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

Eur J Surg Oncol. 2019 Dec;45(12):2392-2397. doi: 10.1016/j.ejso.2019.06.015. Epub 2019 Jun 22.

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.

MeSH terms

  • Appendiceal Neoplasms / mortality
  • Appendiceal Neoplasms / pathology*
  • Appendiceal Neoplasms / therapy*
  • Chemotherapy, Cancer, Regional Perfusion
  • Combined Modality Therapy
  • Cytoreduction Surgical Procedures
  • Female
  • Humans
  • Male
  • Middle Aged
  • Neoplasm Recurrence, Local / mortality
  • Neoplasm Recurrence, Local / pathology*
  • Peritoneal Neoplasms / mortality
  • Peritoneal Neoplasms / secondary*
  • Peritoneal Neoplasms / therapy*
  • Prognosis
  • Retrospective Studies
  • Survival Rate