25 名（50.0%）患者被诊断为高级别 PMP（HG-PMP）。有 4 名（8.0%）患者有血管肿瘤栓子，3 名（6.0%）患者有神经侵犯，5 名（10.0%）患者有淋巴结转移。免疫组织化学结果显示，Ki67 标记指数<25%的有 18 例（36.0%），25-50%的有 18 例（36.0%），>50%的有 14 例（28.0%）。TSR 的范围为 2-24%（中位数：8%）。根据受试者工作特征（ROC）曲线和 X-Tile 分析，TSR 的截断值为 10%。有 31 例（62.0%）患者的 TSR<10%，19 例（38.0%）患者的 TSR≥10%。TSR 与组织病理学类型（P<0.001）和 Ki67 标记指数（P<0.001）密切相关。单因素分析显示，术前癌胚抗原（CEA）、术前碳水化合物抗原 19-9、病理类型、血管肿瘤栓子和 TSR 影响 PMP 患者的预后（P<0.05）。多因素分析显示，术前 CEA、血管肿瘤栓子和 TSR 是独立的预后因素。
TSR 可能是 PMP 的一个新的独立预后因素。
