Advanced primary peritoneal carcinoma: clinicopathological and prognostic factor analyses

Abstract

Abstract:Objective: To investigate the factors favoring a positive prognosis for advanced primary peritoneal carcinoma (PPC). Methods: Twenty-four cases meeting the criteria for PPC were analyzed retrospectively for the clinicopathologic profiles. Immunohistochemistry was used to determine the expressions of p53, Top2α, Ki-67 and Her-2/neu. Then all these clinicopathological factors and molecular markers were correlated with the prognosis. Results: There were 15 cases of primary peritoneal serous papillary carcinoma (PPSPC), 6 cases of mixed epithelial carcinoma (MEC) and 3 cases of malignant mixed Mullerian tumor (MMMT). All patients underwent cytoreductive surgery with optimal debulking achieved in 3 cases. Among those receiving first-line chemotherapy, 13 patients received the TP regimen (paclitaxel-cisplatin or carboplatin) and 7 patients received the PAC regimen (cisplatin-doxorubicin-cyclophosphamide). The median overall survival of all patients was 42 months, while the breakdown for survival time for patients with PPSPC, MMT and MEC was 44, 13 and 19 months, respectively. The expressions of p53, Top2α and Ki-67 were all demonstrated in 11 cases respectively. None showed the expression of Her-2/neu. There were significant differences in the median survival between patients with PPSPC and those with MMMT (44 months vs 13 months, P<0.05), also between patients receiving TP combination and those receiving the PAC regimen (75 months vs 28 months, P<0.05).Another significant difference in the median progression-free survival (PFS) was identified between patients with positive p53 immunostaining and those with negative p53 immunostaining (15 months vs 47 months, P<0.05), whereas age, menopausal status, residual tumor size and the other molecular factors did not significantly impact survival. Conclusion: Patients with PPC should be treated with a comprehensive management plan including appropriate cytoreductive surgery and responsive chemotherapy. Overestimating an optimal debulking surgery may not benefit survival. The pathologic subtype, chemotherapy regimen and p53 overexpression were significant prognostic factors.

Treatment and Prognostic Factors in Primary Peritoneal Carcinoma: A Multicenter Study of the Anatolian Society of Medical Oncology (ASMO)

“…PPC is generally observed in advanced-age and post-menopausal women. Although affected patients in different age groups have been reported, the typical age of patients with PPC ranges from 57 to 66 years, with 75-88.7% of patients reported to be postmenopausal women [3,11,12]. Our patient group demonstrates similarities with other studies with regard to the mean age of the patients (63 years) and their menopausal status (91.0% postmenopausal).…”

“…In 3 separate evaluations of patients who had been treated with platinum and alkylating agents before taxane therapy, median survival times were 24, 19 and 15 months, respectively [13,14,15]. In contrast, studies on prognosis after taxane therapy reported longer survival times, and the median survival times were 33, 41 and 42 months, respectively in 3 separate studies [3,11,12]. All patients included in our retrospective analysis received taxane therapy which conceivably had an impact on our patients' longer median survival time (31 months).…”

“…The most important clinical sign of PPC is widespread tumor invasion on the peritoneal surface with intact ovaries or minimal ovarian involvement. PPC has been classified into 3 histological types: primary peritoneal serous carcinoma (PPSC), mixed epithelial carcinoma (MEC), and malignant mullerian tumor (MMT) [3]. Among them, PPSC demonstrates histological and molecular similarities with serous ovarian carcinoma [4,5].…”

Primary Peritoneal Cancer

“…Fakat primer peritoneal kanserlerin gerek overleri hiç tutmaması veya minimal tutması gerekse de hastalığın davranış şekli-nin özellikle üst batını da tutacak şekilde difüz mikronodüler yayılması nedeni ile sitoredüktif cerrahinin over kanserli hastalarda olduğu gibi yeterli olamayabileceği vurgulanmaktadır. [35][36][37] Fakat diğer kapsamlı çalışmalarda, primer peritoneal kanserlerde de yeterince "debulking" yapılabildiği ve optimal "debulking" yapmanın hasta sağkalımına belirgin avantajlar sağladığı belirtilmektedir. [38][39][40] Bu hastalarda optimal "debulking" %70'in üzerinde olup, over kanserleriyle benzerlik göstermektedir.…”

The lack of clinical value of peritoneal washing cytology in high risk patients undergoing risk-reducing salpingo-oophorectomy: a retrospective study and review

“…Conversely, a positive test result in women who have (subclinical) PPC, PWC may lead to earlier diagnosis and possibly improve the prognosis. Studies on PPC have shown that the median survival is 23.5 (95 % CI, 18.6–39.8) [ 14 ] to 42 (95 % CI 22–62) months [ 15 ], but the advantage in survival for early diagnosis of PPC is not known.…”