Cytoreductive Surgery and Hyperthermic Intraperitoneal Chemotherapy for Moderately and Poorly Differentiated Appendiceal Adenocarcinoma: Survival Outcomes and Patient Selection

Grotz, Travis E.; Overman, Michael J.; Eng, Cathy; Raghav, Kanwal; Royal, Richard E.; Mansfield, Paul F.; Mann, Gary N.; Robinson, Kristin; Beaty, Karen A.; Rafeeq, Safia; Matamoros, Aurelio; Taggart, Melissa W.; Fournier, Keith F.

doi:10.1245/s10434-017-5938-8

Cited by 35 publications

(31 citation statements)

References 30 publications

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“…The major challenge in GIM‐PM is identifying which GIM‐PM subsets benefit from CRS‐HIPEC and systemic therapy versus those which are refractory. Established predictors of outcomes following CRS include: tumor burden measured by peritoneal cancer index (PCI), optimal cytoreduction, responsiveness to chemotherapy, and absence of signet ring cell histology 4,12 . Unfortunately, these predictors are determined intra‐ or postoperatively, and reliable preoperative selection tools have not been established in peritoneal disease.…”

Section: Introductionmentioning

confidence: 99%

Investigating the utility of extended mutation analysis in gastrointestinal peritoneal metastasis

Foster

Patel

Zhang

et al. 2020

Journal of Surgical Oncology

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Background and Objectives: Outcomes for gastrointestinal peritoneal metastases (GI-PM) are worse compared to systemic metastases, with a paucity of data exploring extended mutation profiling. An exploratory mutation analysis in GI-PMs was performed as a "proof of concept" of potential predictive values of profiling in GI-PM and rates of actionable mutations. Methods: The study included 40 GI-PM patients: 14 low-grade mucinous carcinoma peritonei and 26 HG-PM (12 colons, 10 appendix, 4 small bowels). Demographics, histologies, peritoneal cancer indexes, cytoreduction scores, and survival data were collected. NGS 50-gene mutation profiling was performed on 38 specimens. The association of mutations with survival was evaluated in high-grade PM. Results: KRAS, TP53, and SMAD4 mutations were observed in 61%, 29%, and 8% of cases across all tumor histologies. In 66% cases >1 mutations occurred, associated with decreased survival in HG-PM: 32 vs 73 months, P = .03. TP53 or SMAD4 mutations were associated with decreased survival in HG-PM: 22 vs 48 months, P = .02. Actionable mutations were detected in 70%. Conclusion: Actionable mutations were detected at high rates. GI-PMs have similar mutational profiles and TP53, SMAD4, and/or >1 mutation were associate with decreased survival in HG-PM. This data supports the concept of the extended mutation profiling utility in GI-PM warranting further investigation.

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Section: Introductionmentioning

confidence: 99%

Investigating the utility of extended mutation analysis in gastrointestinal peritoneal metastasis

Foster

Patel

Zhang

et al. 2020

Journal of Surgical Oncology

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“… 30 – 32 While treatment with CRS/HIPEC clearly improves long-term survival, patient prognosis remains worse than for those with other histological subtype tumors. 33 , 34 Hence, PM with SRC remains a challenging condition clinically.…”

Section: Discussionmentioning

confidence: 99%

<p>Factors Prognostic for Peritoneal Metastases from Colorectal Cancer Treated with Surgery</p>

Chen

Wang

Zhao

et al. 2020

CMAR

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Purpose To analysis factors prognostic for peritoneal metastases (PM) from colorectal cancer (CRC) treated with surgery using data from two sources and investigate the origin and effective treatment of ovarian metastases (OM). Patients and Methods Data from CRC patients with PM who had undergone surgery were collected from the Surveillance, Epidemiology, and End Results (SEER) database (n = 639) and a single Chinese institution (n = 60). Cumulative survival was evaluated by Kaplan–Meier analysis. Factors associated with overall survival (OS) and progression-free survival (PFS) prognosis were assessed using Cox’s proportional hazard regression models. Results Median OS values for patients who underwent surgery were 19 and 32 months in the SEER database and Chinese center, respectively. Age was an independent predictor of OS in both datasets. Signet-ring cell cancer and perineural invasion were independent predictors of inferior OS only in the SEER dataset, while completeness of cytoreduction (CC) and peritoneal carcinomatosis index were independent predictors for OS and PFS only in the Chinese center. Median OS was 24 months in CRC patients with PM alone and 36 months in those with both PM and OM (p = 0.181). Further, median PSF in patients with PM alone was 10 months, while that in individuals with both PM and OM was 20 months (p = 0.181). Conclusion Surgical treatment of the primary and metastatic sites is effective and safe for CRC patients with PM. CC-0 is recommended for improved prognosis. Moreover, OM should be recognized as a feature of PM, and cytoreductive surgery combined with hyperthermic intraperitoneal chemotherapy is beneficial for CRC patients with OM.

