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Trecourt A, Bakrin N, Glehen O, Gertych W, Villeneuve L, Isaac S, Benzerdjeb N, Fontaine J, Genestie C, Dartigues P, Leroux A, Quenet F, Marchal F, Odin C, Khellaf L, Svrcek M, Thierry S, Augros M, Omar A, Devouassoux-Shisheboran M, Kepenekian V. Cytoreductive Surgery and Hyperthermic Intraperitoneal Chemotherapy to Treat Pseudomyxoma Peritonei of Ovarian Origin: A Retrospective French RENAPE Group Study. Ann Surg Oncol 2024; 31:3325-3338. [PMID: 38341381 PMCID: PMC10997733 DOI: 10.1245/s10434-023-14850-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2023] [Accepted: 12/15/2023] [Indexed: 02/12/2024]
Abstract
BACKGROUND Ovarian pseudomyxoma peritonei (OPMP) are rare, without well-defined therapeutic guidelines. We aimed to evaluate cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) to treat OPMP. METHODS Patients from the French National Network for Rare Peritoneal Tumors (RENAPE) database with proven OPMP treated by CRS/HIPEC and with histologically normal appendix and digestive endoscopy were retrospectively included. Clinical and follow-up data were collected. Histopathological and immunohistochemical features were reviewed. RESULTS Fifteen patients with a median age of 56 years were included. The median Peritoneal Cancer Index was 16. Following CRS, the completeness of cytoreduction (CC) score was CC-0 for 9/15 (60%) patients, CC-1 for 5/15 (33.3%) patients, and CC-2 for 1/15 (6.7%) patients. The median tumor size was 22.5 cm. After pathological review and immunohistochemical studies, tumors were classified as Group 1 (mucinous ovarian epithelial neoplasms) in 3/15 (20%) patients; Group 2 (mucinous neoplasm in ovarian teratoma) in 4/15 (26.7%) patients; Group 3 (mucinous neoplasm probably arising in ovarian teratoma) in 5/15 (33.3%) patients; and Group 4 (non-specific group) in 3/15 (20%) patients. Peritoneal lesions were OPMP pM1a/acellular, pM1b/grade 1 (hypocellular) and pM1b/grade 3 (signet-ring cells) in 13/15 (86.7%), 1/15 (6.7%) and 1/15 (6.7%) patients, respectively. Disease-free survival analysis showed a difference (p = 0.0463) between OPMP with teratoma/likely-teratoma origin (groups 2 and 3; 100% at 1, 5, and 10 years), and other groups (groups 1 and 4; 100%, 66.6%, and 50% at 1, 5, and 10 years, respectively). CONCLUSION These results suggested that a primary therapeutic strategy using complete CRS/HIPEC for patients with OPMP led to favorable long-term outcomes.
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Affiliation(s)
- Alexis Trecourt
- Hospices Civils de Lyon, Hôpital Lyon Sud, Service de Pathologie, Lyon, France
- Université Claude Bernard Lyon 1, UR3738-Centre pour l'Innovation en Cancérologie de Lyon (CICLY), Lyon, France
| | - Naoual Bakrin
- Université Claude Bernard Lyon 1, UR3738-Centre pour l'Innovation en Cancérologie de Lyon (CICLY), Lyon, France
- Hospices Civils de Lyon, Hôpital Lyon Sud, Service de Chirurgie Digestive, Lyon, France
| | - Olivier Glehen
- Université Claude Bernard Lyon 1, UR3738-Centre pour l'Innovation en Cancérologie de Lyon (CICLY), Lyon, France
- Hospices Civils de Lyon, Hôpital Lyon Sud, Service de Chirurgie Digestive, Lyon, France
| | - Witold Gertych
- Université Claude Bernard Lyon 1, UR3738-Centre pour l'Innovation en Cancérologie de Lyon (CICLY), Lyon, France
- Hospices Civils de Lyon, Hôpital Lyon Sud, Service de Gynécologie, Lyon, France
| | - Laurent Villeneuve
- Université Claude Bernard Lyon 1, UR3738-Centre pour l'Innovation en Cancérologie de Lyon (CICLY), Lyon, France
- Hospices Civils de Lyon, Hôpital Lyon Sud, Service de Chirurgie Digestive, Lyon, France
| | - Sylvie Isaac
- Hospices Civils de Lyon, Hôpital Lyon Sud, Service de Pathologie, Lyon, France
| | - Nazim Benzerdjeb
- Hospices Civils de Lyon, Hôpital Lyon Sud, Service de Pathologie, Lyon, France
- Université Claude Bernard Lyon 1, UR3738-Centre pour l'Innovation en Cancérologie de Lyon (CICLY), Lyon, France
