Unit of Surgical Oncology, Department of Surgery, Reina Sofia University Hospital, Spain; Maimonides Biomedical Research Institute of Cordoba (IMIBIC), Reina Sofia University Hospital, University of Cordoba, Cordoba, Spain. Electronic address: https://twitter.com/alarjosan.
Unit of Surgical Oncology, Department of Surgery, Reina Sofia University Hospital, Spain; Pathology Unit, Reina Sofia University Hospital, Spain.
Eur J Surg Oncol. 2023 Aug;49(8):1481-1488. doi: 10.1016/j.ejso.2023.03.206. Epub 2023 Mar 15.
Pseudomyxoma peritonei (PMP) is a rare malignant disease. Adding of the Ki67 proliferation index to the PSOGI PMP classification provided two different subcategories of the extensive HG-PMP group (HG-PMP ≤15% and HG-PMP >15%) with different survival in a previous unicentric study. This study aims to carry out an external and multicentre validation of this new proposed classification.
It was a prospective analysis of samples from a historical and international cohort of patients. A representative area with higher cellular density was used to determine the Ki67%. The Ki67 proliferation index (%) was determined in all the HG-PMP patients. A Cox proportional hazard models and multivariable COX models were used. The Kaplan-Meier method and the two-tailed log-rank test were used to analyse the effect of different PSOGI-Ki67 categories on OS and DFS. Its predictive accuracy was analysed using Harrel's C-index and the ROC curve. The calibration was performed using the calibration plots matching.
After exclusions, 349 patients were available for analysis. The 5-years OS were 86% for LG-PMP, 59% for HG-PMP≤15, 38% for HG-PMP>15 and 42% for SRC-PMP (p = 0.0001). The 5-years DFS were 49% for LG-PMP, 35% for HG-PMP≤15, 16% for HG-PMP>15 and 18% SRC-PMP (p = 0.0001). The discrimination capability of PSOGI-Ki67 was validated.
the PSOGI-Ki67 classification discriminates and predicts the OS and DFS in patients with PMP dividing the HG-PMP category into two well-defined sub-categories. The Ki67 proliferation index should be incorporated routinely in the pathology report for these patients.
假性黏液瘤腹膜（PMP）是一种罕见的恶性疾病。在之前的单中心研究中，将 Ki67 增殖指数加入 PSOGI PMP 分类中，将广泛高细胞密度的 PMP 组（HG-PMP≤15%和 HG-PMP>15%）分为两个不同的亚组，其生存情况也不同。本研究旨在对这一新提出的分类进行外部和多中心验证。
这是对患者历史和国际队列的样本进行的前瞻性分析。使用具有较高细胞密度的代表性区域来确定 Ki67%。对所有 HG-PMP 患者均测定 Ki67 增殖指数（%）。使用 Cox 比例风险模型和多变量 COX 模型。使用 Kaplan-Meier 方法和双侧对数秩检验分析不同 PSOGI-Ki67 类别对 OS 和 DFS 的影响。使用 Harrel 的 C 指数和 ROC 曲线分析其预测准确性。使用校准图匹配来进行校准。
排除后，有 349 例患者可用于分析。LG-PMP 的 5 年 OS 为 86%，HG-PMP≤15 的为 59%，HG-PMP>15 的为 38%，SRC-PMP 的为 42%（p=0.0001）。LG-PMP 的 5 年 DFS 为 49%，HG-PMP≤15 的为 35%，HG-PMP>15 的为 16%，SRC-PMP 的为 18%（p=0.0001）。PSOGI-Ki67 的鉴别能力得到了验证。
PSOGI-Ki67 分类可区分和预测 PMP 患者的 OS 和 DFS，将 HG-PMP 分为两个明确的亚类。Ki67 增殖指数应常规纳入这些患者的病理报告中。
