Pseudomyxoma Peritonei: Clinical Pathological and Biological Prognostic Factors in Patients Treated with Cytoreductive Surgery and Hyperthermic Intraperitoneal Chemotherapy (HIPEC)

Background Surgical cytoreduction combined with hyperthermic intraperitoneal chemotherapy (HIPEC) has been recently advocated as the standard of care for pseudomyxoma peritonei (PMP). We reviewed our 10-year monoinstitutional case series to identify selection factors predicting postoperative outcome...

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Bibliographic Details
Published in:Annals of surgical oncology 2008-02, Vol.15 (2), p.526-534
Main Authors: Baratti, Dario, Kusamura, Shigeki, Nonaka, Daisuke, Langer, Martin, Andreola, Salvatore, Favaro, Miriam, Gavazzi, Cecilia, Laterza, Barbara, Deraco, Marcello
Format: Article
Language:English
Subjects:
Adenocarcinoma, Mucinous - drug therapy
Adenocarcinoma, Mucinous - surgery
Adult
Aged
Antibiotics, Antineoplastic - administration & dosage
Appendiceal Neoplasms - drug therapy
Appendiceal Neoplasms - surgery
Biomarkers, Tumor - blood
Chemotherapy, Cancer, Regional Perfusion - methods
Cisplatin - administration & dosage
Combined Modality Therapy
Female
Gastrointestinal Oncology
Humans
Hyperthermia, Induced
Injections, Intraperitoneal
Male
Medicine
Medicine & Public Health
Middle Aged
Mitomycin - administration & dosage
Multivariate Analysis
Omentum - surgery
Oncology
Peritoneal Neoplasms - drug therapy
Peritoneal Neoplasms - mortality
Peritoneal Neoplasms - pathology
Peritoneal Neoplasms - surgery
Peritoneum - surgery
Prognosis
Pseudomyxoma Peritonei - drug therapy
Pseudomyxoma Peritonei - mortality
Pseudomyxoma Peritonei - pathology
Pseudomyxoma Peritonei - surgery
Surgery
Surgical Oncology
Survival Analysis
Treatment Outcome
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Summary:Background Surgical cytoreduction combined with hyperthermic intraperitoneal chemotherapy (HIPEC) has been recently advocated as the standard of care for pseudomyxoma peritonei (PMP). We reviewed our 10-year monoinstitutional case series to identify selection factors predicting postoperative outcome. Methods One hundred and four patients with PMP were operated on with the aim of performing adequate cytoreduction (residual tumor nodules ≤2.5 mm) and closed-abdomen HIPEC with mytomicin-C and cisplatin. Previously, 26 patients had systemic chemotherapy. PMP was histologically classified into disseminated peritoneal adenomucinosis (DPAM), peritoneal mucinous carcinomatosis (PMCA), and intermediate/discordant group (ID). Immunohistochemical stains were performed for cytokeratin (CK)-7, CK-20, CDX-2, MUC-2, MUC-5AC, CD-44s. The significance of 22 potential clinical, pathological, and biological prognostic variables was assessed by multivariate analysis. Results Adequate cytoreduction was performed in 89 patients, suboptimal cytoreduction in six, palliative surgery in nine. Operative mortality was 1%. Seventy-eight patients were diagnosed with DPAM, 26 with PMCA, and none with ID. Median follow-up was 37 months (range, 1–110) for the overall series. Five-year overall survival (OS) and progression-free survival (PFS) were 78.3% and 31.1%, respectively. At multivariate analysis, adequate cytoreduction, no previous systemic chemotherapy, and DPAM correlated to better OS and PFS, elevated serum CA19.9 correlated only to better PFS. In most cases, CK20, CDX-2, and MUC-2 were diffusely positive, while CK-7, MUC-5AC, and CD44s were variably expressed. CK20 expression correlated to prognosis at univariate analysis. Conclusions Favorable outcome after comprehensive treatment can be expected in patients with DPAM, not treated with preoperative systemic chemotherapy and amenable to adequate cytoreduction. MUC-2, CK-20, and CD44s expression may be related to PMP unique biologic behavior.
ISSN:1068-9265
1534-4681
DOI:10.1245/s10434-007-9691-2