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Chen P, Su L, Yang W, Zhang J, Wang Y, Wang C, Yu Y, Yang L, Zhou Z. Development and validation of prognostic nomograms for pseudomyxoma peritonei patients after surgery: A population-based study. Medicine (Baltimore) 2020; 99:e20963. [PMID: 32756083 PMCID: PMC7402788 DOI: 10.1097/md.0000000000020963] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND The aim of study was to develop and validate nomograms for predicting overall survival (OS) and cancer-specific survival (CSS) of patients with pseudomyxoma peritonei (PMP) and compare the predictive accuracy with the American Joint Committee on Cancer (AJCC) staging system. METHODS Data of 4959 PMP patients who underwent surgical resection were collected between 2004 and 2015 from the Surveillance Epidemiology and End Results (SEER) database. All included patients were divided into training (n = 3307) and validation (n = 1652) cohorts. The Kaplan-Meier method and Cox proportional hazard model were applied. Nomograms were validated by discrimination and calibration. Finally, concordance index (C-index) was used to compare the predictive performance of nomograms with that of the AJCC staging system. RESULTS According to the univariate and multivariate analyses of training sets, both nomograms for predicting OS and CSS combining age, grade, location, N stage, M stage, and chemotherapy were identified. Nomograms predicting OS also incorporated T stage and the number of lymph nodes removed (LNR). The calibration curves showed good consistency between predicted and actual observed survival. Moreover, C-index values demonstrated that the nomograms predicting both OS and CSS were superior to the AJCC staging system in both cohorts. CONCLUSION We successfully developed and validated prognostic nomograms for predicting OS and CSS in PMP patients. Two nomograms were more accurate and applicable than the AJCC staging system for predicting patient survival, which may help clinicians stratify patients into different risk groups, tailor individualized treatment, and accurately predict patient survival in PMP.
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Affiliation(s)
- Peng Chen
- Department of Gastrointestinal Surgery
| | | | | | | | - Yong Wang
- Department of Gastrointestinal Surgery
- Institute of Digestive Surgery, State Key Laboratory of Biotherapy and Cancer Center, West China Hospital of Sichuan University, Chengdu
| | - Cun Wang
- Department of Gastrointestinal Surgery
- Institute of Digestive Surgery, State Key Laboratory of Biotherapy and Cancer Center, West China Hospital of Sichuan University, Chengdu
| | - Yongyang Yu
- Department of Gastrointestinal Surgery
- Institute of Digestive Surgery, State Key Laboratory of Biotherapy and Cancer Center, West China Hospital of Sichuan University, Chengdu
| | - Lie Yang
- Department of Gastrointestinal Surgery
- Institute of Digestive Surgery, State Key Laboratory of Biotherapy and Cancer Center, West China Hospital of Sichuan University, Chengdu
- Department of General Surgery, West China-Ziyang Hospital of Sichuan University/The First People's Hospital of Ziyang, Ziyang, Sichuan Province, China
| | - Zongguang Zhou
- Department of Gastrointestinal Surgery
- Institute of Digestive Surgery, State Key Laboratory of Biotherapy and Cancer Center, West China Hospital of Sichuan University, Chengdu
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Narasimhan V, Wilson K, Britto M, Warrier S, Lynch AC, Michael M, Tie J, Akhurst T, Mitchell C, Ramsay R, Heriot A. Outcomes Following Cytoreduction and HIPEC for Pseudomyxoma Peritonei: 10-Year Experience. J Gastrointest Surg 2020; 24:899-906. [PMID: 31090036 DOI: 10.1007/s11605-019-04239-4] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2019] [Accepted: 04/20/2019] [Indexed: 01/31/2023]
Abstract
BACKGROUND Pseudomyxoma peritonei (PMP) is a rare clinical presentation, with considerable morbidity and mortality if left untreated. In recent decades, there is growing acceptance for the use of cytoreductive surgery (CRS) with heated intraperitoneal chemotherapy (HIPEC). The aim of this study was to report on our 10-year single-center experience on outcomes following CRS and HIPEC for PMP of appendiceal origin. METHODS A retrospective analysis of a prospectively maintained database of all patients undergoing CRS and HIPEC for PMP of appendiceal origin over a 10-year period at a statewide referral center was conducted. RESULTS One hundred and seventy-five cytoreductive procedures were undertaken in 140 patients. The mean patient age was 57.4 years, with a female preponderance (56%). The median PCI was 16, with 73.1% of cases having a complete cytoreduction. Grade III/IV complications occurred in 36 (20.6%) cases, with no mortalities. The median overall and disease-free survival was 100 months and 40 months, respectively, with a 71% 5-year survival. High-grade histology was the main factor identified as an independent predictor of worse overall survival. CONCLUSION CRS and HIPEC are safe with acceptable rates of morbidity. It can provide very favorable survival in patients with PMP. High-grade histology is a key prognostic factor associated with a worse overall survival.
