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Romero-Ruiz A, Granados-Rodríguez M, Bura FI, Valenzuela-Molina F, Rufián-Andújar B, Martínez-López A, Rodríguez-Ortiz L, Ortega-Salas R, Torres-Martínez M, Moreno-Serrano A, Castaño J, Michán C, Alhama J, Vázquez-Borrego MC, Arjona-Sánchez Á. Breaking the Mucin Barrier: A New Affinity Chromatography-Mass Spectrometry Approach to Unveil Potential Cell Markers and Pathways Altered in Pseudomyxoma Peritonei. Biol Proced Online 2024; 26:13. [PMID: 38750435 PMCID: PMC11094946 DOI: 10.1186/s12575-024-00239-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2024] [Accepted: 04/25/2024] [Indexed: 05/19/2024] Open
Abstract
BACKGROUND Pseudomyxoma peritonei (PMP) is a rare peritoneal mucinous carcinomatosis with largely unknown underlying molecular mechanisms. Cytoreductive surgery combined with hyperthermic intraperitoneal chemotherapy is the only therapeutic option; however, despite its use, recurrence with a fatal outcome is common. The lack of molecular characterisation of PMP and other mucinous tumours is mainly due to the physicochemical properties of mucin. RESULTS This manuscript describes the first protocol capable of breaking the mucin barrier and isolating proteins from mucinous tumours. Briefly, mucinous tumour samples were homogenised and subjected to liquid chromatography using two specific columns to reduce mainly glycoproteins, albumins and immunoglobulin G. The protein fractions were then subjected to mass spectrometry analysis and the proteomic profile obtained was analysed using various bioinformatic tools. Thus, we present here the first proteome analysed in PMP and identified a distinct mucin isoform profile in soft compared to hard mucin tumour tissues as well as key biological processes/pathways altered in mucinous tumours. Importantly, this protocol also allowed us to identify MUC13 as a potential tumour cell marker in PMP. CONCLUSIONS In sum, our results demonstrate that this protein isolation protocol from mucin will have a high impact, allowing the oncology research community to more rapidly advance in the knowledge of PMP and other mucinous neoplasms, as well as develop new and effective therapeutic strategies.
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Affiliation(s)
- Antonio Romero-Ruiz
- Department of Biochemistry and Molecular Biology, University of Córdoba, Córdoba, Spain.
- Maimonides Biomedical Research Institute of Córdoba, IMIBIC and University of Córdoba, Av. Menéndez Pidal, s/n, Córdoba, 14004, Spain.
| | - Melissa Granados-Rodríguez
- Department of Biochemistry and Molecular Biology, University of Córdoba, Córdoba, Spain
- Maimonides Biomedical Research Institute of Córdoba, IMIBIC and University of Córdoba, Av. Menéndez Pidal, s/n, Córdoba, 14004, Spain
| | - Florina I Bura
- Department of Biochemistry and Molecular Biology, University of Córdoba, Córdoba, Spain
- Maimonides Biomedical Research Institute of Córdoba, IMIBIC and University of Córdoba, Av. Menéndez Pidal, s/n, Córdoba, 14004, Spain
| | - Francisca Valenzuela-Molina
- Maimonides Biomedical Research Institute of Córdoba, IMIBIC and University of Córdoba, Av. Menéndez Pidal, s/n, Córdoba, 14004, Spain
- Surgical Oncology Unit, Surgery Department, Reina Sofía University Hospital, Córdoba, Spain
| | - Blanca Rufián-Andújar
- Maimonides Biomedical Research Institute of Córdoba, IMIBIC and University of Córdoba, Av. Menéndez Pidal, s/n, Córdoba, 14004, Spain
- Surgical Oncology Unit, Surgery Department, Reina Sofía University Hospital, Córdoba, Spain
| | - Ana Martínez-López
- Maimonides Biomedical Research Institute of Córdoba, IMIBIC and University of Córdoba, Av. Menéndez Pidal, s/n, Córdoba, 14004, Spain
- Pathology Unit, HURS, Córdoba, Spain
| | - Lidia Rodríguez-Ortiz
- Maimonides Biomedical Research Institute of Córdoba, IMIBIC and University of Córdoba, Av. Menéndez Pidal, s/n, Córdoba, 14004, Spain
- Surgical Oncology Unit, Surgery Department, Reina Sofía University Hospital, Córdoba, Spain
| | - Rosa Ortega-Salas
- Maimonides Biomedical Research Institute of Córdoba, IMIBIC and University of Córdoba, Av. Menéndez Pidal, s/n, Córdoba, 14004, Spain
- Pathology Unit, HURS, Córdoba, Spain
| | - María Torres-Martínez
- Department of Biochemistry and Molecular Biology, University of Córdoba, Córdoba, Spain
- Maimonides Biomedical Research Institute of Córdoba, IMIBIC and University of Córdoba, Av. Menéndez Pidal, s/n, Córdoba, 14004, Spain
| | - Ana Moreno-Serrano
- Maimonides Biomedical Research Institute of Córdoba, IMIBIC and University of Córdoba, Av. Menéndez Pidal, s/n, Córdoba, 14004, Spain
| | - Justo Castaño
- Department of Cell Biology, Physiology, and Immunology, University of Córdoba, Córdoba, Spain
- CIBER Fisiopatología de La Obesidad y Nutrición, Córdoba, Spain
| | - Carmen Michán
- Department of Biochemistry and Molecular Biology, University of Córdoba, Córdoba, Spain
- Maimonides Biomedical Research Institute of Córdoba, IMIBIC and University of Córdoba, Av. Menéndez Pidal, s/n, Córdoba, 14004, Spain
| | - José Alhama
- Department of Biochemistry and Molecular Biology, University of Córdoba, Córdoba, Spain
- Maimonides Biomedical Research Institute of Córdoba, IMIBIC and University of Córdoba, Av. Menéndez Pidal, s/n, Córdoba, 14004, Spain
| | - Mari C Vázquez-Borrego
- Maimonides Biomedical Research Institute of Córdoba, IMIBIC and University of Córdoba, Av. Menéndez Pidal, s/n, Córdoba, 14004, Spain.
