Early recurrence of pseudomyxoma peritonei following treatment failure of cytoreductive surgery and perioperative intraperitoneal chemotherapy is indicative of a poor survival outcome
Early recurrence of pseudomyxoma peritonei following treatment failure of cytoreductive surgery and perioperative intraperitoneal chemotherapy is indicative of a poor survival outcome
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DOI：
10.1007/s00384-011-1303-8
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发表时间：
2012-03-01
影响因子：
2.8
通讯作者：
Morris, David L.
中科院分区：
文献类型：
--
作者：
Chua, Terence C.;Liauw, Winston;Morris, David L.
本研究的目的是确定早期复发的预测因素，以优化预后。通过单因素和多因素分析，对早期复发（千分之一货币符号12个月）和晚期复发（千分之一货币符号12个月）患者的临床病理因素进行比较，以确定治疗失败的预测因素。使用Kaplan-Meier法估计生存参数。共有113例PCI中位值为24（范围2-39）的患者接受了细胞减少手术。中位无进展生存期和总生存期分别为48个月和104个月。多变量分析发现，术前手术、每千分之一单位新鲜冷冻血浆（FFP）输注、不完全细胞减少和诊断后12个月内未接受明确的细胞减少手术是疾病复发的预测因素。41例患者中有20例（49%）出现早期复发。早期复发患者的中位总生存期为38个月，未早期复发患者的中位总生存期为97个月（P = 0.002）。亚组分析发现，男性（P = 0.028）、CA 125升高（P = 0.037）、癌胚胎抗原（CEA）、CA 125和CA 19-9升高（P = 0.029）、腹膜癌指数>5 （P = 0.020）、细胞不完全减少（P = 0.020）、>输血6单位（P = 0.020）和>输血10单位（P = 0.009）是早期复发的相关因素。腹膜假性黏液瘤的早期复发，尽管达到肿瘤最佳的细胞减少率很高。本研究中发现的与早期复发相关的临床病理因素可能会告诉我们在细胞减少后随访中治疗失败风险最大的患者。
The aim of this study was to identify predictors of early recurrence to optimize outcomes.A comparison of clinicopathological factors between patients who developed early recurrence (a parts per thousand currency sign12 months) and late recurrence (> 12 months) was performed to identify predictors of treatment failure through univariate and multivariate analyses. Survival parameters were estimated using the Kaplan-Meier method.A total of 113 patients with a median PCI of 24 (range, 2-39) underwent cytoreductive surgery. The median progression-free and overall survival was 48 and 104 months, respectively. Multivariate analysis identified prior operations > 1, a parts per thousand yen10 units of fresh frozen plasma (FFP) transfusion, incomplete cytoreduction and not undergoing definitive cytoreductive surgery within 12 months of diagnosis as predictors for disease recurrence. Twenty of 41 patients (49%) developed early recurrence. The median overall survival of patients who developed early recurrence was 38 months and in patients who did not develop early recurrence was 97 months (P = 0.002). Subgroup analysis of patients with recurrence identified the male gender (P = 0.028), elevated CA 125 (P = 0.037), having elevated carcinoembryonic antigen (CEA), CA 125 and CA 19-9 (P = 0.029), peritoneal cancer index > 25 (P = 0.020), incomplete cytoreduction (P = 0.020), > 6 units of blood transfusion (P = 0.020) and > 10 units of FFP transfusion (P = 0.009) as factors associated with early recurrence.Early recurrence of pseudomyxoma peritonei occurs despite achieving high rates of oncologically optimal cytoreduction. The clinicopathologic factors associated with early recurrence identified in this study may inform us about patients at greatest risk of treatment failure during the post cytoreduction follow-up.