内容紹介
Summary
Background and objectives: Treatment failure after complete cytoreduction for appendiceal mucinous carcinoma peritonei(AMCP)has not been fully investigated. The present study was performed to clarify the risk factor for recurrence after complete cytoreduction for AMCP. Methods: A total of 400 patients with AMCP who underwent complete cytoreductive surgery combined with perioperative chemotherapy were investigated. Results: Documented recurrence was developed in 135(33.8%)patients. The 5- and 10-year progression-free survival was 51% and 49%, respectively. By multivariate analysis, histological subtype of peritoneal disease(high-grade AMCP[AMCP-H]and AMCP-H with signet ring cells), serum CA19-9 level, and PCI≥20 were significantly associated with reduced progression-free survival. In contrast, histologic subtype of mucin without epithelial cells(MWEC)showed the lowest risk for recurrence. Eighty-six patients had localized intra-abdominal recurrence, and 42 patients had diffuse peritoneal recurrence. Recurrence was found in the various peritoneal sectors. Eighty-one patients underwent complete cytoreduction for the recurrence, and the overall survival 5-year survival rate after secondary cytoreduction was 49%. Conclusions: Risk factors for recurrence were histologic subtype, PCI cutoff level, and serum CA19-9 levels. Aggressive second attempt of cytoreduction in patients with localized recurrence improved the survival.
要旨
虫垂由来の腹膜偽粘液腫(AMCP)に対する腹膜切除と温熱化学療法(HIPEC)は現在世界の標準治療である。しかしAMCP完全切除後(CCR-0)の再発やそのリスクファクターは十分解明されていない。対象・方法: 腹膜播種を完全に切除したAMCP 400例の術後再発形式を解析した。結果: 再発は135例(33.8%)にみられた。5・10年無増悪生存率は51%・49%であった。多変量解析で組織亜型[high-grade AMCP(AMCP-H),AMCP-H with signet ring cells],術前血清CA19-9>37,PCI≧20が有意に無増悪生存率を低下させる因子であった。一方,無細胞性腹水は再発低リスク群であった。再発135例のうち86例は限局性腹腔内再発,42例は多発性再発であった。再発は腹腔内の様々な部位に認められた。81例に再発巣の完全切除が行われ,再手術後の5年生存率は49%であった。一方,不完全切除例や非切除例は5年以内に全例死亡した。考察: 再発関連因子は組織亜型・PCI cut-off値・術前血清CA19-9値であった。限局性再発に対し積極的に再切除を行うことが予後改善につながる。
目次
癌と化学療法 TOPへ
癌と化学療法 46巻2号 2019年2月号トップへ
【原著】
▶Analysis of Treatment Failure after Complete Cytoreductive Surgery for Peritoneal Metastasis from Appendiceal Mucinous Neoplasm at a Japanese High Volume Center for Peritoneal Surface Malignancy 米村 豊ほか
Background and objectives: Treatment failure after complete cytoreduction for appendiceal mucinous carcinoma peritonei(AMCP)has not been fully investigated. The present study was performed to clarify the risk factor for recurrence after complete cytoreduction for AMCP. Methods: A total of 400 patients with AMCP who underwent complete cytoreductive surgery combined with perioperative chemotherapy were investigated. Results: Documented recurrence was developed in 135(33.8%)patients. The 5- and 10-year progression-free survival was 51% and 49%, respectively. By multivariate analysis, histological subtype of peritoneal disease(high-grade AMCP[AMCP-H]and AMCP-H with signet ring cells), serum CA19-9 level, and PCI≥20 were significantly associated with reduced progression-free survival. In contrast, histologic subtype of mucin without epithelial cells(MWEC)showed the lowest risk for recurrence. Eighty-six patients had localized intra-abdominal recurrence, and 42 patients had diffuse peritoneal recurrence. Recurrence was found in the various peritoneal sectors. Eighty-one patients underwent complete cytoreduction for the recurrence, and the overall survival 5-year survival rate after secondary cytoreduction was 49%. Conclusions: Risk factors for recurrence were histologic subtype, PCI cutoff level, and serum CA19-9 levels. Aggressive second attempt of cytoreduction in patients with localized recurrence improved the survival.
要旨
虫垂由来の腹膜偽粘液腫(AMCP)に対する腹膜切除と温熱化学療法(HIPEC)は現在世界の標準治療である。しかしAMCP完全切除後(CCR-0)の再発やそのリスクファクターは十分解明されていない。対象・方法: 腹膜播種を完全に切除したAMCP 400例の術後再発形式を解析した。結果: 再発は135例(33.8%)にみられた。5・10年無増悪生存率は51%・49%であった。多変量解析で組織亜型[high-grade AMCP(AMCP-H),AMCP-H with signet ring cells],術前血清CA19-9>37,PCI≧20が有意に無増悪生存率を低下させる因子であった。一方,無細胞性腹水は再発低リスク群であった。再発135例のうち86例は限局性腹腔内再発,42例は多発性再発であった。再発は腹腔内の様々な部位に認められた。81例に再発巣の完全切除が行われ,再手術後の5年生存率は49%であった。一方,不完全切除例や非切除例は5年以内に全例死亡した。考察: 再発関連因子は組織亜型・PCI cut-off値・術前血清CA19-9値であった。限局性再発に対し積極的に再切除を行うことが予後改善につながる。