Early- and Long-Term Outcome Data of Patients With Pseudomyxoma Peritonei From Appendiceal Origin Treated by a Strategy of Cytoreductive Surgery and Hyperthermic Intraperitoneal Chemotherapy
Terence C. Chua, Brendan J. Moran, Paul H. Sugarbaker, Edward A. Levine, Olivier Glehen, François N. Gilly, Dario Baratti, Marcello Deraco, Dominique Elias, Armando Sardi, Winston Liauw, Tristan D. Yan, Pedro Barrios, Alberto Gómez Portilla, Ignace H.J.T. de Hingh, Wim P. Ceelen, Joerg O. Pelz, Pompiliu Piso, Santiago González-Moreno, Kurt Van Der Speeten and David L. Morris
+ Author Affiliations
Terence C. Chua, Winston Liauw, and David L. Morris, University of New South Wales, St George Hospital, Sydney, Australia; Brendan J. Moran, Basingstoke and North Hampshire National Health Service Foundation Trust, Basingstoke, United Kingdom; Paul H. Sugarbaker and Tristan D. Yan, Washington Cancer Institute, Washington Hospital Center, Washington, DC; Edward A. Levine, Wake Forest University Baptist Medical Center, Winston-Salem, NC; Olivier Glehen and François N. Gilly, Centre Hospitalo-Universitaire Lyon Sud, Hospices Civils de Lyon, Pierre Bénite; Dominique Elias, Institut Gustave Roussy Cancer Center, Villejuif, France; Dario Baratti and Marcello Deraco, National Cancer Institute, Milan, Italy; Armando Sardi, Institute for Cancer Care, Mercy Medical Center, Baltimore, MD; Pedro Barrios, Hospital Sant Joan Despí Moises Broggi, Barcelona; Alberto Gómez Portilla, Hospital Santiago Apostol, Vitoria; Santiago González-Moreno, MD Anderson Cancer Center Madrid, Madrid, Spain; Ignace H.J.T. de Hingh, Catharina Hospital, Eindhoven, the Netherlands; Wim P. Ceelen, University Hospital, Ghent; Kurt Van Der Speeten, Ziekenhuis Oost-Limburg, Genk, Belgium; Joerg O. Pelz, University of Wuerzburg, Wuerzburg; and Pompiliu Piso, University Medical Center Regensburg, Regensburg, Germany.
Purpose Pseudomyxoma peritonei (PMP) originating from an appendiceal mucinous neoplasm remains a biologically heterogeneous disease. The purpose of our study was to evaluate outcome and long-term survival after cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) consolidated through an international registry study.
Patients and Methods A retrospective multi-institutional registry was established through collaborative efforts of participating units affiliated with the Peritoneal Surface Oncology Group International.
Two thousand two hundred ninety-eight patients from 16 specialized units underwent CRS for PMP. Treatment-related mortality was 2% and major operative complications occurred in 24% of patients. The median survival rate was 196 months (16.3 years) and the median progression-free survival rate was 98 months (8.2 years), with 10- and 15-year survival rates of 63% and 59%, respectively. Multivariate analysis identified prior chemotherapy treatment (P < .001), peritoneal mucinous carcinomatosis (PMCA) histopathologic subtype (P < .001), major postoperative complications (P = .008), high peritoneal cancer index (P = .013), debulking surgery (completeness of cytoreduction [CCR], 2 or 3; P < .001), and not using HIPEC (P = .030) as independent predictors for a poorer progression-free survival. Older age (P = .006), major postoperative complications (P < .001), debulking surgery (CCR 2 or 3; P < .001), prior chemotherapy treatment (P = .001), and PMCA histopathologic subtype (P < .001) were independent predictors of a poorer overall survival.
The combined modality strategy for PMP may be performed safely with acceptable morbidity and mortality in a specialized unit setting with 63% of patients surviving beyond 10 years. Minimizing nondefinitive operative and systemic chemotherapy treatments before definitive cytoreduction may facilitate the feasibility and improve the outcome of this therapy to achieve long-term survival. Optimal cytoreduction achieves the best outcomes.
Full article: http://jco.ascopubs.org/content/30/20/2449.abstract