| | - Álvaro Arjona-Sánchez
- Maimonides Biomedical Research Institute of Córdoba, IMIBIC and University of Córdoba, Av. Menéndez Pidal, s/n, Córdoba, 14004, Spain
- Surgical Oncology Unit, Surgery Department, Reina Sofía University Hospital, Córdoba, Spain
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Rufián-Andujar B, Valenzuela-Molina F, Rufián-Peña S, Casado-Adam Á, Sánchez-Hidalgo JM, Rodríguez-Ortiz L, Medina-Fernández FJ, Díaz-López C, Ortega-Salas R, Martínez-López A, Briceño-Delgado J, Romero-Ruíz A, Arjona-Sánchez Á. From the Ronnett to the PSOGI Classification System for Pseudomyxoma Peritonei: A Validation Study. Ann Surg Oncol 2021; 28:2819-2827. [PMID: 33471266 DOI: 10.1245/s10434-020-09560-w] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2020] [Accepted: 12/23/2020] [Indexed: 12/12/2022]
Abstract
BACKGROUND Several classifications have been used for pseudomyxoma peritonei (PMP), and among these, the Ronnett classification is the most commonly used. However, a new consensual Peritoneal Surface Oncology Group International (PSOGI) classification has recently been proposed. Nonetheless, to date, the ability of the PSOGI classification to predict survival based on its different disease histologic categories has not been validated. METHODS This study enrolled 117 patients with PMP who had undergone cytoreductive surgery and hyperthermic intraperitoneal chemotherapy (HIPEC) between 1997 and 2020. Cox proportional hazards regression models and time-dependent curve receiver operating characteristic (ROC) analyses were used to assess the predictive capacity of both classification systems for the overall survival (OS) and disease-free survival (DFS) of these patients. RESULTS Significant differences in the 5-year OS rate were found for the different histologic grades according to each of the classifications. The completeness of cytoreduction score (CCS) was identified as a factor that predicted patient OS prognosis (p = 0.006). According to the time-dependent ROC curves at the "100" time point, adjusted by the CCS and DFS, the capacity to predict OS was optimal and achieved an area under the curve (AUC) of about 69% for OS and approximately 62% for DFS. CONCLUSIONS Both the Ronnett and PSOGI classifications were able to predict survival optimally for this patient cohort. However, when the classifications were adjusted by the CCS, the predictive availability for OS was better with the PSOGI classification than with the Ronnett classification.
