Shigeki Kusamura1, Francesco Barretta2, Yutaka Yonemura3, Paul Hendrick Sugarbaker4, Brendan John Moran5, Edward A Levine6, Diane Goere7, Dario Baratti1, Eran Nizri1,8, David Lawson Morris9, Olivier Glehen10, Armando Sardi11, Pedro Barrios12, François Quénet13, Laurent Villeneuve14, Alberto Gómez-Portilla15,16,17, Ignace de Hingh18, Wim Ceelen19, Joerg O W Pelz20, Pompiliu Piso21, Santiago González-Moreno22, Kurt Van Der Speeten23, Marcello Deraco1. 1. Peritoneal Surface Malignancies Unit, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Istituto Nazionale Tumori dei Tumori di Milano, Milano, Italy. 2. Clinical Epidemiology and Trial Organization Unit, Fondazione IRCCS Istituto Nazionale Tumori dei Tumori di Milano, Milano, Italy. 3. Nonprofit Organization to Support Peritoneal Surface Malignancy Treatment, Kishiwada, Japan. 4. Washington Cancer Institute, Washington Hospital Center, Washington, DC. 5. Basingstoke and North Hampshire National Health Service Foundation Trust, Basingstoke, United Kingdom. 6. Surgical Oncology Service, Wake Forest University Baptist Medical Center, Winston-Salem, North Carolina. 7. Department of Visceral and Oncologic Surgery, Hôpital Saint-Louis, Assistance Publique-Hôpitaux de Paris, Paris, France. 8. fellow at European School of Peritoneal Surface Oncology, Milano, Italy. 9. Hepatobiliary and Surgical Oncology Unit, Department of Surgery, University of New South Wales, St George Hospital, Sydney, Australia. 10. Department of Digestive Surgery, Centre Hospitalo-Universitaire Lyon-Sud, Hospices Civils de Lyon, Lyon, France. 11. Division of Surgery, Department of Surgical Oncology, The Institute for Cancer Care, Mercy Medical Center, Baltimore, Maryland. 12. Department of Oncological Surgery, Hospital Sant Joan Despí, Moises Broggi, Peritoneal Surface Malignancy Catalonian's Programme, Sant Joan Despí, Barcelona, Spain. 13. Centre Régional de Lutte Contre le Cancer Val d'Aurell, Montpellier, France. 14. Réseau National de Prise en Charge des Tumeurs Rares du Péritoine, French National Registry of Rare Peritoneal Surface Malignancies, Lyon, France. 15. Department of General Surgery, Hospital Universitario de Araba, Hospital Universitario Araba Sede Hospital Santiago, Santiago, Spain. 16. Departamento de Cirugía General, Universidad del País Vasco, Vitoria, Spain. 17. Programa de Carcinomatosis Peritoneal, Hospital San José, Vitoria, Spain. 18. Department of Surgery, Catharina Hospital, Eindhoven, the Netherlands. 19. Department of Gastrointestinal Surgery, Ghent University Hospital, Ghent, Belgium. 20. Department of Surgery I, University of Wuerzburg, Wuerzburg, Germany. 21. Department of General and Visceral Surgery, Krankenhaus Barmherzige Brüder, Regensburg, Germany. 22. Peritoneal Surface Oncology Program, Department of Surgical Oncology, MD Anderson Cancer Center, Madrid, Spain. 23. Department of Surgical Oncology, Ziekenhuis Oost-Limburg, Genk, Belgium.