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Affiliation(s)
- Vignesh Narasimhan
- Department of Surgical Oncology, Peter MacCallum Cancer Centre, Melbourne, Australia.
- Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, Australia.
| | - Kasmira Wilson
- Department of Surgical Oncology, Peter MacCallum Cancer Centre, Melbourne, Australia
- Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, Australia
| | - Maneka Britto
- Department of Surgical Oncology, Peter MacCallum Cancer Centre, Melbourne, Australia
| | - Satish Warrier
- Department of Surgical Oncology, Peter MacCallum Cancer Centre, Melbourne, Australia
| | - A Craig Lynch
- Department of Surgical Oncology, Peter MacCallum Cancer Centre, Melbourne, Australia
| | - Michael Michael
- Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, Australia
- Department of Medical Oncology, Peter MacCallum Cancer Centre, Melbourne, Australia
| | - Jeanne Tie
- Department of Medical Oncology, Peter MacCallum Cancer Centre, Melbourne, Australia
| | - Tim Akhurst
- Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, Australia
| | - Catherine Mitchell
- Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, Australia
| | - Robert Ramsay
- Department of Surgical Oncology, Peter MacCallum Cancer Centre, Melbourne, Australia
- Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, Australia
| | - Alexander Heriot
- Department of Surgical Oncology, Peter MacCallum Cancer Centre, Melbourne, Australia
- Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, Australia
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The American Society of Colon and Rectal Surgeons, Clinical Practice Guidelines for the Management of Appendiceal Neoplasms. Dis Colon Rectum 2019; 62:1425-1438. [PMID: 31725580 DOI: 10.1097/dcr.0000000000001530] [Citation(s) in RCA: 57] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
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Lemoine L, Sugarbaker P, Van der Speeten K. Drugs, doses, and durations of intraperitoneal chemotherapy: standardising HIPEC and EPIC for colorectal, appendiceal, gastric, ovarian peritoneal surface malignancies and peritoneal mesothelioma. Int J Hyperthermia 2017; 33:582-592. [DOI: 10.1080/02656736.2017.1291999] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Affiliation(s)
- Lieselotte Lemoine
- Department of Medicine and Life Sciences, Hasselt University, Hasselt, Belgium
- Department of Surgical Oncology, Ziekenhuis Oost-Limburg, Genk, Belgium
| | - Paul Sugarbaker
- Washington Cancer Institute, Washington Hospital Center, Washington DC, USA
| | - Kurt Van der Speeten
- Department of Medicine and Life Sciences, Hasselt University, Hasselt, Belgium
- Department of Surgical Oncology, Ziekenhuis Oost-Limburg, Genk, Belgium
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Van der Speeten K, Lemoine L, Sugarbaker P. Overview of the optimal perioperative intraperitoneal chemotherapy regimens used in current clinical practice. Pleura Peritoneum 2017; 2:63-72. [PMID: 30911634 PMCID: PMC6405035 DOI: 10.1515/pp-2017-0003] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2017] [Accepted: 03/20/2017] [Indexed: 12/17/2022] Open
Abstract
Peritoneal surface malignancy (PSM) is a common manifestation of digestive and gynecologic malignancies alike. At present, patients with isolated PSM are treated with a combination therapy of cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC). The combination of CRS and intraperitoneal (IP) chemotherapy should now be considered standard of care for PSM from appendiceal epithelial cancers, colorectal cancer and peritoneal mesothelioma. Although there is a near universal standardization regarding the CRS, we are still lacking a much-needed standardization among the various IP chemotherapy treatment modalities used today in clinical practice. Pharmacologic evidence should be generated to answer important questions raised by the myriad of variables associated with IP chemotherapy.
