Oncologic Risk Stratification Following Cytoreductive Surgery and Hyperthermic Intraperitoneal Chemotherapy for Appendiceal Carcinomatosis

被引:6
作者
Wagner, Patrick L. [1 ]
Austin, Frances [1 ]
Zenati, Mazen [1 ]
Jaech, Aaron [1 ]
Mavanur, Arun [1 ]
Ramalingam, Lekshmi [1 ]
Jones, Heather L. [1 ]
Holtzman, Matthew P. [1 ]
Ahrendt, Steven A. [1 ]
Zureikat, Amer H. [1 ]
Pingpank, James F. [1 ]
Zeh, Herbert J. [1 ]
Bartlett, David L. [1 ]
Choudry, Haroon A. [1 ]
机构
[1] Univ Pittsburgh, Med Ctr, Div Surg Oncol, Pittsburgh, PA USA
关键词
PERITONEAL SURFACE MALIGNANCIES; QUALITY-OF-LIFE; LONG-TERM SURVIVAL; PSEUDOMYXOMA PERITONEI; MORTALITY ANALYSIS; HEALTH OUTCOMES; CANCER-PATIENTS; LEARNING-CURVE; MORBIDITY; DISSEMINATION;
D O I
10.1245/s10434-015-5037-7
中图分类号
R73 [肿瘤学];
学科分类号
100214 ;
摘要
Patients with peritoneal carcinomatosis (PC) of appendiceal origin demonstrate variable oncologic outcomes, despite aggressive cytoreductive surgery and hyperthermic intraperitoneal chemotherapy (CRS-HIPEC). We sought to devise a prognostic risk stratification system for oncologic outcomes following CRS-HIPEC. A total of 197 patients undergoing CRS-HIPEC for the treatment of appendiceal PC were reviewed from a prospective database. Kaplan-Meier survival curves and multivariate Cox regression models were used to identify prognostic factors affecting oncologic outcomes. Clinicopathologic variables affecting overall survival (OS) were utilized to develop a prognostic staging system and nomograms. Univariate and multivariate Cox regression analysis indicated that high-grade tumor histology, lymph node metastasis, and incomplete cytoreduction were high-risk features, adversely affecting OS. Patients were stratified on the presence of high-risk features as follows: low-risk patients had no risk factors (n = 102); intermediate-risk patients had one risk factor (n = 49); and high-risk patients had more than one risk factor (n = 46). Median OS for low-risk patients was not reached, and was 43 and 22 months for intermediate-risk and high-risk patients, respectively. Five-year OS was 72, 43, and 13 % for low-, intermediate- and high-risk patients, respectively (p < 0.0003 for low vs. intermediate risk, and p = 0.06 for intermediate vs. high risk). We propose a three-tier staging system for appendiceal PC following CRS-HIPEC, based on histologic grade, lymph node involvement, and completeness of cytoreduction. The presence of any one or more of these high-risk features significantly decreased survival in our single-institution database and provided the basis for a prognostic staging system and corresponding nomograms.
引用
收藏
页码:1587 / 1593
页数:7
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