Abstract
Importance: Studies on the prognostic role of hyperthermic intraperitoneal chemotherapy (HIPEC) in pseudomyxoma peritonei (PMP) are currently not available. Objectives: To evaluate outcomes after cytoreductive surgery (CRS) and HIPEC compared with CRS alone in patients with PMP. Design, Setting, and Participants: This cohort study analyzed data from the Peritoneal Surface Oncology Group International (PSOGI) registry, including 1924 patients with histologically confirmed PMP due to an appendiceal mucinous neoplasm. Eligible patients were treated with CRS with or without HIPEC from February 1, 1993, to December 31, 2017, and had complete information on the main prognostic factors and intraperitoneal treatments. Inverse probability treatment weights based on the propensity score for HIPEC treatment containing the main prognostic factors were applied to all models to balance comparisons between the CRS-HIPEC vs CRS-alone groups in the entire series and in the following subsets: optimal cytoreduction, suboptimal cytoreduction, high- and low-grade histologic findings, and different HIPEC drug regimens. Data were analyzed from March 1 to June 1, 2018. Interventions: HIPEC including oxaliplatin plus combined fluorouracil-leucovorin, cisplatin plus mitomycin, mitomycin, and other oxaliplatin-based regimens. Main Outcomes and Measures: Overall survival, severe morbidity (determined using the National Cancer Institute Common Terminology for Adverse Events, version 3.0), return to operating room, and 30- and 90-day mortality. Differences in overall survival were compared using weighted Kaplan-Meier curves, log-rank tests, and Cox proportional hazards multivariable models. A sensitivity analysis was based on the E-value from the results of the main Cox proportional hazards model. Differences in surgical outcomes were compared using weighted multivariable logistic models. Results: Of the 1924 patients included in the analysis (997 [51.8%] men; median age, 56 [interquartile range extremes (IQRE), 45-65] years), 376 were in the CRS-alone group and 1548 in the CRS-HIPEC group. Patients with CRS alone were older (median age, 60 [IQRE, 48-70] vs 54 [IQRE, 44-63] years), had less lymph node involvement (14 [3.7%] vs 119 [7.7%]), received more preoperative systemic chemotherapy (198 [52.7%] vs 529 [34.2%]), and had higher proportions of high-grade disease (179 [47.6%] vs 492 [31.8%]) and suboptimal cytoreduction residual disease (grade 3, 175 [46.5%] vs 117 [7.6%]). HIPEC was not associated with a higher risk of worse surgical outcomes except with mitomycin, with higher odds of morbidity (1.99; 95% CI, 1.25-3.19; P = .004). HIPEC was associated with a significantly better overall survival in all subsets (adjusted hazard ratios [HRs], 0.60-0.68, with 95% CIs not crossing 1.00). The weighted 5-year overall survival was 57.8% (95% CI, 50.8%-65.7%) vs 46.2% (95% CI, 40.3%-52.8%) for CRS-HIPEC and CRS alone, respectively (weighted HR, 0.65; 95% CI, 0.50-0.83; P < .001; E-value, 2.03). Such prognostic advantage was associated with oxaliplatin plus fluorouracil-leucovorin (HR, 0.42; 95% CI, 0.19-0.93; P = .03) and cisplatin plus mitomycin (HR, 0.57; 95% CI, 0.42-0.78; P = .001) schedules. Conclusions and Relevance: In this cohort study, HIPEC was associated with better overall survival when performed after CRS in PMP, generally without adverse effects on surgical outcomes.
