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Survival analysis of pseudomyxoma peritonei patients treated by cytoreductive surgery and hyperthermic intraperitoneal chemotherapy

Smeenk, Robert M ; Verwaal, Vic J LU ; Antonini, Ninja and Zoetmulder, Frans A N (2007) In Annals of Surgery 245(1). p.9-104
Abstract

OBJECTIVE: To evaluate the survival of patients with pseudomyxoma peritonei (PMP) treated by cytoreductive surgery and intraoperative hyperthermic intraperitoneal chemotherapy (HIPEC), and to identify factors with prognostic value.

SUMMARY BACKGROUND DATA: PMP is a clinical syndrome characterized by progressive intraperitoneal accumulation of mucous and mucinous implants, usually derived from a ruptured mucinous neoplasm of the appendix. Survival is dominated by pathology.

METHODS: A total of 103 patients (34 men and 69 women) treated at The Netherlands Cancer Institute between 1996 and 2004 were identified. Survival was calculated from date of initial treatment and corrected for a second procedure. PMP was pathologically... (More)

OBJECTIVE: To evaluate the survival of patients with pseudomyxoma peritonei (PMP) treated by cytoreductive surgery and intraoperative hyperthermic intraperitoneal chemotherapy (HIPEC), and to identify factors with prognostic value.

SUMMARY BACKGROUND DATA: PMP is a clinical syndrome characterized by progressive intraperitoneal accumulation of mucous and mucinous implants, usually derived from a ruptured mucinous neoplasm of the appendix. Survival is dominated by pathology.

METHODS: A total of 103 patients (34 men and 69 women) treated at The Netherlands Cancer Institute between 1996 and 2004 were identified. Survival was calculated from date of initial treatment and corrected for a second procedure. PMP was pathologically categorized into disseminated peritoneal adenomucinosis (DPAM), peritoneal mucinous carcinomatosis (PMCA), and an intermediate subtype (PMCA-I). Clinical and pathologic factors were analyzed to identify their prognostic value for survival.

RESULTS: Median follow-up was 51.5 months (range, 0.1-99.5 months). Recurrence developed in 44%. A second procedure for recurrence was performed in 11 patients. The median disease-free interval was 25.6 months (95% confidence interval [CI], 14.8-43.6 months). The 3-year and 5-year disease-free survival probability was 43.6% (95% CI, 34.4%-55.2%) and 37.4% (95% CI, 28.2%-49.5%), respectively. The disease-specific 3-year and 5-year survival probability was 70.9% (95% CI, 62.0%-81.2%) and 59.5% (95% CI 48.7%-72.5%), respectively. Factors associated with survival were pathological subtype, completeness of cytoreduction, and degree and location of tumor load (P < 0.05). The main prognostic factor, independently associated with survival, was the pathologic subtype (P < 0.01).

CONCLUSION: Cytoreductive surgery in combination with intraoperative HIPEC is a feasible treatment strategy for PMP in terms of survival. The pathologic subtype remains the dominant factor in survival. Patients should be centralized to improve survival by a combination of surgical experience and adequate patient selection.

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author
; ; and
publishing date
type
Contribution to journal
publication status
published
subject
keywords
Adult, Aged, Antineoplastic Agents/administration & dosage, Combined Modality Therapy, Female, Follow-Up Studies, Humans, Hyperthermia, Induced, Infusions, Parenteral, Male, Middle Aged, Peritoneal Neoplasms/drug therapy, Pseudomyxoma Peritonei/drug therapy, Retrospective Studies, Survival Rate, Treatment Outcome
in
Annals of Surgery
volume
245
issue
1
pages
9 - 104
publisher
Lippincott Williams & Wilkins
external identifiers
  • scopus:33845934133
  • pmid:17197972
ISSN
0003-4932
DOI
10.1097/01.sla.0000231705.40081.1a
language
English
LU publication?
no
id
d1f16659-ce9d-4a4d-8cfa-1671fe01bd31
date added to LUP
2022-04-12 09:53:25
date last changed
2024-04-23 00:01:03
@article{d1f16659-ce9d-4a4d-8cfa-1671fe01bd31,
  abstract     = {{<p>OBJECTIVE: To evaluate the survival of patients with pseudomyxoma peritonei (PMP) treated by cytoreductive surgery and intraoperative hyperthermic intraperitoneal chemotherapy (HIPEC), and to identify factors with prognostic value.</p><p>SUMMARY BACKGROUND DATA: PMP is a clinical syndrome characterized by progressive intraperitoneal accumulation of mucous and mucinous implants, usually derived from a ruptured mucinous neoplasm of the appendix. Survival is dominated by pathology.</p><p>METHODS: A total of 103 patients (34 men and 69 women) treated at The Netherlands Cancer Institute between 1996 and 2004 were identified. Survival was calculated from date of initial treatment and corrected for a second procedure. PMP was pathologically categorized into disseminated peritoneal adenomucinosis (DPAM), peritoneal mucinous carcinomatosis (PMCA), and an intermediate subtype (PMCA-I). Clinical and pathologic factors were analyzed to identify their prognostic value for survival.</p><p>RESULTS: Median follow-up was 51.5 months (range, 0.1-99.5 months). Recurrence developed in 44%. A second procedure for recurrence was performed in 11 patients. The median disease-free interval was 25.6 months (95% confidence interval [CI], 14.8-43.6 months). The 3-year and 5-year disease-free survival probability was 43.6% (95% CI, 34.4%-55.2%) and 37.4% (95% CI, 28.2%-49.5%), respectively. The disease-specific 3-year and 5-year survival probability was 70.9% (95% CI, 62.0%-81.2%) and 59.5% (95% CI 48.7%-72.5%), respectively. Factors associated with survival were pathological subtype, completeness of cytoreduction, and degree and location of tumor load (P &lt; 0.05). The main prognostic factor, independently associated with survival, was the pathologic subtype (P &lt; 0.01).</p><p>CONCLUSION: Cytoreductive surgery in combination with intraoperative HIPEC is a feasible treatment strategy for PMP in terms of survival. The pathologic subtype remains the dominant factor in survival. Patients should be centralized to improve survival by a combination of surgical experience and adequate patient selection.</p>}},
  author       = {{Smeenk, Robert M and Verwaal, Vic J and Antonini, Ninja and Zoetmulder, Frans A N}},
  issn         = {{0003-4932}},
  keywords     = {{Adult; Aged; Antineoplastic Agents/administration & dosage; Combined Modality Therapy; Female; Follow-Up Studies; Humans; Hyperthermia, Induced; Infusions, Parenteral; Male; Middle Aged; Peritoneal Neoplasms/drug therapy; Pseudomyxoma Peritonei/drug therapy; Retrospective Studies; Survival Rate; Treatment Outcome}},
  language     = {{eng}},
  number       = {{1}},
  pages        = {{9--104}},
  publisher    = {{Lippincott Williams & Wilkins}},
  series       = {{Annals of Surgery}},
  title        = {{Survival analysis of pseudomyxoma peritonei patients treated by cytoreductive surgery and hyperthermic intraperitoneal chemotherapy}},
  url          = {{http://dx.doi.org/10.1097/01.sla.0000231705.40081.1a}},
  doi          = {{10.1097/01.sla.0000231705.40081.1a}},
  volume       = {{245}},
  year         = {{2007}},
}