Martín-Román Lorena, Hannan Enda, Faraz Khan Mohammad, Müller Anna Sophia, Shields Conor, Aird John, Moran Brendan, Mulsow Jurgen
Department of Surgery, National Centre for Peritoneal Malignancy, Mater Misericordiae University Hospital, Dublin, Ireland.
Department of Pathology, Mater Misericordiae University Hospital, Dublin, Ireland.
Pleura Peritoneum. 2023 May 1;8(2):65-74. doi: 10.1515/pp-2023-0001. eCollection 2023 Jun.
The Peritoneal Surface Oncology Group International (PSOGI) consensus subdivided pseudomyxoma peritonei (PMP) into four groups according to histopathological features. The aim of this paper is to report survival outcomes after cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) from a national referral centre and to correlate the PSOGI classification with survival.
A retrospective study of a prospectively maintained database was performed. Consecutive patients treated with CRS + HIPEC for PMP of appendiceal origin were included (September-2013 to December-2021). Pathological features of the peritoneal disease were used to classify patients into the four groups proposed by PSOGI. Survival analysis was performed to evaluate the correlation of pathology on overall survival (OS) and disease-free survival (DFS).
Overall, 104 patients were identified; 29.6 % were reclassified as acellular mucin (AM), 43.9 % as low-grade mucinous carcinoma peritonei (LGMCP), 22.4 % as high-grade MCP (HGMCP) and 4.1 % as HGMCP with signet ring cells (HGMCP-SRC). Median PCI and rate of optimal cytoreduction were 19 and 82.7 %, respectively. Median OS and DFS were not reached, 5-year OS and DFS were 88.6(SD 0.04) % and 61.6(SD 0.06) %, respectively. Log-Rank test revealed significant differences in terms of OS and DFS across the different histological subgroups (p<0.001 in both cases). However, histology did not retain its significance in the multivariate analysis for OS or DFS (p=0.932 and p=0.872, respectively).
Survival outcomes after CRS + HIPEC for PMP are excellent. The PSOGI pathological classification correlates with OS and DFS, but differences were not significant at multivariate analysis when adjusted for other prognostic factors.
国际腹膜表面肿瘤学组（PSOGI）共识根据组织病理学特征将腹膜假黏液瘤（PMP）分为四组。本文旨在报告一家国家转诊中心接受细胞减灭术（CRS）和腹腔内热灌注化疗（HIPEC）后的生存结果，并将PSOGI分类与生存情况相关联。
对一个前瞻性维护的数据库进行回顾性研究。纳入连续接受CRS + HIPEC治疗阑尾源性PMP的患者（2013年9月至2021年12月）。利用腹膜疾病的病理特征将患者分为PSOGI提出的四组。进行生存分析以评估病理与总生存（OS）和无病生存（DFS）的相关性。
总体上，共识别出104例患者；29.6%重新分类为无细胞黏液（AM），43.9%为低级别腹膜黏液癌（LGMCP），22.4%为高级别MCP（HGMCP），4.1%为伴有印戒细胞的HGMCP（HGMCP-SRC）。中位腹膜癌指数（PCI）和最佳细胞减灭率分别为19和82.7%。未达到中位OS和DFS，5年OS和DFS分别为88.6（标准差0.04）%和61.6（标准差0.06）%。对数秩检验显示不同组织学亚组之间在OS和DFS方面存在显著差异（两种情况均p<0.001）。然而，在OS或DFS的多变量分析中，组织学不再具有显著性（分别为p = 0.932和p = 0.872）。
CRS + HIPEC治疗PMP后的生存结果良好。PSOGI病理分类与OS和DFS相关，但在多变量分析中，在调整其他预后因素后差异不显著。
