Objectives To establish a survival prognostic model for pseudomyxoma peritonei (PMP) treated with cytoreductive surgery (CRS) plus hyperthermic intraperitoneal chemotherapy (HIPEC) based on Bayesian network (BN). Methods 453 PMP patients were included from the database at our center. The dataset was divided into a training set to establish BN model and a testing set to perform internal validation at a ratio of 8:2. From the training set, univariate and multivariate analyses were performed to identify independent prognostic factors for BN model construction. The confusion matrix, receiver operating characteristic (ROC) curve and the area under curve (AUC) were used to evaluate the performance of the BN model. Results The univariate and multivariate analyses identified 7 independent prognostic factors: gender, previous operation history, histological grading, lymphatic metastasis, peritoneal cancer index, completeness of cytoreduction and splenectomy (all p < 0.05). Based on independent factors, the BN model of training set was established. After internal validation, the accuracy and AUC of the BN model were 70.3% and 73.5%, respectively. Conclusion The BN model provides a reasonable level of predictive performance for PMP patients undergoing CRS + HIPEC.
Objective To analyze the diagnosis and treatment status, natural course, and related factors of patients with pseudomyxoma peritonei based on Chinese real-world data. Methods Retrospective analysis was conducted on real world data of PMP patients with a complete natural history at the our center from February 2009 to July 2020, including clinicopathological characteristics, non-standardized treatment (time of misdiagnosis, time of mistreatment, previous anti-tumor treatment), CRS + HIPEC treatment (operation time, intraoperative blood transfusion, PCI score, CC score, number of organ removed, number of peritoneal resection areas, serious adverse events (SAE)), and the end point of follow-up was death due to disease-specific death. The natural course and the postoperative course of disease and related factors were analyzed. Results a total of 142 patients were included, 83 (58.5%) males and 59 (41.5%) females, the median age was 55 (24~79) years old, the median time of misdiagnosis was 0.8 (0~62.5) months, and the median time of mistreatment was 15.6 (0~411.1) months. The median time of misdiagnosis and mistreatment after 2016 was shorter than that before. All patients were treated with CRS + HIPEC. The median operation time was 10 (3.33~16.5) h, and the median PCI score was 33 (3~39). The median overall survival of the natural course was 30.3 (2.4~416.7) months, and the 1 -, 2 -, 3-and 5-year survival rates were 90.1%, 62.7%, 43.7% and 19.7%, respectively. Multivariate analysis showed that there were three independent prognostic factors affecting the natural course: PSS 1–3 (HR = 0.472, 95%CI:0.324 ~ 0.688, P = 0.000), lymph node metastasis (HR = 2.219, 95%CI:1.226 ~ 4.014, P = 0.008), and number of CRS + HIPEC operations (HR = 0.523, 95%CI:0.353 ~ 0.777, P = 0.001). Median postoperative survival was 11.93 (0.03~79.70) months, and the 1 -, 2 -, 3-and 5-year postoperative survival rates were 49.3%, 19.7%, 10.6% and 1.4%, respectively. Multivariate analysis showed that there were five independent prognostic factors affecting the postoperative course: previous targeted therapy (HR = 1.628, 95%CI:1.017 ~ 2.607, P = 0.042), occurrence of serious adverse events (SAE) (HR = 1.562, 95%CI:1.053 ~ 2.317, P = 0.026), preoperative CEA level > 39.29 ng/mL (HR = 0.667, 95%CI:0.462 ~ 0.963, P = 0.031), postoperative adjuvant therapy (HR = 0.418, 95%CI:0.284 ~ 0.614, P = 0.000). Postoperative SAE occurred in 44 cases (31%), and 4 cases (2.8%) died within 30 days after operation. Preoperative thrombosis and previous intravenous chemotherapy are independent influencing factors of SAE. Conclusion The diagnosis and treatment of PMP in China has a trend of improvement year by year, and CRS + HIPEC is still the standard treatment for PMP. Early diagnosis and the popularization and application of CRS + HIPEC procedures still need to be strengthened. How to reduce postoperative complications is still a problem that we need to solve.
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