Department of Surgical Oncology, Institut Jules Bordet, Université Libre de Bruxelles, 90 Rue Meylemeersch, 1070, Brussels, Belgium.
Department of Pathology, Institut Jules Bordet, Université Libre de Bruxelles, Brussels, Belgium.
World J Surg Oncol. 2023 Aug 28;21(1):269. doi: 10.1186/s12957-023-03153-z.
Complete cytoreductive surgery (CRS), remain the gold standard in the treatment of peritoneal metastases of ovarian cancer (PMOC). Given the increasing rate of neoadjuvant chemotherapy in patients with high PCI, prior abdominal surgeries, inflammation and fibrotic changes, the benefit of removing any "peritoneal scar-like tissues" (PST) during CRS, hasn't been thoroughly investigated. Our objective in this retrospective cohort was to identify the proportion of malignant cells positivity in PST of patients with PMOC, undergoing curative-intent CRS ± HIPEC.
This is a retrospective study, conducted at our comprehensive cancer center, including patients with PMOC, presenting for curative-intent CRS. During CRS, benign-looking peritoneal lesions, lacking the typical hard nodular, aggressive, and invasive morphology, were systematically resected or electro fulgurated. PSTs were analyzed for the presence of tumoral cells by our pathologist. Correlations between the presence of PST and their positivity, and the different patients' variables, were studied.
In 51% of patients, PST harbored malignant cells. Those were associated with poorly differentiated serous tumors, a high PCI (> 8) and a worse DFS: 17 months in the positive PST group versus 29 months in the negative PST group (p = 0.05), on univariate analysis. Multivariate analysis revealed that PCI > 8 and poorly differentiated primary tumor histology were correlated with a worse DFS, and that higher PCI and advanced FIGO were correlated with a worse OS.
Benign-looking PST harbors malignancy in 51% of cases. The benefit of their systematic resection and their prognostic value should be further investigated in larger cohorts.
彻底细胞减灭术（CRS）仍然是卵巢癌腹膜转移（PMOC）治疗的金标准。鉴于新辅助化疗在 PCI 较高、既往腹部手术、炎症和纤维化改变的患者中的应用率不断增加，在 CRS 期间去除任何“腹膜瘢痕样组织”（PST）的益处尚未得到充分研究。我们在这项回顾性队列研究中的目的是确定在接受根治性 CRS±HIPEC 的 PMOC 患者中，PST 中恶性细胞阳性的比例。
这是一项回顾性研究，在我们的综合癌症中心进行，包括接受根治性 CRS 的 PMOC 患者。在 CRS 期间，系统地切除或电灼具有良性外观的腹膜病变，这些病变缺乏典型的硬结节状、侵袭性和侵袭性形态。通过我们的病理学家分析 PST 中是否存在肿瘤细胞。研究了 PST 的存在及其阳性率与不同患者变量之间的相关性。
在 51%的患者中，PST 中存在恶性细胞。这些与低分化浆液性肿瘤、高 PCI（>8）和较差的DFS 相关：阳性 PST 组为 17 个月，阴性 PST 组为 29 个月（p=0.05），单变量分析。多变量分析显示，PCI>8 和低分化原发肿瘤组织学与较差的 DFS 相关，较高的 PCI 和晚期 FIGO 与较差的 OS 相关。
外观良性的 PST 中有 51%存在恶性肿瘤。应在更大的队列中进一步研究其系统切除的益处及其预后价值。