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Affiliation(s)
- Blanca Rufián-Andujar
- Unit of Surgical Oncology, Department of Surgery, Reina Sofia University Hospital, Av. Menendez Pidal, s/n, 14004, Cordoba, Spain.,GE09 Research in Peritoneal and Retroperitoneal Oncological Surgery, Maimonides Biomedical, Research Institute of Cordoba (IMIBIC), Reina Sofia University Hospital, University of Cordoba, Cordoba, Spain
| | - Francisca Valenzuela-Molina
- Unit of Surgical Oncology, Department of Surgery, Reina Sofia University Hospital, Av. Menendez Pidal, s/n, 14004, Cordoba, Spain.,GE09 Research in Peritoneal and Retroperitoneal Oncological Surgery, Maimonides Biomedical, Research Institute of Cordoba (IMIBIC), Reina Sofia University Hospital, University of Cordoba, Cordoba, Spain
| | - Sebastián Rufián-Peña
- Unit of Surgical Oncology, Department of Surgery, Reina Sofia University Hospital, Av. Menendez Pidal, s/n, 14004, Cordoba, Spain.,GE09 Research in Peritoneal and Retroperitoneal Oncological Surgery, Maimonides Biomedical, Research Institute of Cordoba (IMIBIC), Reina Sofia University Hospital, University of Cordoba, Cordoba, Spain
| | - Ángela Casado-Adam
- Unit of Surgical Oncology, Department of Surgery, Reina Sofia University Hospital, Av. Menendez Pidal, s/n, 14004, Cordoba, Spain.,GE09 Research in Peritoneal and Retroperitoneal Oncological Surgery, Maimonides Biomedical, Research Institute of Cordoba (IMIBIC), Reina Sofia University Hospital, University of Cordoba, Cordoba, Spain
| | - Juan Manuel Sánchez-Hidalgo
- Unit of Surgical Oncology, Department of Surgery, Reina Sofia University Hospital, Av. Menendez Pidal, s/n, 14004, Cordoba, Spain.,GE09 Research in Peritoneal and Retroperitoneal Oncological Surgery, Maimonides Biomedical, Research Institute of Cordoba (IMIBIC), Reina Sofia University Hospital, University of Cordoba, Cordoba, Spain
| | - Lidia Rodríguez-Ortiz
- Unit of Surgical Oncology, Department of Surgery, Reina Sofia University Hospital, Av. Menendez Pidal, s/n, 14004, Cordoba, Spain.,GE09 Research in Peritoneal and Retroperitoneal Oncological Surgery, Maimonides Biomedical, Research Institute of Cordoba (IMIBIC), Reina Sofia University Hospital, University of Cordoba, Cordoba, Spain
| | - Francisco Javier Medina-Fernández
- Unit of Surgical Oncology, Department of Surgery, Reina Sofia University Hospital, Av. Menendez Pidal, s/n, 14004, Cordoba, Spain.,GE09 Research in Peritoneal and Retroperitoneal Oncological Surgery, Maimonides Biomedical, Research Institute of Cordoba (IMIBIC), Reina Sofia University Hospital, University of Cordoba, Cordoba, Spain
| | - Cesar Díaz-López
- Unit of Surgical Oncology, Department of Surgery, Reina Sofia University Hospital, Av. Menendez Pidal, s/n, 14004, Cordoba, Spain.,GE09 Research in Peritoneal and Retroperitoneal Oncological Surgery, Maimonides Biomedical, Research Institute of Cordoba (IMIBIC), Reina Sofia University Hospital, University of Cordoba, Cordoba, Spain
| | - Rosa Ortega-Salas
- GE09 Research in Peritoneal and Retroperitoneal Oncological Surgery, Maimonides Biomedical, Research Institute of Cordoba (IMIBIC), Reina Sofia University Hospital, University of Cordoba, Cordoba, Spain.,Pathology Unit, Reina Sofia University Hospital, Cordoba, Spain
| | - Ana Martínez-López
- GE09 Research in Peritoneal and Retroperitoneal Oncological Surgery, Maimonides Biomedical, Research Institute of Cordoba (IMIBIC), Reina Sofia University Hospital, University of Cordoba, Cordoba, Spain.,Pathology Unit, Reina Sofia University Hospital, Cordoba, Spain
| | - Javier Briceño-Delgado
- Unit of Surgical Oncology, Department of Surgery, Reina Sofia University Hospital, Av. Menendez Pidal, s/n, 14004, Cordoba, Spain
| | - Antonio Romero-Ruíz
- Unit of Surgical Oncology, Department of Surgery, Reina Sofia University Hospital, Av. Menendez Pidal, s/n, 14004, Cordoba, Spain. .,GE09 Research in Peritoneal and Retroperitoneal Oncological Surgery, Maimonides Biomedical, Research Institute of Cordoba (IMIBIC), Reina Sofia University Hospital, University of Cordoba, Cordoba, Spain.
| | - Álvaro Arjona-Sánchez
- Unit of Surgical Oncology, Department of Surgery, Reina Sofia University Hospital, Av. Menendez Pidal, s/n, 14004, Cordoba, Spain. .,GE09 Research in Peritoneal and Retroperitoneal Oncological Surgery, Maimonides Biomedical, Research Institute of Cordoba (IMIBIC), Reina Sofia University Hospital, University of Cordoba, Cordoba, Spain.
