Outcomes Following Cytoreduction and HIPEC for Pseudomyxoma Peritonei: 10-Year Experience

Narasimhan, Vignesh; Wilson, Kasmira; Britto, Maneka; Warrier, Satish; Lynch, A. C.; Michael, Michael; Tie, Jeanne; Akhurst, Tim; Mitchell, Catherine; Ramsay, Robert G.; Heriot, Alexander G.

doi:10.1007/s11605-019-04239-4

Cited by 28 publications

(34 citation statements)

References 42 publications

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“…[ 30 ] In addition, tumor differentiation degree is an important prognostic factor in cancer patients. [ 9 , 16 , 31 , 32 ] Our result also indicated that poor differentiation has a poor prognosis.…”

Section: Discussionsupporting

confidence: 59%

Development and validation of prognostic nomograms for pseudomyxoma peritonei patients after surgery

Chen¹,

Su²,

Yang³

et al. 2020

Medicine

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Background: The aim of study was to develop and validate nomograms for predicting overall survival (OS) and cancer-specific survival (CSS) of patients with pseudomyxoma peritonei (PMP) and compare the predictive accuracy with the American Joint Committee on Cancer (AJCC) staging system. Methods: Data of 4959 PMP patients who underwent surgical resection were collected between 2004 and 2015 from the Surveillance Epidemiology and End Results (SEER) database. All included patients were divided into training (n = 3307) and validation (n = 1652) cohorts. The Kaplan–Meier method and Cox proportional hazard model were applied. Nomograms were validated by discrimination and calibration. Finally, concordance index (C-index) was used to compare the predictive performance of nomograms with that of the AJCC staging system. Results: According to the univariate and multivariate analyses of training sets, both nomograms for predicting OS and CSS combining age, grade, location, N stage, M stage, and chemotherapy were identified. Nomograms predicting OS also incorporated T stage and the number of lymph nodes removed (LNR). The calibration curves showed good consistency between predicted and actual observed survival. Moreover, C-index values demonstrated that the nomograms predicting both OS and CSS were superior to the AJCC staging system in both cohorts. Conclusion: We successfully developed and validated prognostic nomograms for predicting OS and CSS in PMP patients. Two nomograms were more accurate and applicable than the AJCC staging system for predicting patient survival, which may help clinicians stratify patients into different risk groups, tailor individualized treatment, and accurately predict patient survival in PMP.

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Section: Discussionsupporting

confidence: 59%

Development and validation of prognostic nomograms for pseudomyxoma peritonei patients after surgery

Chen¹,

Su²,

Yang³

et al. 2020

Medicine

View full text Add to dashboard Cite

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“…( 2 ). In the present study, high-grade pathology and not undergoing HIPEC were also identified as independent predictors of poorer survival rates according to the multivariate analysis, which was consistent with previous reports ( 27 ). A simple-to-use nomogram that included these independent factors was developed using our study data, which might be a useful visualization tool for predicting 1-, 2-, and 3-year survival probabilities for PMP in clinical practice.…”

Section: Discussionsupporting

confidence: 92%

Ultrasound for Preoperatively Predicting Pathology Grade, Complete Cytoreduction Possibility, and Survival Outcomes of Pseudomyxoma Peritonei

et al. 2021

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ObjectivesThis study aimed to investigate the value of using ultrasound (US) preoperatively for predicting pathological classification, complete cytoreduction possibility, and survival rate of patients with pseudomyxoma peritonei (PMP).MethodsWe retrospectively studied PMP patients who were scheduled for cytoreductive surgery between May 2009 and October 2019. US examination was performed before surgery. Factors related to high-grade pathology and poor completeness of cytoreduction (CC) score were identified. Associations between ultrasound characteristics and the survival status were also examined to identify independent predictive factors.ResultsPMP patients with clear ascites, abdominal lymph nodes, omental cake, abdominal mass, portal infiltration, and mesenteric involvement visible on US were considered to have high-grade pathology. Various US features were shown to be independent prognostic markers for inadequate cytoreduction in PMP patients. Portal infiltration and mesenteric involvement were significant prognostic factors for lower survival rates (hazard ratio = 3.092, 3.932, respectively). A visual nomogram including these factors was constructed to predict survival rates. The consistency index was 0.777, which reflected relatively high accuracy.ConclusionsPreoperative US has the potential to predict pathological grade and resectability of PMP. Portal infiltration and mesenteric involvement were independent predictors of poor clinical outcomes in PMP patients. Furthermore, a simple-to-use nomogram derived from our study data may be a helpful visual tool in clinical practice to predict 1-, 2-, and 3-year survival rates for PMP patients.

