Recurrence Incidence and Optimal Surveillance After Complete Cytoreductive Surgery and Hyperthermic Intraperitoneal Chemotherapy in Mucinous Appendix Cancer.

INTRODUCTION

The optimal surveillance for mucinous appendix cancer (MAC) after cytoreductive surgery and hyperthermic intraperitoneal chemotherapy (CRS/HIPEC) remains unclear. We identified postoperative periods reflecting significant changes in recurrence probability.

METHODS

A prospective database (1998-2024) of patients with stage IV MAC with low-grade (LGMCP), high-grade (HGMCP), and signet-ring cell (SRC) histology treated with initial complete (CC-0/1) CRS/HIPEC was analyzed. A piecewise exponential recurrence-free survival model was employed. Excluding the first 6 months, postoperative follow-up was divided into periods by forwardly selected knots using minimal Bayesian Information Criterion (BIC) in an adjusted Cox regression. Per-period cumulative recurrence risk (CRR) was calculated by histology. Optimal surveillance was modeled based on 5% CRR changes.

RESULTS

Of 385 patients, 60.3% had LGMCP, 20.8% HGMCP, and 19.0% SRC. Median age was 54 years, 64.9% were female, and median peritoneal cancer index was 26. Median follow-up was 92 months. Knots at 16 and 48 months (BIC = 484.4) defined three periods: I (6-16 months), II (16-48 months), and III (48-120 months). The CRR was highest in period I: 1.0, 2.6, and 3.8 per 10 person-years for LGMCP, HGMCP, and SRC, respectively. The CRR in period II was 0.5, 2.9, and 3.5 and in period III was 0.4, 0.5, and 1.8, respectively. Optimal surveillance occurs every 5.5, 8, and 18 months for LGMCP and every 2-2.5, 4, and 24 months for HGMCP in periods I-III, respectively.

CONCLUSION

Mucinous appendix cancer exhibits a distinct recurrence probability by histology and key post-CRS/HIPEC periods, which can be addressed by a tailored surveillance schedule.