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
Sugarbaker, Paul H
Yan, Tristan D
text
xx
2012
monographic
en
CONCLUSION: 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.
PATIENTS AND METHODS: A retrospective multi-institutional registry was established through collaborative efforts of participating units affiliated with the Peritoneal Surface Oncology Group International.
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.
RESULTS: 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.
Available online from MWHC library: 1999 - present, Available in print through MWHC library: 1999 - 2008
English
*Antineoplastic Combined Chemotherapy Protocols/tu [Therapeutic Use]
*Appendiceal Neoplasms/pa [Pathology]
*Hyperthermia, Induced/mt [Methods]
*Peritoneal Neoplasms/sc [Secondary]
*Peritoneal Neoplasms/th [Therapy]
*Pseudomyxoma Peritonei/dt [Drug Therapy]
*Pseudomyxoma Peritonei/su [Surgery]
Adolescent
Adult
Aged
Aged, 80 and over
Combined Modality Therapy
Disease-Free Survival
Female
Humans
Injections, Intraperitoneal
Male
Middle Aged
Peritoneal Neoplasms/dt [Drug Therapy]
Peritoneal Neoplasms/mo [Mortality]
Peritoneal Neoplasms/su [Surgery]
Pseudomyxoma Peritonei/mo [Mortality]
Survival Rate
Young Adult
MedStar Washington Hospital Center
Washington Cancer Institute
Surgery/General Surgery
0732-183X
http://dx.doi.org/10.1200/JCO.2011.39.7166
http://dx.doi.org/10.1200/JCO.2011.39.7166
Ovid MEDLINE(R)
130917