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“…PCI has been one of the most consistent independent predictors of morbidity and mortality from CRS-HIPEC. 2,[5][6][7][8][9] There has, however, been no consensus on a PCI cut off in CPM that predicts poorer post-operative outcomes, with studies thus far reporting a wide range (6)(7)(8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18)(19)(20) that are significantly predictive of DFS and OS. 6,8,[10][11][12] Results from our study suggest that for patients with PC from colorectal primaries, a lower cut-off value of 7-11 is a satisfactorily significant predictor of postoperative OS.…”

Section: Discussionmentioning

confidence: 99%

“…PCI was a significant independent predictor of 3‐ and 5‐year OS and DFS in our study. PCI has been one of the most consistent independent predictors of morbidity and mortality from CRS‐HIPEC . There has, however, been no consensus on a PCI cut off in CPM that predicts poorer post‐operative outcomes, with studies thus far reporting a wide range (6–20) that are significantly predictive of DFS and OS .…”

Section: Discussionmentioning

confidence: 99%

Novel prognostic score for outcomes after cytoreductive surgery and hyperthermic intraperitoneal chemotherapy for colorectal cancer with metachronous peritoneal carcinomatosis

Chin

Tan

Chia

et al. 2020

ANZ Journal of Surgery

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Background: This study aimed to determine pre-and peri-operative parameters with significant predictive value for post-operative outcomes in patients with recurrent colorectal cancer presenting as peritoneal carcinomatosis undergoing cytoreductive surgery and hyperthermic intraperitoneal chemotherapy (CRS-HIPEC), and to develop a novel prognostic scoring system for prediction of survival outcomes. Methods: A single-institution review of prospectively collected data from all patients who underwent CRS-HIPEC between October 2005 and October 2017 was conducted. Univariate and multivariate analyses were used to identify significant parameters for prediction of post-CRS-HIPEC disease-free survival and overall survival (OS). Results: A total of 278 patients underwent CRS-HIPEC, of whom 72 were for peritoneal carcinomatosis from recurrent colorectal cancer. Disease-free interval (DFI; P = 0.006), peritoneal cancer index (PCI; P = 0.001) and left upper quadrant disease (P = 0.023) were significant independent predictors of 3-year OS. DFI (0.007), PCI (P < 0.001) and intraoperative blood loss (BL; P = 0.001) were significant independent predictors of 5-year OS. PCI and BL were significant independent predictors of both 3-year (P = 0.026, PCI; P = 0.009, BL) and 5-year (P = 0.002, PCI; P = 0.011, BL) disease-free survival. Predictive models were developed for risk stratification of OS. Conclusion: PCI, DFI, left upper quadrant disease and BL have significant predictive value for post-CRS-HIPEC outcomes. Risk stratification models allow for more prudent patient selection and ultimately more accurate prognostication of post-operative outcomes.

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Cytoreductive Surgery and Hyperthermic Intraperitoneal Chemotherapy for Moderately and Poorly Differentiated Appendiceal Adenocarcinoma: Survival Outcomes and Patient Selection

Abstract: In selected patients, long-term survival can be obtained. Mucinous histology, absence of signet ring cells, negative peritoneal cytology, PCI ≤ 20, and response/stable disease after neoadjuvant chemotherapy are important selection criteria for CRS and HIPEC.

Cited by 35 publications

References 30 publications

Investigating the utility of extended mutation analysis in gastrointestinal peritoneal metastasis

Investigating the utility of extended mutation analysis in gastrointestinal peritoneal metastasis

<p>Factors Prognostic for Peritoneal Metastases from Colorectal Cancer Treated with Surgery</p>

Novel prognostic score for outcomes after cytoreductive surgery and hyperthermic intraperitoneal chemotherapy for colorectal cancer with metachronous peritoneal carcinomatosis

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