| | - Juliette Fontaine
- Hospices Civils de Lyon, Hôpital Lyon Sud, Service de Pathologie, Lyon, France
| | | | - Peggy Dartigues
- Institut Gustave Roussy, Service de Pathologie, Paris, France
| | - Agnès Leroux
- Institut de Cancérologie de Lorraine, Service de Biopathologie CHRU-ICL, Nancy, France
| | - François Quenet
- Institut du Cancer de Montpellier, Service de Chirurgie Digestive Oncologique, Montpellier, France
| | - Frederic Marchal
- Institut de Cancérologie de Lorraine, Service de Chirurgie Oncologique, Vandoeuvre-lès-Nancy, France
| | - Cecile Odin
- Université Claude Bernard Lyon 1, UR3738-Centre pour l'Innovation en Cancérologie de Lyon (CICLY), Lyon, France
- Hospices Civils de Lyon, Hôpital Lyon Sud, Service de Chirurgie Digestive, Lyon, France
| | - Lakhdar Khellaf
- Institut du Cancer de Montpellier, Service de Pathologie, Montpellier, France
| | - Magali Svrcek
- Sorbonne Université, Assistance Publique-Hôpitaux de Paris, Hôpital Saint-Antoine, Service de d'Anatomie pathologique, Paris, France
| | - Sixte Thierry
- Center Hospitalier de Valence, Service de Pathologie, Valence, France
| | - Marilyn Augros
- Center Hospitalier de Valence, Service de Pathologie, Valence, France
| | - Alhadeedi Omar
- Department of Surgery, Al-Amiri Hospital, Kuwait City, Kuwait
| | - Mojgan Devouassoux-Shisheboran
- Hospices Civils de Lyon, Hôpital Lyon Sud, Service de Pathologie, Lyon, France.
- Université Claude Bernard Lyon 1, UR3738-Centre pour l'Innovation en Cancérologie de Lyon (CICLY), Lyon, France.
| | - Vahan Kepenekian
- Université Claude Bernard Lyon 1, UR3738-Centre pour l'Innovation en Cancérologie de Lyon (CICLY), Lyon, France
- Hospices Civils de Lyon, Hôpital Lyon Sud, Service de Chirurgie Digestive, Lyon, France
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Wang C, Yin XY, An LB, Zhai XC, Cai Y, Shi GJ, Fan XW, Zhang P, Wang KM, Ma RQ. Significance of laparoscopic cytoreductive surgery for appendiceal pseudomyxoma peritonei with limited disease and low tumor burden. Asian J Surg 2023; 46:1220-1225. [PMID: 36064480 DOI: 10.1016/j.asjsur.2022.08.052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2022] [Revised: 07/19/2022] [Accepted: 08/16/2022] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVE To investigate the clinical value of laparoscopic cytoreductive surgery (CRS) in treating of appendiceal pseudomyxoma peritonei with limited disease and low tumor burden. METHODS The clinical data of patients with appendiceal pseudomyxoma peritonei treated by surgery with CRS at the Aerospace Center Hospital from January 2018 to December 2021 were retrospectively analyzed. The patients were divided into laparoscopic or open CRS groups according to the operation method. A propensity score-matched (PSM) analysis (1:1) was performed, the related clinical variables were compared between the two groups, and the effect on progression-free survival (PFS) was also analyzed. RESULTS One hundred and eight patients were included in this study. After PSM, 33 patients were selected from each group and the age and peritoneal cancer index were matched between the two groups. There were significant differences in operation time (P < 0.001), intraoperative bleeding (P < 0.001), intraoperative blood transfusion (P = 0.007), hospital stay (P < 0.001). The analysis of PFS showed that there was no significant difference between the two operation methods. After multivariate analysis, the pathologic subtype (P = 0.012) was identified as an independent prognostic factor for PFS. CONCLUSION The curative effect of laparoscopic CRS is like that of open operation, which can significantly shorten the operation time and hospital stay and reduce intraoperative bleeding and blood transfusion event. The laparoscopic CRS is safe and feasible in strictly selected patients. The pathologic subtype is an independent factor affecting the prognosis for PFS.
