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Peritoneal metastasis histological grade independently predicts outcome in pseudomyxoma peritonei treated with

Awen Hasan1,2, Bipasha Chakrabarty2, Christopher Kearsey2

  • 1Division of Cancer Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK.

Clinical & Translational Oncology : Official Publication of the Federation of Spanish Oncology Societies and of the National Cancer Institute of Mexico
|January 20, 2026
PubMed
Abstract

Insights

Histopathological grade of peritoneal metastasis in Pseudomyxoma Peritonei (PMP) from appendiceal mucinous neoplasms (AMN) significantly impacts patient prognosis after cytoreductive surgery plus heated intraperitoneal chemotherapy (CRS+HIPEC). High-grade mucinous carcinoma peritonei (HGMCP) is a strong predictor of poor overall survival.

Area of Science:

  • Oncology
  • Surgical Oncology
  • Gastroenterology

Background:

  • Pseudomyxoma Peritonei (PMP) is a rare malignancy characterized by peritoneal metastasis from appendiceal mucinous neoplasms (AMN).
  • The PSOGI classification (2016) categorizes PMP into acellular mucin (AM), low-grade mucinous carcinoma peritonei (LGMCP), and high-grade mucinous carcinoma peritonei (HGMCP).
  • Accurate prognostic stratification is crucial for guiding treatment and predicting outcomes in PMP patients.

Purpose of the Study:

  • To evaluate the long-term prognostic significance of the PSOGI classification for PMP.
  • To determine if peritoneal metastasis histopathological grade predicts survival outcomes following CRS+HIPEC.
  • To assess the independent predictive value of peritoneal histology on overall survival (OS) and disease-free survival (DFS).

Main Methods:

  • Retrospective pathology review of 290 PMP patients with AMNs who underwent CRS+HIPEC between 2006 and 2021.
  • Standardized surveillance protocols were applied to all patients.
  • Survival analyses (OS and DFS) were performed using Cox proportional hazards regression, log-rank tests, and Kaplan-Meier curves, stratified by peritoneal metastasis grade.

Main Results:

  • The cohort comprised 34% AM, 59% LGMCP, and 7% HGMCP, with a median follow-up of 49 months.
  • Univariate analysis revealed significantly worse OS and DFS for LGMCP and HGMCP compared to AM (p < 0.001).
  • Multivariate analysis confirmed HGMCP as a significant independent predictor of poor OS (HR: 5.54, p=0.019), while LGMCP did not show a significant association.

Conclusions:

  • Peritoneal metastasis histopathological grade, as defined by the PSOGI classification, is a critical independent prognostic factor for PMP patients.
  • High-grade mucinous carcinoma peritonei (HGMCP) is associated with significantly poorer overall survival following CRS+HIPEC.
  • This classification aids in stratifying PMP patients and predicting outcomes, irrespective of primary appendiceal neoplasm histology.
Keywords:
Appendiceal mucinous neoplasmClassificationHistological gradePeritoneal metastasisPrognosisPseudomyxoma peritonei

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