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Histologic Predictors of Recurrence in Mucinous Appendiceal Tumors with Peritoneal Dissemination after HIPEC

Meera Reghunathan1, Kaitlyn J Kelly1, Mark A Valasek2

  • 1Department of Surgery, Moores Cancer Center, University of California, San Diego, 3855 Health Sciences Dr. #0987, La Jolla, CA, 92093-0987, USA.

Annals of Surgical Oncology
|December 29, 2017
PubMed
Abstract

Insights

Standardized peritoneal histology in mucinous appendiceal tumors (MAT) treated with CRS/HIPEC predicts progression-free survival (PFS). Low-grade peritoneal disease (LGMCP) shows better PFS than high-grade (HGMCP), with CEA and CC score further discriminating outcomes.

Area of Science:

  • Oncology
  • Surgical Oncology
  • Gastroenterology

Background:

  • Mucinous appendiceal tumors (MAT) are rare neoplasms with metastatic potential to the peritoneum.
  • Treatment often involves cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC).
  • Standardized pathologic criteria are emerging for classification and outcome prediction.

Purpose of the Study:

  • To evaluate patient outcomes after CRS/HIPEC for MAT with peritoneal metastases (PM).
  • To utilize standardized pathologic criteria for classifying primary tumors and peritoneal metastases.
  • To identify predictors of progression-free survival (PFS).

Main Methods:

  • Retrospective review of 183 patients undergoing 197 CRS/HIPECs for MAT with PM (2007-2015).
  • Histologic classification based on WHO and consensus definitions: primary tumors (LAMN, LGAC, HGAC) and peritoneal metastases (acellular mucin, LGMCP, HGMCP).
  • Cox proportional hazards model for univariate and multivariate analysis of PFS predictors.

Main Results:

  • Peritoneal histology significantly predicted PFS: acellular mucin (not reached), LGMCP (34.3 months), HGMCP (16.8 months) (p < 0.001).
  • Multivariate analysis confirmed peritoneal histology as a predictor (HR 9.82 for LGMCP, 24.60 for HGMCP vs. AM).
  • In the LGMCP group, CEA levels and completeness of cytoreduction (CC score) were significant PFS predictors.

Conclusions:

  • Standardized peritoneal histology is a crucial predictor of PFS in patients with PM from MAT undergoing CRS/HIPEC.
  • Patients with low-grade mucinous carcinoma peritonei (LGMCP) exhibit better PFS compared to high-grade (HGMCP).
  • For LGMCP patients, serum CEA levels and completeness of cytoreduction (CC score) further refine PFS prediction.

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