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Affiliation(s)
- Kurt Van der Speeten
- Department of Medicine and Life Sciences, Hasselt University, Hasselt, Belgium
- Department of Surgical Oncology, Ziekenhuis Oost-Limburg, Schiepse Bos 6, 3600 Genk, Belgium
| | | | - Paul Sugarbaker
- Washington Cancer Institute, Washington Hospital Center, Washington DC, USA
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Abstract
OBJECTIVE The purpose of this article is to discuss the role of the radiologist in the treatment of peritoneal cancer, with focus placed on advanced treatment options and selection of patients with resectable disease for whom complete cytoreduction can be achieved. CONCLUSION Peritoneal cancers traditionally have been associated with significant morbidity and universal mortality; however, the management of such cancers has evolved substantially. Advanced treatment options, including cytoreductive surgery and intraperitoneal chemotherapy, are associated with significantly improved long-term patient survival. To ensure that patients benefit from aggressive multimodality treatments, the radiologist plays a pivotal role in the multidisciplinary team to ensure careful patient selection, identifying individuals with resectable disease for whom complete cytoreduction can be achieved.
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Dehal A, Smith JJ, Nash GM. Cytoreductive surgery and intraperitoneal chemotherapy: an evidence-based review-past, present and future. J Gastrointest Oncol 2016; 7:143-57. [PMID: 26941992 DOI: 10.3978/j.issn.2078-6891.2015.112] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
Peritoneal carcinomatosis (PC) has historically been considered a terminal condition with merely palliative treatment achieving a survival rate measured in months. Cytoreductive surgery (CyRS) and intraperitoneal chemotherapy (IPC) have emerged as potentially effective regional treatments with the potential for long-term survival in well-selected patients. The fundamentals of CyRS and IPC are patient selection and complete cytoreduction. Since there is now sufficient evidence for the superiority of CyRS and IPC to systemic chemotherapy alone in a highly select group of patients, surgeons and oncologists should be aware of this modality as a potential benefit for patients with PC. The aim of this report is to highlight cancer-specific evidence in the context of ongoing studies regarding the outcome of this treatment.
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Affiliation(s)
- Ahmed Dehal
- 1 Kaiser Permanente, Fontana, CA, USA ; 2 Department of Surgery, Colorectal Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - J Joshua Smith
- 1 Kaiser Permanente, Fontana, CA, USA ; 2 Department of Surgery, Colorectal Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Garrett M Nash
- 1 Kaiser Permanente, Fontana, CA, USA ; 2 Department of Surgery, Colorectal Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA
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Elliot CR. Adenocarcinoma of the appendix: a rural experience. ANZ J Surg 2015; 87:E321-E322. [PMID: 25988511 DOI: 10.1111/ans.13163] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Claire R Elliot
- Department of General Surgery, Kalgoorlie Regional Hospital, Kalgoorlie, Western Australia, Australia
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Teo MCC, Ching Tan GH, Lim C, Chia CS, Tham CK, Soo KC. Colorectal peritoneal carcinomatosis treated with cytoreductive surgery and hyperthermic intraperitoneal chemotherapy: the experience of a tertiary Asian center. Asian J Surg 2014; 38:65-73. [PMID: 25059814 DOI: 10.1016/j.asjsur.2014.05.001] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2014] [Revised: 04/01/2014] [Accepted: 05/12/2014] [Indexed: 10/25/2022] Open
Abstract
INTRODUCTION Compared with intravenous chemotherapy, cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) have been shown to improve survival in patients with recurrent colorectal disease confined to the peritoneum. We report our experience with CRS and HIPEC for colorectal cancer patients with peritoneal carcinomatosis, evaluating prognostic factors for disease-free survival (DFS), overall survival (OS), and perioperative morbidity and mortality. METHODS All patients who underwent CRS and HIPEC were included in our study. Clinical characteristics, operative data, and 30-day morbidity and mortality were collected and evaluated. RESULTS Between January 2001 and December 2012, there were 35 consecutive patients who underwent CRS and HIPEC at our institution. Thirty-three patients (94%) had optimal cytoreduction. No 30-day mortality was reported, but 14 patients had postoperative complications. The median DFS was 9.4 months (95% confidence interval 5.5-18.7 months), and DFS at 1 year, 3 years, and 5 years were 43.8%, 22.3%, and 22.3%, respectively. The median OS was calculated to be 27.1 months (95% confidence interval 15.3-39.1), and the OS at 1 year, 3 years, and 5 years were 83.7%, 38.2%, and 19.1%, respectively. CONCLUSION CRS and HIPEC can provide survival benefit, with reasonable morbidity and mortality for Asian patients with peritoneal carcinomatosis from colorectal cancer. Patient selection and perioperative management of the patients are key to the success of the procedure.
