PSEUDOMYXOMA PERITONEI: PATHOLOGICAL CLASSIFICATION AND CLINICAL OUTCOME OF PATIENTS TREATED BY CYTOREDUCTIVE SURGERY AND HYPERTHERMIC INTRAPERITONEAL CHEMOTHERAPY
Andre Lopes*, Evandro S. Mello, Rossana Veronica Mendoza Lopez, Paulo C. Leonardi, Ulysses Ribeiro
Gastroenterology Department, Digestive Surgery Division, Universidade de Sao Paulo, Sao Paulo, Brazil
Classification of pseudomyxoma peritonei is controversial and association of pathologic features with prognosis is unclear. Aim: Pathologic review of peritoneal metastasis and association with overall survival and disease-free survival. Secondary objective was associate preoperative serum levels of CEA, CA 19 9 and CA-125 with overall survival, sensitivity and specificity for CC0-1 cytoreduction. Methods: Retrospective cohort study of patients treated by cytoreductive surgery and hyperthermic intraperitoneal chemotherapy. Pathology review was performed in all cases and peritoneal disease was classified as low-grade, high-grade, signet-ring cells and acellular mucin. Results: Seventy-two patients were included. Peritoneal disease was low-grade in 41 (57%), high-grade in 21 (29%) and 10 (14%) had acellular mucin. Forty-four (61%) underwent CC0-1 cytoreduction, and 28 (39%) underwent CC2-3. Acellular mucin and low-grade tumors were associated with longer disease-free survival, p = 0.02. CC0-1 cytoreduction was associated with longer survival, 122.80 months (95% CI 95.38-150.23) p <0.0001. Patients with elevated CA 19-9 had worse overall survival, 36,8 months (95% CI 23.05-50,73) p<0,001. Normal CEA (5,0 U / ml) was associated with 100% sensibility of achieving CC0-1, while CA 19 9 level of 625 U/ml was associated with low possibility (21% sensitivity and 100% specificity). CONCLUSIONS: Histological grade was associated with better disease-free survival in patients who underwent CC0-1 cytoreduction. Preoperative normal CA 19 9 was associated with better overall survival. CEA and CA 19 9 can be good predictors of the possibility of achieving CC0-1. CC0-1 cytoreduction is the main determinant of longer survival.
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