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Affiliation(s)
- Chong Wang
- Department of Myxoma, Aerospace Center Hospital, Beijing, 100049, China
| | - Xiang-Yang Yin
- Peking University Aerospace School of Clinical Medicine, Aerospace Center Hospital, Beijing, 100049, China
| | - Lu-Biao An
- Department of Myxoma, Aerospace Center Hospital, Beijing, 100049, China
| | - Xi-Chao Zhai
- Department of Myxoma, Aerospace Center Hospital, Beijing, 100049, China
| | - Ying Cai
- Department of Myxoma, Aerospace Center Hospital, Beijing, 100049, China
| | - Guan-Jun Shi
- Department of Myxoma, Aerospace Center Hospital, Beijing, 100049, China
| | - Xi-Wen Fan
- Department of Myxoma, Aerospace Center Hospital, Beijing, 100049, China
| | - Pu Zhang
- Department of Myxoma, Aerospace Center Hospital, Beijing, 100049, China
| | - Kai-Min Wang
- Department of Hepatobiliary Pancreatic Gastrointestinal, Changchun Tumor Hospital, Jilin, 130000, China.
| | - Rui-Qing Ma
- Department of Myxoma, Aerospace Center Hospital, Beijing, 100049, China.
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Pietrantonio F, Berenato R, Maggi C, Caporale M, Milione M, Perrone F, Tamborini E, Baratti D, Kusamura S, Mariani L, Niger M, Mennitto A, Gloghini A, Bossi I, Settanni G, Busico A, Bagnoli PF, Di Bartolomeo M, Deraco M, de Braud F. GNAS mutations as prognostic biomarker in patients with relapsed peritoneal pseudomyxoma receiving metronomic capecitabine and bevacizumab: a clinical and translational study. J Transl Med 2016; 14:125. [PMID: 27154293 PMCID: PMC4859944 DOI: 10.1186/s12967-016-0877-x] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2015] [Accepted: 04/26/2016] [Indexed: 12/17/2022] Open
Abstract
Background There is lack of evidence about systemic treatment of pseudomyxoma peritonei (PMP) relapsing after cytoreductive surgery and hyperthermic intraperitoneal chemotherapy. There is also lack of biomarkers able to predict outcomes beyond known clinical and pathological prognostic features. Methods Fifteen patients with relapsed PMP and progressive disease within the last 6 months were included and received metronomic capecitabine (625 mg/mq/day b.i.d.) and bevacizumab (7.5 mg/Kg three-weekly) until progressive disease/unacceptable toxicity. The primary endpoint was progression-free survival (PFS). Ion Torrent® next generation sequencing technology (Hot-spot Cancer Panel) was used to characterize molecular features. Results At a median follow up of 12 months, median PFS was 8.2 months and 1-year overall survival was 91 %. Partial responses were observed in 20 % of cases, but a significant reduction of tumor markers in up to 79 %. Treatment was very well tolerated without no new safety signals. All tumor samples except one had KRAS mutations. Patients with GNAS mutations had a significantly shorter median PFS as compared to GNAS wild-type ones (5.3 months vs. not reached; p < 0.007). The results were externally validated on our previous series of PMP patients. GNAS mutations were rare in a parallel cohort of 121 advanced colorectal cancers (2.5 %), but were associated with peculiar clinical-pathological features and aggressive course. Conclusions Metronomic capecitabine and bevacizumab is an active and well tolerated option in patients with relapsed PMP. The negative prognostic effect of GNAS mutations in gastrointestinal cancers warrants further confirmatory studies and may prompt the development of effective targeted strategies. Electronic supplementary material The online version of this article (doi:10.1186/s12967-016-0877-x) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Filippo Pietrantonio
- Medical Oncology Department, Fondazione IRCCS Istituto Nazionale dei Tumori, Via Venezian, 1, 20133, Milan, Italy.