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Affiliation(s)
- Melissa Ching Ching Teo
- Department of Surgical Oncology, National Cancer Centre Singapore, 11 Hospital Drive, 169610 Singapore; Department of General Surgery, Singapore General Hospital, 9 Hospital Drive, 169612 Singapore.
| | - Grace Hwei Ching Tan
- Department of General Surgery, Singapore General Hospital, 9 Hospital Drive, 169612 Singapore
| | - Cindy Lim
- Department of Surgical Oncology, National Cancer Centre Singapore, 11 Hospital Drive, 169610 Singapore
| | - Claramae Shulyn Chia
- Department of Surgical Oncology, National Cancer Centre Singapore, 11 Hospital Drive, 169610 Singapore
| | - Chee Kian Tham
- Department of Medical Oncology, National Cancer Centre Singapore, 11 Hospital Drive, 169610 Singapore
| | - Khee-Chee Soo
- Department of Surgical Oncology, National Cancer Centre Singapore, 11 Hospital Drive, 169610 Singapore; Department of General Surgery, Singapore General Hospital, 9 Hospital Drive, 169612 Singapore
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Surgical management of colorectal peritoneal metastases: treatment and outcomes compared with hepatic metastases. J Gastrointest Cancer 2013; 44:170-6. [PMID: 23138597 DOI: 10.1007/s12029-012-9452-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
PURPOSE The liver and peritoneum are common sites of colorectal metastases. Hepatectomy for colorectal liver metastases (CLM) is considered gold standard treatment. We attempt to compare the survival outcomes for CLM patients after hepatectomy to that of patients with colorectal peritoneal metastases (CPM) who underwent cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC). METHODS A retrospective review of patients with CPM and CLM who underwent surgery between January 2003 and May 2011 was performed. The overall (OS) and disease-free survivals (DFS) were compared. RESULTS There were 22 patients with CPM who underwent CRS and HIPEC and 186 patients who underwent hepatectomy for CLM. Patients with CPM had a 3-year OS of 39 % and DFS of 27.7 %. CLM patients showed a 3-year OS of 58.5 % and a DFS of 28.8 %. Most recurrences for CPM occurred within 2 years, while CLM patients continue to develop systemic recurrences over 3 years, showing a gradual decline in DFS and OS during this period of time. CONCLUSION Our results show that CRS and HIPEC for CPM confer good OS and DFS rates and that the DFS after CRS and HIPEC is comparable to that after hepatectomy for CLM.
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Kelly KJ, Nash GM. Peritoneal debulking/intraperitoneal chemotherapy-non-sarcoma. J Surg Oncol 2013; 109:14-22. [PMID: 24166680 DOI: 10.1002/jso.23449] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2013] [Accepted: 09/10/2013] [Indexed: 01/18/2023]
Abstract
The combination of cytoreductive surgery (CRS) and intraperitoneal chemotherapy (IPC) is widely practiced for appendiceal, colorectal, gastric, and ovarian cancers with isolated peritoneal metastasis as well as for primary peritoneal cancer. The aim of this report is to explain the rationale and available techniques for CRS and IPC, and to highlight disease-specific considerations that should be taken into account when evaluating potential candidates for CRS and IPC.
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Affiliation(s)
- Kaitlyn J Kelly
- Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, New York
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