Systemic chemotherapy before cytoreductive surgery and hyperthermic intraperitoneal chemotherapy (CRS/HIPEC) in patients with high-grade mucinous carcinoma peritonei of appendiceal origin |
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| Affiliation: | 1. Department of Hepato-Biliary Surgery, University Hospital Aintree, Liverpool, UK;2. Liverpool Clinical and Cancer Research UK Trials Unit, University of Liverpool, Liverpool, UK;3. Department of Hepato-Biliary Medicine, University Hospital Aintree, Liverpool, UK;4. Department of Hepato-Biliary Medicine, Royal Liverpool Hospital, Liverpool, UK;5. Department of Radiology, University Hospital Aintree, Liverpool, UK;6. Department of Radiology, Royal Liverpool Hospital, Liverpool, UK;7. Oncology Department, Clatterbridge Hospital, Bebington, UK;1. Vascular Surgery, Department of Surgery and Morphological Sciences, University of Insubria School of Medicine, Circolo University Hospital, Varese, Italy;2. Interventional Radiology, and Department of Surgery and Morphological Sciences, University of Insubria School of Medicine, Circolo University Hospital, Varese, Italy;3. Anesthesia and Palliative Care, Circolo University Hospital, Varese, Italy;1. Melanoma Institute Australia, The University of Sydney, Sydney, Australia;2. University of Utrecht, Utrecht, the Netherlands;3. Skin Cancer Department, A.C. Camargo Cancer Center, São Paulo, Brazil;4. Alfred Nuclear Medicine and Ultrasound, Sydney, Australia;5. Faculty of Medicine and Health, The University of Sydney, Sydney, Australia;6. Department of Melanoma and Surgical Oncology, Royal Prince Alfred Hospital, Sydney, Australia |
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| Abstract: | BackgroundThe role of systemic chemotherapy (SC) before cytoreductive surgery and hyperthermic intraperitoneal chemotherapy (CRS/HIPEC) in appendiceal high-grade mucinous carcinoma peritonei (HGMCP) is controversial. We analyzed the effect of SC prior to CRS/HIPEC in HGMCP.MethodsA prospective database of CRS/HIPEC procedures for HGMCP without signet ring cells and with signet ring cells (HGMCP-S) from 1998 to 2017 was reviewed. Exclusion criteria was prior surgery >5 regions or >2 regimens of prior SC. Perioperative variables were analyzed.ResultsThere were 140 HGMCP/HGMCP-S identified: 64 with prior SC (preSC) and 76 without (noSC). Groups were balanced for lymph node status, complete cytoreduction rate, disease burden, complications, and postoperative SC. PreSC had more HGMCP-S, moderately/poorly differentiated histology, and longer time-to-surgery (median: 6 vs 2 months, p < 0.001). Median overall survival (mOS) was 40 vs 86 and median progression-free survival (mPFS) was 19 vs 43 months for preSC vs noSC, respectively (p = 0.006 and p = 0.007). In HGMCP-S subanalysis, mOS was 25 vs 39 and mPFS 16 vs 29 months for preSC vs noSC, respectively (p = 0.188 and p = 0.063). In moderately/poorly differentiated histology subanalysis, mOS was 38 vs 56 and mPFS 18 vs 29 months in preSC vs noSC, respectively (p = 0.199 and 0.082). Prior SC was not linked to improved OS or PFS in non-signet ring HGMCP or well-differentiated histology subanalysis.ConclusionPrior SC was not associated with less disease burden, better cytoreduction rates, or improved clinical outcomes in HGMCP, regardless of histopathologic subtype. Traditional SC agents may not be effective in HGMCP in the neoadjuvant setting. |
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| Keywords: | Cytoreductive surgery Hyperthermic intraperitoneal chemotherapy Appendiceal cancer Systemic chemotherapy Peritoneal neoplasms Signet ring cells |
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