Department of Surgical Oncology, University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Unit 1484, Houston, TX, 77030-4009, USA.
Department of Gastrointestinal Medical Oncology, University of Texas MD Anderson Cancer Center, Houston, TX, USA.
Langenbecks Arch Surg. 2023 Feb 28;408(1):110. doi: 10.1007/s00423-022-02732-0.
Appendiceal neoplasms have a propensity for peritoneal dissemination. The standard of care for select individuals is CRS/HIPEC. In the current 8 AJCC Staging system, a finding of only intraperitoneal acellular mucin (M1a) is classified as Stage IVa. There is concern that the current AJCC system may over-stage patients.
This was a single-institution retrospective review of 164 cases of mucinous appendiceal neoplasm. Patients undergoing CRS/HIPEC with M1a disease were compared to patients with peritoneal deposits containing tumor cells (well-differentiated adenocarcinoma; low-grade mucinous carcinoma peritonei-M1b,G1). Overall and recurrence-free survival were assessed.
Median age was 51 years, 70% were female, and 75% White. Sixty-four patients had M1a disease and 100 M1b,G1 disease. M1a disease had a lower median PCI score (11 vs. 20, p = .0001) and a higher rate of complete CRS (62% vs. 50%, p = .021). Median follow-up was 7.6 years (IQR 5.6-10.5 years). For M1a disease, there were no recurrences and only one patient died during the study interval. In comparison, for M1b disease, 66/100 (66%) recurred with a 5-year RFS of 40.5% (HR 8.0, 95% CI 4.9-15.1, p < .0001), and 31/100 (31%) died with a 5-year OS of 84.8% (HR 4.5, 95% CI 2.2-9.2, p < .0001).
Acellular mucin (M1a disease) after CRS/HIPEC for appendiceal neoplasm is associated with longer OS and RFS compared to M1b, G1 disease. Current AJCC staging does not accurately reflect the differing outcomes of these two patient populations. The presence of acellular mucin in the peritoneal cavity should not be perceived as a metastatic equivalent.
阑尾肿瘤具有腹膜扩散的倾向。对于某些特定人群，标准治疗方法是 CRS/HIPEC。在现行的 8 版 AJCC 分期系统中，仅发现腹腔内无细胞黏蛋白（M1a）被归类为 IVa 期。有人担心当前的 AJCC 系统可能会对患者进行过度分期。
这是一项对 164 例黏液性阑尾肿瘤患者的单机构回顾性研究。接受 CRS/HIPEC 治疗且患有 M1a 疾病的患者与腹膜沉积物中含有肿瘤细胞的患者（分化良好的腺癌；低级别黏液性腹膜癌-M1b，G1）进行比较。评估总生存期和无复发生存期。
中位年龄为 51 岁，70%为女性，75%为白人。64 例患者患有 M1a 疾病，100 例患者患有 M1b，G1 疾病。M1a 疾病的 PCI 评分中位数较低（11 分比 20 分，p=0.0001），完全 CRS 的发生率较高（62%比 50%，p=0.021）。中位随访时间为 7.6 年（IQR 5.6-10.5 年）。对于 M1a 疾病，研究期间无复发，仅有 1 例患者死亡。相比之下，对于 M1b 疾病，100 例中有 66 例（66%）复发，5 年 RFS 为 40.5%（HR 8.0，95%CI 4.9-15.1，p<0.0001），31 例（31%）死亡，5 年 OS 为 84.8%（HR 4.5，95%CI 2.2-9.2，p<0.0001）。
与 M1b，G1 疾病相比，CRS/HIPEC 治疗阑尾肿瘤后无细胞黏蛋白（M1a 疾病）与较长的 OS 和 RFS 相关。当前的 AJCC 分期不能准确反映这两种患者群体的不同结局。腹腔内无细胞黏蛋白的存在不应被视为转移性等同物。