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“…Concerning safety, the grade III-IV complication rate of the present cohort was 10%, with 2% of postoperative deaths. In a recent series by Narasimhan et al (15) on 140 PMP patients treated with CRS and HIPEC, the grade III-IV complications incidence was 20.6%, without postoperative mortality, while the above-mentioned paper of Chua et al (5) reported major postoperative complications in 24% of patients and 2% treatment-related mortality. Among preoperative and procedure-related variables, none was significantly associated with major postoperative complications (Table 7), so we cannot draw any conclusions on their morbidity predictive value.…”

Section: Discussionmentioning

confidence: 94%

Cytoreduction and Hyperthermic Intraperitoneal Chemotherapy for Pseudomyxoma Peritonei of Appendiceal Origin: A Single Center Experience

et al. 2021

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Background: Pseudomyxoma peritonei (PMP) originating from appendiceal mucinous neoplasm is a rare peritoneal malignancy characterized by the progressive intraperitoneal accumulation of mucus leading to death if left untreated. In recent years, cytoreductive surgery (CRS) combined with hyperthermic intraperitoneal chemotherapy (HIPEC) offered increased survival rates. This study aims to identify the clinical, pathological, and surgical features influencing safety and survival outcomes of patients undergoing CRS and HIPEC for PMP of appendiceal origin.Methods: A retrospective analysis of all patients undergoing CRS and HIPEC for PMP of appendiceal origin from January 2015 to May 2019 was conducted at our institution.Results: Study population included 50 patients (74% female, 26% male). The median age at CRS was 60 (38–84). The median peritoneal cancer index (PCI) was 17. Complete cytoreductive surgery (CC 0–1) was achieved in 47 patients (94%). HIPEC chemotherapeutic regimen was based on oxaliplatin for 13 (28%) patients and mitomycin for 34 (72%) patients. We experienced a total of 19 (38%) postoperative complications, of which 14 (74%) of grade I-II and 5 (26%) of grade III-IV, according to the Clavien-Dindo classification. The median follow-up period was 27 months (12–107) from the date of cytoreductive surgery. The mean survival rate was 100 months, with a 5-year OS of 91%. The mean progression-free survival rate was 77 months (0–107), with a 5-year PFS of 63%. Multivariate analysis identified adenocarcinoma histotype and incomplete cytoreduction to significantly worsen progression-free survival, while incomplete cytoreduction was the only independent predictor of poorer overall survival.Conclusion: Complete cytoreduction and appendiceal neoplasm histotype play a crucial role in the survival of patients affected by PMP of appendiceal origin. The rates of morbidity associated with CRS and HIPEC for PMP are acceptable.

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Outcomes Following Cytoreduction and HIPEC for Pseudomyxoma Peritonei: 10-Year Experience

Cited by 28 publications

References 42 publications

Development and validation of prognostic nomograms for pseudomyxoma peritonei patients after surgery

Development and validation of prognostic nomograms for pseudomyxoma peritonei patients after surgery

Ultrasound for Preoperatively Predicting Pathology Grade, Complete Cytoreduction Possibility, and Survival Outcomes of Pseudomyxoma Peritonei

Cytoreduction and Hyperthermic Intraperitoneal Chemotherapy for Pseudomyxoma Peritonei of Appendiceal Origin: A Single Center Experience

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