| | - Rosa Berenato
- Medical Oncology Department, Fondazione IRCCS Istituto Nazionale dei Tumori, Via Venezian, 1, 20133, Milan, Italy
| | - Claudia Maggi
- Medical Oncology Department, Fondazione IRCCS Istituto Nazionale dei Tumori, Via Venezian, 1, 20133, Milan, Italy
| | - Marta Caporale
- Medical Oncology Department, Fondazione IRCCS Istituto Nazionale dei Tumori, Via Venezian, 1, 20133, Milan, Italy
| | - Massimo Milione
- Pathology and Molecular Biology Department, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Federica Perrone
- Pathology and Molecular Biology Department, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Elena Tamborini
- Pathology and Molecular Biology Department, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Dario Baratti
- Surgery Department, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Shigeki Kusamura
- Surgery Department, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Luigi Mariani
- Unit of Medical Statistics, Biometry and Bioinformatics, Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy
| | - Monica Niger
- Medical Oncology Department, Fondazione IRCCS Istituto Nazionale dei Tumori, Via Venezian, 1, 20133, Milan, Italy
| | - Alessia Mennitto
- Medical Oncology Department, Fondazione IRCCS Istituto Nazionale dei Tumori, Via Venezian, 1, 20133, Milan, Italy
| | - Annunziata Gloghini
- Pathology and Molecular Biology Department, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Ilaria Bossi
- Medical Oncology Department, Fondazione IRCCS Istituto Nazionale dei Tumori, Via Venezian, 1, 20133, Milan, Italy
| | - Giulio Settanni
- Pathology and Molecular Biology Department, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Adele Busico
- Pathology and Molecular Biology Department, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | | | - Maria Di Bartolomeo
- Medical Oncology Department, Fondazione IRCCS Istituto Nazionale dei Tumori, Via Venezian, 1, 20133, Milan, Italy
| | - Marcello Deraco
- Surgery Department, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Filippo de Braud
- Medical Oncology Department, Fondazione IRCCS Istituto Nazionale dei Tumori, Via Venezian, 1, 20133, Milan, Italy
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Pietrantonio F, Maggi C, Fanetti G, Iacovelli R, Di Bartolomeo M, Ricchini F, Deraco M, Perrone F, Baratti D, Kusamura S, Tamborini E, Castano A, Consonni PV, Bossi I, Gavazzi C, Milione M, Pelosi G, de Braud F. FOLFOX-4 chemotherapy for patients with unresectable or relapsed peritoneal pseudomyxoma. Oncologist 2014; 19:845-50. [PMID: 24951608 DOI: 10.1634/theoncologist.2014-0106] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
PURPOSE The standard treatment of peritoneal pseudomyxoma is based on cytoreductive surgery combined with hyperthermic intraperitoneal chemotherapy (HIPEC). The establishment of newer systemic treatments is an unmet clinical need for unresectable or relapsed peritoneal pseudomyxoma. The aim of our study was to assess the activity of chemotherapy with 5-fluorouracil and oxaliplatin (FOLFOX-4 regimen) in terms of response rate in this subset of patients. MATERIALS AND METHODS Patients were included in a single-center, observational study and treated with FOLFOX-4 administered every 2 weeks for up to 12 cycles or until progressive disease or unacceptable toxicity. RESULTS Twenty consecutive patients were reviewed from July 2011 to September 2013. Only partial responses were observed, with an objective response rate of 20%. Median progression-free survival and overall survival were 8 months and 26 months, respectively. Two patients were able to undergo laparotomy with complete cytoreduction and HIPEC in one case. Safety data for FOLFOX-4 were consistent with the literature. By means of a mutant enriched polymerase chain reaction, KRAS mutation was found in 16 of 19 cases (84%), and MGMT promoter methylation was found in 8 (42%, all KRAS mutant). CONCLUSION FOLFOX-4 chemotherapy is tolerable and active in patients with peritoneal pseudomyxoma when disease is deemed unresectable or relapsed after peritonectomy and HIPEC. The identification of predictive biomarkers, such as KRAS for resistance to anti-epidermal growth factor receptor monoclonal antibodies and MGMT for response to temozolomide, is a priority for the development of evidence-based treatment strategies for peritoneal pseudomyxoma.
