Peritoneal Malignancy Program, Department of Surgery, National Cancer Institute, via Venezian,1, 20133, Milano, Italy.
Peritoneal Malignancy Program, Department of Surgery, National Cancer Institute, via Venezian,1, 20133, Milano, Italy.
Eur J Surg Oncol. 2022 Jul;48(7):1590-1597. doi: 10.1016/j.ejso.2022.01.010. Epub 2022 Jan 20.
The metastasizing potential of pseudomyxoma peritonei (PMP) is largely unknown. We assessed incidence, impact on prognosis, treatments, and outcomes of systemic metastases after cytoreductive surgery and hyperthermic intraperitoneal chemotherapy (CRS/HIPEC).
A prospective database of 327 patients undergoing CRS/HIPEC for PMP of appendiceal origin was reviewed. PMP was graded according to the Peritoneal Surface Oncology Group International (PSOGI) classification. Haematogenous metastases, and non-regional lymph-node involvement were considered as systemic metastases.
After a median follow-up of 74.8 months (95% confidence interval [CI] = 68.0-94.8), systemic metastases occurred in 21 patients. Eleven patients were affected by low-grade PMP, and ten by high-grade PMP. Metastatic disease involved the lung (n = 12), bone (n = 1), liver (n = 4), distant nodes (n = 3), both lung and distant nodes (n = 1). Systemic metastases independently correlated with PSOGI histological subtypes (P = 0.001), and incomplete cytoreduction (P = 0.026). Median OS was 139.0 months (95%CI = 56.6-161.9) for patients who experienced systemic metastases, and 213.8 months (95%CI = 148.7-not reached) for those who did not (P = 0.159). Eight of eleven patients who had curative-intent surgery are presently alive at a median of 52.5 months (range 2.0-112.7). Seven are disease-free at a median of 27.4 months (range 2.0-110.4). At multivariate analysis, PSOGI histological subtypes (P = 0.001), completeness of cytoreduction (P = 0.001), and preoperative systemic chemotherapy (P = 0.020) correlated with poorer survival. Systemic metastases did not (P = 0.861).
After CRS/HIPEC, systemic metastases occur in a small but clinically relevant number of patients, and the risk increases with incomplete cytoreduction and aggressive histology. In selected patients, surgical resection of metastatic disease can result in long survival.
假性黏液瘤腹膜转移（PMP）的转移潜能很大程度上是未知的。我们评估了细胞减灭术和腹腔热灌注化疗（CRS/HIPEC）后全身转移的发生率、对预后的影响、治疗方法和结局。
回顾性分析了 327 例阑尾来源 PMP 患者行 CRS/HIPEC 的前瞻性数据库。根据腹膜表面肿瘤国际组织（PSOGI）分类对 PMP 进行分级。血行转移和非区域性淋巴结受累被视为全身转移。
中位随访 74.8 个月（95%置信区间[CI] = 68.0-94.8）后，21 例患者出现全身转移。11 例患者为低级别 PMP，10 例为高级别 PMP。转移疾病累及肺（n = 12）、骨（n = 1）、肝（n = 4）、远处淋巴结（n = 3）、肺和远处淋巴结（n = 1）。全身转移与 PSOGI 组织学亚型独立相关（P = 0.001），与不完全肿瘤细胞减灭术相关（P = 0.026）。发生全身转移的患者中位 OS 为 139.0 个月（95%CI = 56.6-161.9），未发生全身转移的患者中位 OS 为 213.8 个月（95%CI = 148.7-未达到）（P = 0.159）。11 例接受治愈性手术的患者中，有 8 例目前存活，中位时间为 52.5 个月（范围 2.0-112.7）。7 例无疾病生存，中位时间为 27.4 个月（范围 2.0-110.4）。多因素分析显示，PSOGI 组织学亚型（P = 0.001）、肿瘤细胞减灭术的完全程度（P = 0.001）和术前全身化疗（P = 0.020）与较差的生存相关。全身转移与生存无关（P = 0.861）。
CRS/HIPEC 后，全身转移发生在少数但具有临床意义的患者中，风险随着不完全肿瘤细胞减灭术和侵袭性组织学的增加而增加。在选择的患者中，转移性疾病的手术切除可以带来长期生存。
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