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A clinicopathologic analysis of peritoneal metastases of colorectal and appendiceal origin

Bruin, Sjoerd C ; Verwaal, Victor J LU ; Vincent, Andrew ; van't Veer, Laura J and van Velthuysen, Marie-Louise F (2010) In Annals of Surgical Oncology 17(9). p.2330-2340
Abstract

OBJECTIVE: To predict clinical outcome by classification of peritoneal metastases (PM) of colorectal or appendiceal origin.

BACKGROUND: This study investigates whether standardized histological classification can predict outcome for PM of colorectal or appendiceal origin treated with cytoreduction and hyperthermic intraperitoneal chemotherapy (HIPEC).

METHODS: Histology of PM (n = 269) was evaluated by analysis of mitotic activity, atypia, cellularity, and mucinous component. For overall survival (OS) and disease-free survival (DFS) Cox proportional-hazard models were constructed. Covariates included tumor, patient, and treatment characteristics.

RESULTS: PM could be categorized into four groups: low-grade,... (More)

OBJECTIVE: To predict clinical outcome by classification of peritoneal metastases (PM) of colorectal or appendiceal origin.

BACKGROUND: This study investigates whether standardized histological classification can predict outcome for PM of colorectal or appendiceal origin treated with cytoreduction and hyperthermic intraperitoneal chemotherapy (HIPEC).

METHODS: Histology of PM (n = 269) was evaluated by analysis of mitotic activity, atypia, cellularity, and mucinous component. For overall survival (OS) and disease-free survival (DFS) Cox proportional-hazard models were constructed. Covariates included tumor, patient, and treatment characteristics.

RESULTS: PM could be categorized into four groups: low-grade, well-differentiated mucinous tumor (DPAM); intermediated-grade mucinous carcinoma (PMCA-i); high-grade mucinous carcinoma (PMCA); and high-grade nonmucinous carcinoma (PCA). Multivariate analysis showed that histological classification, gender, number of segments affected, completeness of cytoreduction, and HIPEC as primary treatment were significant related to OS and DFS. The 5-year OS was 64% in the DPAM group, 36% in the PMCA group, and 24% in the PCA group. Of PM originating from an appendix tumor, 29% were of non-DPAM type. Of primary colorectal tumors, 37% resulted in mucinous PM, and another 26% of PM of colorectal origin had partly mucinous histology.

CONCLUSION: Histology is a significant predictive factor of OS and DFS in PM treated with surgical cytoreduction and HIPEC. Low-grade PM (DPAM) should be regarded as a separate entity because of its clearly different clinical course. High-grade mucinous PM has significant better prognosis than nonmucinous PM and should thus be distinguished.

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author
; ; ; and
publishing date
type
Contribution to journal
publication status
published
keywords
Adenocarcinoma, Mucinous/secondary, Aged, Appendiceal Neoplasms/pathology, Colorectal Neoplasms/pathology, Combined Modality Therapy, Female, Humans, Male, Middle Aged, Neoplasm Staging, Peritoneal Neoplasms/secondary, Prognosis, Survival Rate
in
Annals of Surgical Oncology
volume
17
issue
9
pages
2330 - 2340
publisher
Springer
external identifiers
  • pmid:20232161
  • scopus:77956340709
ISSN
1534-4681
DOI
10.1245/s10434-010-0984-5
language
English
LU publication?
no
id
1d24b0b6-5b5f-43aa-9f85-389694d734e8
date added to LUP
2022-04-05 11:20:27
date last changed
2024-01-09 12:41:10
@article{1d24b0b6-5b5f-43aa-9f85-389694d734e8,
  abstract     = {{<p>OBJECTIVE: To predict clinical outcome by classification of peritoneal metastases (PM) of colorectal or appendiceal origin.</p><p>BACKGROUND: This study investigates whether standardized histological classification can predict outcome for PM of colorectal or appendiceal origin treated with cytoreduction and hyperthermic intraperitoneal chemotherapy (HIPEC).</p><p>METHODS: Histology of PM (n = 269) was evaluated by analysis of mitotic activity, atypia, cellularity, and mucinous component. For overall survival (OS) and disease-free survival (DFS) Cox proportional-hazard models were constructed. Covariates included tumor, patient, and treatment characteristics.</p><p>RESULTS: PM could be categorized into four groups: low-grade, well-differentiated mucinous tumor (DPAM); intermediated-grade mucinous carcinoma (PMCA-i); high-grade mucinous carcinoma (PMCA); and high-grade nonmucinous carcinoma (PCA). Multivariate analysis showed that histological classification, gender, number of segments affected, completeness of cytoreduction, and HIPEC as primary treatment were significant related to OS and DFS. The 5-year OS was 64% in the DPAM group, 36% in the PMCA group, and 24% in the PCA group. Of PM originating from an appendix tumor, 29% were of non-DPAM type. Of primary colorectal tumors, 37% resulted in mucinous PM, and another 26% of PM of colorectal origin had partly mucinous histology.</p><p>CONCLUSION: Histology is a significant predictive factor of OS and DFS in PM treated with surgical cytoreduction and HIPEC. Low-grade PM (DPAM) should be regarded as a separate entity because of its clearly different clinical course. High-grade mucinous PM has significant better prognosis than nonmucinous PM and should thus be distinguished.</p>}},
  author       = {{Bruin, Sjoerd C and Verwaal, Victor J and Vincent, Andrew and van't Veer, Laura J and van Velthuysen, Marie-Louise F}},
  issn         = {{1534-4681}},
  keywords     = {{Adenocarcinoma, Mucinous/secondary; Aged; Appendiceal Neoplasms/pathology; Colorectal Neoplasms/pathology; Combined Modality Therapy; Female; Humans; Male; Middle Aged; Neoplasm Staging; Peritoneal Neoplasms/secondary; Prognosis; Survival Rate}},
  language     = {{eng}},
  number       = {{9}},
  pages        = {{2330--2340}},
  publisher    = {{Springer}},
  series       = {{Annals of Surgical Oncology}},
  title        = {{A clinicopathologic analysis of peritoneal metastases of colorectal and appendiceal origin}},
  url          = {{http://dx.doi.org/10.1245/s10434-010-0984-5}},
  doi          = {{10.1245/s10434-010-0984-5}},
  volume       = {{17}},
  year         = {{2010}},
}