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Background <p>Pseudomyxoma Peritonei is characterised by peritoneal metastasis from appendiceal mucinous neoplasms (AMN). The PSOGI classification (2016) categorises PMP into acellular mucin (AM), low-grade mucinous carcinoma peritonei (LGMCP), and high-grade mucinous carcinoma peritonei (HGMCP). This study aimed to determine long-term prognosis based on this classification.</p> Materials and methods <p>Pathology review from PMP patients with AMNs undergoing cytoreductive surgery and heated intraperitoneal chemotherapy (CRS + HIPEC) with curative intent over a 15-year period (2006–2021) was undertaken. Patients underwent standardised surveillance. Cox proportional hazards regression models, log-rank test, and Kaplan–Meier method were used to assess overall (OS) and disease-free survival (DFS) based on histopathological peritoneal metastasis grade. DFS was only calculated for patients who had a complete cytoreduction.</p> Results <p>290 PMP patients were identified (AM = 34%, LGMCP = 59%, HGMCP = 7%) with median follow-up of 49&#xa0;months. Median age was 59&#xa0;years (range: 22–79), M: F of 1:2.5, peritoneal cancer index median of 18 (range: 0–39). Univariate OS hazard ratio (HR) is 2.75 for LGMCP vs AM (95% CI: 1.05 –7.21, <i>p</i> &lt; 0.040) and 14.29 for HGMCP vs AM (95% CI: 3.92– 52.11, <i>p</i> &lt; 0.001). DFS HR = 5.15 for LGMCP (95% CI: 2.19–12.10, <i>p</i> &lt; 0.001) and 4.16 for HGMCP (95% CI: 1.03–16.80, <i>p</i> &lt; 0.045) with an overall peritoneal metastasis <i>p</i> value &lt; 0.001. Multivariate OS analysis showed that peritoneal histology for HGMCP remained a significant predictor of poor prognosis for OS (HR: 5.54, 95% CI: 1.32–23.25, <i>p</i> = 0.019), whilst LGMCP did not demonstrate a significant association (HR: 1.59, 95% CI: 0.59–4.26, <i>p</i> = 0.359).</p> Discussion <p>Peritoneal metastasis histopathological grade predicts outcome for patients with PMP from AMN following CRS + HIPEC independent of primary histology.</p>

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Peritoneal metastasis histological grade independently predicts outcome in pseudomyxoma peritonei treated with curative surgery

  • 期刊论文

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  • 发表日期：

    2026年1月20日

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  • Awen Hasan,
  • Bipasha Chakrabarty,
  • Christopher Kearsey,
  • Raghavendar Nagaraju,
  • Malcolm Wilson,
  • Andrew Renehan,
  • Rebecca Fish,
  • Paul Sutton,
  • Jonathan Wild,
  • Chelliah Selvasekar,
  • Hamish Clouston,
  • Jorge Barriuso,
  • Sarah Theresa O’Dwyer,
  • Omer Aziz

摘要

Background

Pseudomyxoma Peritonei is characterised by peritoneal metastasis from appendiceal mucinous neoplasms (AMN). The PSOGI classification (2016) categorises PMP into acellular mucin (AM), low-grade mucinous carcinoma peritonei (LGMCP), and high-grade mucinous carcinoma peritonei (HGMCP). This study aimed to determine long-term prognosis based on this classification.

Materials and methods

Pathology review from PMP patients with AMNs undergoing cytoreductive surgery and heated intraperitoneal chemotherapy (CRS + HIPEC) with curative intent over a 15-year period (2006–2021) was undertaken. Patients underwent standardised surveillance. Cox proportional hazards regression models, log-rank test, and Kaplan–Meier method were used to assess overall (OS) and disease-free survival (DFS) based on histopathological peritoneal metastasis grade. DFS was only calculated for patients who had a complete cytoreduction.

Results

290 PMP patients were identified (AM = 34%, LGMCP = 59%, HGMCP = 7%) with median follow-up of 49 months. Median age was 59 years (range: 22–79), M: F of 1:2.5, peritoneal cancer index median of 18 (range: 0–39). Univariate OS hazard ratio (HR) is 2.75 for LGMCP vs AM (95% CI: 1.05 –7.21, p < 0.040) and 14.29 for HGMCP vs AM (95% CI: 3.92– 52.11, p < 0.001). DFS HR = 5.15 for LGMCP (95% CI: 2.19–12.10, p < 0.001) and 4.16 for HGMCP (95% CI: 1.03–16.80, p < 0.045) with an overall peritoneal metastasis p value < 0.001. Multivariate OS analysis showed that peritoneal histology for HGMCP remained a significant predictor of poor prognosis for OS (HR: 5.54, 95% CI: 1.32–23.25, p = 0.019), whilst LGMCP did not demonstrate a significant association (HR: 1.59, 95% CI: 0.59–4.26, p = 0.359).

Discussion

Peritoneal metastasis histopathological grade predicts outcome for patients with PMP from AMN following CRS + HIPEC independent of primary histology.