Importance: Studies on the prognostic role of hyperthermic intraperitoneal chemotherapy (HIPEC) in pseudomyxoma peritonei (PMP) are currently not available. Objectives: To evaluate outcomes after cytoreductive surgery (CRS) and HIPEC compared with CRS alone in patients with PMP. Design, Setting, and Participants: This cohort study analyzed data from the Peritoneal Surface Oncology Group International (PSOGI) registry, including 1924 patients with histologically confirmed PMP due to an appendiceal mucinous neoplasm. Eligible patients were treated with CRS with or without HIPEC from February 1, 1993, to December 31, 2017, and had complete information on the main prognostic factors and intraperitoneal treatments. Inverse probability treatment weights based on the propensity score for HIPEC treatment containing the main prognostic factors were applied to all models to balance comparisons between the CRS-HIPEC vs CRS-alone groups in the entire series and in the following subsets: optimal cytoreduction, suboptimal cytoreduction, high- and low-grade histologic findings, and different HIPEC drug regimens. Data were analyzed from March 1 to June 1, 2018. Interventions: HIPEC including oxaliplatin plus combined fluorouracil-leucovorin, cisplatin plus mitomycin, mitomycin, and other oxaliplatin-based regimens. Main Outcomes and Measures: Overall survival, severe morbidity (determined using the National Cancer Institute Common Terminology for Adverse Events, version 3.0), return to operating room, and 30- and 90-day mortality. Differences in overall survival were compared using weighted Kaplan-Meier curves, log-rank tests, and Cox proportional hazards multivariable models. A sensitivity analysis was based on the E-value from the results of the main Cox proportional hazards model. Differences in surgical outcomes were compared using weighted multivariable logistic models. Results: Of the 1924 patients included in the analysis (997 [51.8%] men; median age, 56 [interquartile range extremes (IQRE), 45-65] years), 376 were in the CRS-alone group and 1548 in the CRS-HIPEC group. Patients with CRS alone were older (median age, 60 [IQRE, 48-70] vs 54 [IQRE, 44-63] years), had less lymph node involvement (14 [3.7%] vs 119 [7.7%]), received more preoperative systemic chemotherapy (198 [52.7%] vs 529 [34.2%]), and had higher proportions of high-grade disease (179 [47.6%] vs 492 [31.8%]) and suboptimal cytoreduction residual disease (grade 3, 175 [46.5%] vs 117 [7.6%]). HIPEC was not associated with a higher risk of worse surgical outcomes except with mitomycin, with higher odds of morbidity (1.99; 95% CI, 1.25-3.19; P = .004). HIPEC was associated with a significantly better overall survival in all subsets (adjusted hazard ratios [HRs], 0.60-0.68, with 95% CIs not crossing 1.00). The weighted 5-year overall survival was 57.8% (95% CI, 50.8%-65.7%) vs 46.2% (95% CI, 40.3%-52.8%) for CRS-HIPEC and CRS alone, respectively (weighted HR, 0.65; 95% CI, 0.50-0.83; P < .001; E-value, 2.03). Such prognostic advantage was associated with oxaliplatin plus fluorouracil-leucovorin (HR, 0.42; 95% CI, 0.19-0.93; P = .03) and cisplatin plus mitomycin (HR, 0.57; 95% CI, 0.42-0.78; P = .001) schedules. Conclusions and Relevance: In this cohort study, HIPEC was associated with better overall survival when performed after CRS in PMP, generally without adverse effects on surgical outcomes.
Authors: L Martín Román; P Lozano; D Baratti; S Kusamura; M Deraco; W Vásquez; L González Bayón Journal: Ann Surg Oncol Date: 2022-07-25 Impact factor: 4.339
Authors: Nima Ahmadi; Danko Kostadinov; Shinichiro Sakata; William Robert Ball; Jamish Gandhi; Norman John Carr; Alexios Tzivanakis; Sanjeev Paul Dayal; Faheez Mohamed; Thomas Desmond Cecil; Brendan John Moran Journal: Ann Surg Oncol Date: 2021-05-26 Impact factor: 5.344
Authors: Álvaro Arjona-Sánchez; Ana Martínez-López; Francisca Valenzuela-Molina; Blanca Rufián-Andújar; Sebastián Rufián-Peña; Ángela Casado-Adam; Juan Manuel Sánchez-Hidalgo; Lidia Rodríguez-Ortiz; Francisco Javier Medina-Fernández; Cesar Díaz-López; Melissa Granados-Rodríguez; Rosa Ortega-Salas; Justo P Castaño; Manuel Tena-Sempere; Javier Briceño-Delgado; Antonio Romero-Ruíz Journal: Ann Surg Oncol Date: 2021-07-02 Impact factor: 5.344