The Prognostic Impact of Pathology on Patients With Pseudomyxoma Peritonei Undergoing Debulking Surgery: A Systematic Review and Meta-Analysis of Retrospective Studies

Abstract

Background: Pseudomyxoma peritonei (PMP) is a rare clinical condition with fatal outcomes, which is characterized by the progressive accumulation of mucinous ascites and peritoneal implants. Some studies have reported the effect of PMP biology on patient outcome. The objective of this study was to analyze published articles focusing on the impact of pathology on the prognosis of PMP patients undergoing debulking. Methods: Data from all studies regarding the prognosis of patients, with different pathologies, who underwent debulking surgery were analyzed. We searched PubMed, the Wiley Online Library, Ovid, and the Cochrane Library (through January 2020). Studies were confined to those articles written in English. Five studies were identified, and the differences in 5-year survival rates were analyzed according to the Kaplan–Meier survival curves. The hazard ratios (HRs) of the 5-year survival rates were calculated. Results: The mean and median 5-year survival rates of all patients were 39 and 40%, respectively. The median overall survival was 49.3 months. The mean 5-year survival rates of low-grade PMP was 45.2%. The five studies had sufficient data to calculate HRs from the 5-year survival rates data, and three had HRs lower than 1. The total HRs was 0.54, with a 95% CI between 0.33 and 0.89 ( P = 0.01). Conclusions: Among PMP patients receiving debulking surgery who are not able to undergo complete cytoreductive surgery, low-grade biological PMP had a better prognosis than high-grade PMP.

Tumor-stroma Ratio as a New Prognosticator for Pseudomyxoma Peritonei: a Comprehensive Clinicopathological and Immunohistochemical Study

“…The results are easily affected by the experience level of pathologists, the complexity of images and the visual search process, which leads to inaccurate pathological diagnosis. It showed that pathological type is an independent prognostic factor in PMP patients [10]. However, Mhhamed et al [11] found that although most DPAM patients had a relatively better prognosis, some DPAM patients showed highly aggressive disease progression, with a 5-year survival rate much lower than those patients with worse tumor differentiation.…”

“…Multiple studies have shown that histopathological type is an independent prognostic factor in PMP patients. Zhou et al [10] searched studies of PMP patients underwent debulking surgery from PubMed, Wiley Online Library and Cochrane Library before Jan. 2020. 766 patients were included for Meta-analysis of pathological indicators and survival, and it showed that the 5-year survival rate of PMP patients with different pathological types after surgery was signi cantly different, and the low-grade biological behavior of PMP had a better survival comparing with high-grade PMP.…”

Tumor-stroma ratio as a new prognosticator for pseudomyxoma peritonei: a comprehensive clinicopathological and immunohistochemical study

“…The results are easily affected by the experience level of pathologists, the complexity of images and the visual search process, which leads to inaccurate pathological diagnosis. This showed that pathological type is an independent prognostic factor in PMP patients [ 12 ]. However, Mhhamed et al [ 13 ] found that although most LG-PMP patients had a relatively better prognosis, some LG-PMP patients showed highly aggressive disease progression, with a 5-year survival rate much lower than those of patients with worse tumor differentiation.…”

“…Multiple studies have shown that histopathological type is an independent prognostic factor in PMP patients. Zhou et al [ 12 ] conducted a meta-analysis of 766 PMP patients who underwent debulking and showed that LG-PMP had better survival than HG-PMP. Yan et al [ 22 ] performed a clinicopathological and immunohistochemical analysis of 155 PMP patients undergoing CRS+HIPEC.…”

Comprehensive Understanding and Evolutional Therapeutic Schemes for Pseudomyxoma Peritonei

“… 41 Other voices argued that palliative resection has proved its superiority in safety and effectiveness under that circumstance. 42 Tumor in bulk brings about volume effect related adverse impact and patient’s condition deteriorates in fast pace, if not intervene. Postoperative complications, the complexity of surgical procedure and the perplexed scope of the operation all add difficulties to make the treatment decision.…”