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Arjona-Sanchez A, Muñoz-Casares FC, Casado-Adam A, Sánchez-Hidalgo JM, Ayllon Teran MD, Orti-Rodriguez R, Padial-Aguado AC, Medina-Fernández J, Ortega-Salas R, Pulido-Cortijo G, Gómez-España A, Rufián-Peña S. Outcome of patients with aggressive pseudomyxoma peritonei treated by cytoreductive surgery and intraperitoneal chemotherapy. World J Surg 2014; 37:1263-70. [PMID: 23532601 DOI: 10.1007/s00268-013-2000-2] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
BACKGROUND Pseudomyxoma peritonei (PMP) is a rare disease with an incidence rate of approximately 1 per million a year. During the past few years, there has been a survival benefit for these patients treated by complete cytoreduction and perioperative chemotherapy. Better survival rates were found in the adenomucinosis group than the carcinomatosis group. The purpose of our study was to analyze the outcome and the prognosis factors of only high-grade PMP. METHODS We selected 38 patients from a prospective database of 59 with high-grade PMP from appendiceal origin who were treated by cytoreduction surgery and HIPEC at the Hospital University Reina Sofia (Cordoba, Spain) between 1998 and July 2012. Clinical, surgical, analytical, radiological, and histological data were obtained prospectively. Survival curves were calculated using the Kaplan-Meier method, a univariate analysis was performed and the log rank-test was used to analyze the effects of several clinical and pathologic factors on overall survival (OS) and disease-free survival (DFS). RESULTS Median follow-up time was 32 months (range, 2-170). Median age at diagnosis was 57 years (range, 32-77). In 89.5 % of patients, optimal cytoreduction CC-0 (57.9 %) and CC-1 (31.6 %) was achieved. In the remaining 10.5 %, cytoreduction was classified as CC-2. The median PCI score was 21 (range, 4-38). Morbidity complications ≥ Grade 3 in the CTCAE v 3.0 classification was 18.4 %. One patient died 45 days postsurgery. Median OS at the end of follow-up was 36 months (range, 9-83); overall 5-year survival rate was 58.7 %. In the univariate analysis for OS, significant values were obtained for lymph-node involvement and suboptimal cytoreduction. The 5-year OS was 64.5 % when an optimal cytoreduction was achieved. Median DFS was 36 months (17-54); 3-year DFS rate was 49.1 %. Neoadjuvant therapy did not affect the survival of these patients; there was no difference in the 5-year OS (43 % vs. 75 %, p = 0.068). CONCLUSIONS In aggressive PMP, cytoreduction with peritonectomy procedure plus HIPEC is a safe procedure that suggests an improvement to the survival rates. Because optimal cytoreduction is a primary prognostic factor for survival rates, this procedure would have to be performed in an experienced center with a low morbidity. Neoadjuvant chemotherapy has not demonstrated benefits in these patients and further research will be required.
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Guo AT, Li YM, Wei LX. Pseudomyxoma peritonei of 92 Chinese patients: Clinical characteristics, pathological classification and prognostic factors. World J Gastroenterol 2012; 18:3081-8. [PMID: 22791943 PMCID: PMC3386321 DOI: 10.3748/wjg.v18.i24.3081] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2011] [Revised: 04/16/2012] [Accepted: 05/26/2012] [Indexed: 02/06/2023] Open
Abstract
AIM: To assess the clinicopathologic features and its relationship with prognosis of pseudomyxoma peritonei (PMP) in Chinese patients.
METHODS: The clinicopathologic features and follow-up data of 92 patients with PMP were reviewed and retrospectively analyzed. The cases were categorized into three groups: disseminated peritoneal adenomucinosis (DPAM), peritoneal mucinous carcinomatosis (PMCA), and peritoneal mucinous carcinomatosis with intermediate or discordant features (PMCA-I/D). The log-rank test was used to analyze survival for each group and various clinicopathological parameters. Multivariate Cox proportional-hazard models were constructed to determine the important factors associated with survival.
RESULTS: The median age at diagnosis was 51.9 years (range: 22-76 years). The median follow up was 124 mo. The 3-, 5- and 10-year survival rates were 74.0%, 67.4% and 49.1%, respectively. There were 49 (53.2%) patients with DPAM, 26 (28.3%) with PMCA-I and 17 (18.5%) with PMCA. Patients with DPAM, PMCA-I/D and PMCA exhibited statistically significant difference in survival (P = 0.001). The 3 year survival for DPAM, PMCAI/D and PMCA was 97.0%, 80.0% and 67.0%, respectively; the 5 year survival was 80.0%, 67.0% and 50.0%, respectively; and the 10 year survival was 65.0%, 28.0% and 14.0%, respectively. Survival rate was significantly lowest in patients < 40 age years of age (P = 0.011). Appendiceal tumor and extra-ovarian parenchymal organ involvement were significantly related to overall survival. Patients with appendiceal mucinous adenocarcinoma (MACA) showed the significantly poorer prognosis (P = 0.011). Multivariate analysis showed that pathological classification, age, appendiceal tumor were significant related to overall survival.
CONCLUSION: The clinical process “PMP” should be pathologically classified into DPAM, PMCA and PMCA-I/D. Pathological classification, age, appendiceal MACA are survival independent predictors in Chinese patients with PMP.
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