Overall survival is more closely associated with peritoneal than primary appendiceal pathological grade in pseudomyxoma peritonei with discordant pathology
| Autor: | Norman J Carr, Ayaz Ahmed Memon, Sanjeev Dayal, Alexios Tzivanakis, Chintamani Godbole, Brendan Moran, Faheez Mohamed, Tom Cecil |
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| Rok vydání: | 2022 |
| Předmět: |
Pathology
medicine.medical_specialty Appendix Neoplasm Appendix Surgical oncology medicine Pseudomyxoma peritonei Humans Prospective Studies Survival analysis Retrospective Studies business.industry Cytoreduction Surgical Procedures Hyperthermia Induced General Medicine medicine.disease Pseudomyxoma Peritonei Primary tumor Combined Modality Therapy Survival Rate medicine.anatomical_structure Appendiceal Neoplasms Oncology Peritoneal Cancer Index Hyperthermic intraperitoneal chemotherapy Surgery business |
| Zdroj: | European Journal of Surgical Oncology. 48:e157 |
| ISSN: | 0748-7983 |
| Popis: | Background The WHO classification of mucinous appendix neoplasms and pseudomyxoma peritonei (PMP) describes low- and high-grade histology and is of prognostic importance. The metastatic peritoneal disease grade can occasionally be different from the primary appendix tumor. This analysis aimed to report outcomes from a high-volume center in patients with pathological discordance. Methods This was a retrospective analysis of prospective data of patients treated by cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) for PMP at a single institution between January 2016 and December 2020. Reporting was by pathologists with a special interest in peritoneal malignancy. Discordant pathology was classified as a low-grade primary appendix tumor with high-grade peritoneal disease, or a high-grade primary appendix tumor with low-grade peritoneal disease. Outcomes analyzed were overall and recurrence-free survival, and Kaplan-Meier survival curves and the log-rank test were used to analyze the outcomes. Results Between 2016 and 2020, 830 patients underwent CRS and HIPEC for PMP, of whom 37 (4.4%) had discordant pathology. The primary appendix tumors were low-grade in 23 patients and high-grade in 14 patients. The median Peritoneal Cancer Index (PCI) was significantly higher in patients with a low-grade primary tumor (31 vs. 16; p = 0.001), while complete cytoreduction (CC0/1) was achieved in 31/37 (83.8%) patients. The median follow-up was 19 months. Overall survival was worse in those with high-grade peritoneal disease (p = 0.029), whereas recurrence-free survival was similar in both groups (p = 0.075). Conclusion In PMP with pathological discordance, the peritoneal disease grade influences prognosis and survival. |
| Databáze: | OpenAIRE |
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