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Eur J Surg Oncol. 2019 Jun 22. pii: S0748-7983(19)30509-8. doi: 10.1016/j.ejso.2019.06.015. [Epub ahead of print]

Early recurrence in peritoneal metastasis of appendiceal neoplasm: Survival and prognostic factors.

Author information

1
Department of Surgery, St George Hospital & University of New South Wales, Sydney, New South Wales, Australia. Electronic address: lees.kyang@gmail.com.
2
Department of Surgery, St George Hospital & University of New South Wales, Sydney, New South Wales, Australia; College of Medicine, Imam Muhammad Ibn Saud Islamic University (IMSIU), Riyadh, Saudi Arabia.
3
Department of Surgery, St George Hospital & University of New South Wales, Sydney, New South Wales, Australia.
4
Department of Medical Oncology, St George Hospital & University of New South Wales, Department of Surgery, Sydney, NSW, Australia; Cancer Care Centre, St George Hospital, Sydney, NSW, Australia.

Abstract

INTRODUCTION:

Early recurrence (ER) is defined as development of loco-regional peritoneal disease within 12-month of the initial CRS/PIC. Our aims were to identify overall survival (OS), recurrence-free survival (RFS) and independent prognostic factors associated with ER in PM of appendiceal neoplasm.

MATERIALS AND METHODS:

A prospectively-maintained database for patients with appendiceal neoplasm undergoing cytoreductive surgery (CRS) and perioperative intraperitoneal chemotherapy (PIC) from year 1996-2018 was retrospectively analysed.

RESULTS:

208 female and 185 male patients were identified. With a median follow-up of 40-month, 40.2% of the patients developed ER. The median OS for ER was 24 months compared to late (LR) at 64 months. Median OS was not reached in non-recurrence (NR). 5-year survival for ER was less favourable compared to LR and NR (19.3%vs54.6%vs94%). No patients in ER group survived beyond 10-year. Independent negative predictors associated with ER on multivariate analysis were male patient (p = 0.013), blood transfusion of >8 units (p = 0.013), elevated preoperative CEA levels (>5 ng/ml; p = 0.002) and hard intraoperative tumour consistency (p < 0.001). Protective factor was a combination of CC1, hard tumour consistency and use of EPIC (p = 0.039). Independent prognostic factors that predicted recurrence of appendiceal PM were PCI >20 (p = 0.049), non-use of EPIC (p = 0.012), hard tumour consistency (p = 0.004) and use of previous chemotherapy (p = 0.023).

CONCLUSION:

ER following CRS and PIC of appendiceal PM is associated with reduced survival outcomes. Our data alludes to the importance of optimising the risk factors in order to delay loco-regional recurrence and improve long-term survival of these patients.

KEYWORDS:

Appendiceal neoplasm; Cytoreductive surgery; Early recurrence; Intraperitoneal chemotherapy; Peritoneal metastasis; Prognostic factors

PMID:
31253546
DOI:
10.1016/j.ejso.2019.06.015

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