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Affiliation(s)
- Filippo Pietrantonio
- Medical Oncology Department, Surgery Department, Pathology and Molecular Biology Department, Scientific Directorate, and Clinical Nutrition Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Claudia Maggi
- Medical Oncology Department, Surgery Department, Pathology and Molecular Biology Department, Scientific Directorate, and Clinical Nutrition Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Giuseppe Fanetti
- Medical Oncology Department, Surgery Department, Pathology and Molecular Biology Department, Scientific Directorate, and Clinical Nutrition Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Roberto Iacovelli
- Medical Oncology Department, Surgery Department, Pathology and Molecular Biology Department, Scientific Directorate, and Clinical Nutrition Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Maria Di Bartolomeo
- Medical Oncology Department, Surgery Department, Pathology and Molecular Biology Department, Scientific Directorate, and Clinical Nutrition Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Francesca Ricchini
- Medical Oncology Department, Surgery Department, Pathology and Molecular Biology Department, Scientific Directorate, and Clinical Nutrition Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Marcello Deraco
- Medical Oncology Department, Surgery Department, Pathology and Molecular Biology Department, Scientific Directorate, and Clinical Nutrition Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Federica Perrone
- Medical Oncology Department, Surgery Department, Pathology and Molecular Biology Department, Scientific Directorate, and Clinical Nutrition Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Dario Baratti
- Medical Oncology Department, Surgery Department, Pathology and Molecular Biology Department, Scientific Directorate, and Clinical Nutrition Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Shigeki Kusamura
- Medical Oncology Department, Surgery Department, Pathology and Molecular Biology Department, Scientific Directorate, and Clinical Nutrition Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Elena Tamborini
- Medical Oncology Department, Surgery Department, Pathology and Molecular Biology Department, Scientific Directorate, and Clinical Nutrition Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Alessandra Castano
- Medical Oncology Department, Surgery Department, Pathology and Molecular Biology Department, Scientific Directorate, and Clinical Nutrition Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Paola Valentina Consonni
- Medical Oncology Department, Surgery Department, Pathology and Molecular Biology Department, Scientific Directorate, and Clinical Nutrition Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Ilaria Bossi
- Medical Oncology Department, Surgery Department, Pathology and Molecular Biology Department, Scientific Directorate, and Clinical Nutrition Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Cecilia Gavazzi
- Medical Oncology Department, Surgery Department, Pathology and Molecular Biology Department, Scientific Directorate, and Clinical Nutrition Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Massimo Milione
- Medical Oncology Department, Surgery Department, Pathology and Molecular Biology Department, Scientific Directorate, and Clinical Nutrition Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Giuseppe Pelosi
- Medical Oncology Department, Surgery Department, Pathology and Molecular Biology Department, Scientific Directorate, and Clinical Nutrition Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Filippo de Braud
- Medical Oncology Department, Surgery Department, Pathology and Molecular Biology Department, Scientific Directorate, and Clinical Nutrition Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
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