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Predictive and Prognostic Survival Factors in Peritoneal Carcinomatosis from Appendiceal Cancer After Cytoreductive Surgery with Hyperthermic Intraperitoneal Chemotherapy

  • Gastrointestinal Oncology
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Background

Cytoreductive surgery (CRS) with hyperthermic intraperitoneal chemotherapy (HIPEC) has survival benefit in the treatment of selected patients with peritoneal carcinomatosis (PC) from appendiceal cancer (AC). We evaluated factors affecting the survival of patients with PC from AC after CRS/HIPEC.

Methods

A retrospective analysis of 387 CRS/HIPEC procedures performed between February 1998 and February 2013 identified 202 patients with PC from AC. Tumor histopathology, complete cytoreduction (CC 0–1), Peritoneal Cancer Index (PCI), and lymph node (LN) status were related to overall survival (OS) and progression-free survival (PFS) using the Kaplan–Meier method.

Results

Overall, 129 women (64 %) and 73 men (36 %), mean age 54 years (range 25–81), with a mean follow-up of 36 months were included in the study. Seventy-seven low-grade tumors (disseminated peritoneal adenomucinosis [DPAM]; 38 %) and 125 high-grade tumors (peritoneal mucinous carcinomatosis [PMCA]; 62 %) were identified. Five- and 10-year OS was 56 % and 47 %, respectively, with PFS of 44 % at 5 and 10 years. Five-year OS in DPAM patients was 83 %, with a 5-year OS significant difference related to CC 0–1 versus CC 2–3 (incomplete cytoreduction) [p = 0.021]. Five-year OS in PMCA patients was 41 %, with a 5-year OS significant difference related to CC 0–1 versus CC 2–3 (p < 0.001), PCI <20 versus PCI ≥20 (p = 0.002), and (–)LN versus (+)LN (p < 0.001). Grade III/IV complications were 16 %. No perioperative mortality was reported.

Conclusion

Positive LN, PMCA histopathology, and PCI ≥20 are negative prognostic factors, while CC 0–1 is a positive survival predictor in PC from AC treated with CRS/HIPEC. However, in patients with PMCA and PCI ≥20 in whom CC 0–1 was a potential outcome should not be denied CRS/HIPEC.

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Aknowledgment

The authors will like to thank Ryan MacDonald, PhD, For providing the statistics and for data analysis, and Roy Hatch for literature and data gathering.

Disclosure

William Jimenez, Armando Sardi, Carol Nieroda, Michelle Sittig, Vladimir Milovanov, Maria Nunez, Nail Aydin, and Vadim Gushchin declare there are no financial or commercial interests in this study.

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Authors and Affiliations

  1. Institute for Cancer Care, Mercy Medical Center, Baltimore, MD, USA

    William Jimenez MD, Armando Sardi MD, FACS, Carol Nieroda MD, Michelle Sittig RN, Vladimir Milovanov MD, Maria Nunez MD, Nail Aydin MD & Vadim Gushchin MD, FACS

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  1. William Jimenez MD
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  2. Armando Sardi MD, FACS
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Correspondence to Armando Sardi MD, FACS.

Electronic supplementary material

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10434_2014_3869_MOESM1_ESM.tif

Supplemental figure 1: Overall Survival (OS) and Progression Free Survival (PFS) of Patients Undergoing CRS/HIPEC for PC from appendix cancer. Fig S-1-a: OS of the entire population. Fig S-1-b: PFS of entire population. Fig S-1-c: OS related to PC index (PCI) score. Fig S-1-d: OS related to completeness of cytoreduction (CC) score. PMCA: peritoneal mucinous adenocarcinoma; DPAM: disseminated peritoneal adenomucinous; LT: lower than; GT: greater than. N/A: not available due to right censoring. *30 patients were never considered at risk (CC 2-3), 2 patients with unknown recurrence date and were excluded from the analysis. † 6 PCI scores unavailable. ‡ 2 CC scores unavailable. Supplementary material 1 (TIFF 163 kb)

10434_2014_3869_MOESM2_ESM.tif

Supplemental Figure 2: Surgical findings comparison between DPAM and PMCA histopathologies. Fig S-2-a-i: Shows DPAM patient’s overall survival (OS) related to PCI. Fig S-2-a-ii: OS of DPAM patients related to CC score. Fig S-2- b-i: Shows PMCA patient’s OS related to PC index (PCI). Fig S-2-b-ii: OS of PMCA patients related to completeness of cytoreduction (CC) score. Figure S-2-b-iii: OS of PMCA patients related to lymph nodes (LN) status. LT: lower than; GT: greater than. *1 PCI score unavailable. ‡5 PCI scores unavailable. §2 CC scores unavailable. †10 LN status unavailable. Supplementary material 2 (TIFF 150 kb)

10434_2014_3869_MOESM3_ESM.tif

Supplemental Figure 3: Surgical Complications. Distribution of the 38 grade III/IV surgical complications in the 32 (15.8%) patients experiencing them (4 patients had 2, and 1 had 3 complications simultaneously). IR: interventional radiology; ARDS: acute respiratory distress syndrome. Supplementary material 3 (TIFF 246 kb)

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Jimenez, W., Sardi, A., Nieroda, C. et al. Predictive and Prognostic Survival Factors in Peritoneal Carcinomatosis from Appendiceal Cancer After Cytoreductive Surgery with Hyperthermic Intraperitoneal Chemotherapy. Ann Surg Oncol 21, 4218–4225 (2014). https://doi.org/10.1245/s10434-014-3869-1

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