Objective: To evaluate the effect of tumor-stroma ratio (TSR) on disease progression and prognosis of pseudomyxoma peritonei (PMP) from the appendix.
Methods: The study included 30 PMP patients with complete individual patient data, who underwent cytoreductive surgery (CRS) plus hyperthermic intraperitoneal chemotherapy (HIPEC) in Beijing Shijitan Hospital. Image-Pro Plus was used to quantitatively analyze the proportion of tumor and stromal areas in hematoxylin-eosin staining pathological images, from which TSR was derived. Correlation studies were conducted to evaluate the relationships between TSR and clinicopathological features, immunohistochemical characteristics, and prognosis of PMP.
Results: Among 30 PMP patients, there were 16 males (53.3%) and 14 females (46.7%), with the mean age of (54.9±2.3) years. There were 15 cases (50.0%) of low-grade mucinous carcinoma peritonei (LMCP) and high-grade mucinous carcinoma peritonei (HMCP), respectively, with vascular tumor emboli occurring in 4 cases (13.3%), nerve invasion occurring in 3 cases (10.0%), and lymphatic metastasis occurring in 4 cases (13.3%). The median peritoneal cancer index (PCI) score was 36 (range: 3-39). The median TSR was 8% (range: 2%-24%), with TSR≤10% in 19 cases (63.3%) and TSR>10% in 11 cases (36.7%). Immunohistochemistry showed that 16 cases (53.3%) had Ki67 label index ≤ 50% and 14 cases (46.7%) > 50%. The mutation rate of p53 was 56.7% and the loss rate of MMR protein was 11.8%. In addition, the expression rates of MUC2, MUC5AC, CDX2, CK7, and CK20 were 66.7%, 100.0%, 82.6%, 56.0%, and 92.3%, respectively. There were significant correlations between TSR and histopathological types, nerve invasion, Ki67 label index, and p53 mutation (P<0.05 for all). At the end of the last follow-up, 21 patients (70.0%) died and 9 patients (30.0%) survived, including 6 patients survived with tumor. The median overall survival (OS) was 12.7 months (95%CI: 10.4-11.5 months), and the 1-, 2-, and 3-year survival rates were 60.5%, 32.3%, and 27.7%, respectively. The median OS was 19.4 months (95%CI: 3.0-35.9 months) in the TSR≤10% group, versus 12.6 months (95%CI: 0.7-24.5 months) in the TSR>10% group (χ2=3.996, P=0.046).
Conclusion: TSR is correlated with histopathological types, tumor proliferation, invasion behaviors and prognosis of PMP, thus could be a new prognostic indicator for PMP.
目的: 研究肿瘤间质比(tumor-stroma ratio,TSR)对腹膜假黏液瘤(pseudomyxoma peritonei,PMP)疾病进展及预后的影响.
方法: 收集北京世纪坛医院2015年6月至2019年6月行肿瘤细胞减灭术加腹腔热灌注化疗治疗,且病例资料完善的PMP患者,利用Image-Pro Plus定量研究其HE病理图像的TSR,分析TSR与PMP临床病理特征,免疫组织化学特征和预后的关系.
结果: 纳入30例PMP患者,男16例(53.3%),女14例(46.7%),平均年龄(54.9 ± 2.3)岁;组织病理学分级为腹膜低级别黏液癌(low-grade mucinous carcinoma peritonei,LMCP)15例(50.0%)和腹膜高级别黏液癌(high-grade mucinous carcinoma peritonei,HMCP)15例(50.0%);脉管癌栓者4例(13.3%),神经侵犯者3例(10.0%),淋巴结转移者4例(13.3%);中位腹膜癌指数(peritoneal cancer index,PCI)评分36分(范围3~39分),中位TSR为8%(范围2%~24%),TSR≤10%者19例(63.3%),TSR>10%者11例(36.7%).免疫组织化学染色结果显示,Ki67标记率≤50%者16例(53.3%),>50%者14例(46.7%);p53突变率为56.7%;错配修复(mismatch repair,MMR)基因相关蛋白缺失率为11.8%;MUC2,MUC5AC,CDX2,CK7与CK20的表达率分别为66.7%,100.0%,82.6%,56.0%和92.3%.TSR与组织病理学分级,神经侵犯,Ki67标记率,p53突变密切相关(P<0.05).截至末次随访时间,21例(70.0%)患者死亡,9例(30.0%)患者存活,其中6例患者带瘤生存.患者中位生存期为12.7个月(95%CI:10.4~11.5个月),1,2,3年生存率分别为60.5%,32.3%,27.7%.生存分析显示,中位总生存期在TSR≤10%组为19.4个月(95%CI:3.0~35.9个月),TSR>10%组为12.6个月(95%CI:0.7~24.5个月),差异有统计学意义(χ 2 = 3.996,P=0.046).