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Validation of the Recent PSOGI Pathological Classification of Pseudomyxoma Peritonei in a Single-Center Series of 265 Patients Treated by Cytoreductive Surgery and Hyperthermic Intraperitoneal Chemotherapy

  • Colorectal Cancer
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Abstract

Background

Controversies still persist regarding the terminology and pathologic classification of appendiceal mucinous neoplasms and associated pseudomyxoma peritonei (PMP). We assessed reproducibility and prognostic significance of the classification recently proposed by the Peritoneal Surface Oncology Group International (PSOGI).

Methods

A prospective database of 265 PMP patients uniformly treated by cytoreductive surgery and hyperthermic intraperitoneal chemotherapy (CRS/HIPEC) from 1995 to 2017 was reviewed. According to the PSOGI, peritoneal disease was retrospectively classified into three categories: low-grade (LG-PMP), high-grade (HG-PMP), and signet-ring cells (SRC-PMP). Acellular mucin (AC) was classified separately. The extent of peritoneal involvement was quantified by the peritoneal cancer index (PCI).

Results

Twenty-six patients were diagnosed with AC (9.8%), 197 with LG-PMP (74.4%), 38 with HG-PMP (14.3%), and 4 with SRC-PMP (1.5%). In the overall series, median follow-up was 65.5 months (95% confidence interval 53.7–78.8) and 10-year overall survival was 62.9% (median 148.7 months). Operative death occurred in 10 patients (3.8%) and major complications occurred in 89 patients (33.6%). Ten-year survival was 89.6% for AC, 63.2% for LG-PMP, 40.1% for HG-PMP, and 0 for SRC-PMP. In a multivariate model, the World Health Organization (WHO) pathological classification independently correlated with survival (p = 0.028). In a separate model, the PSOGI classification did not reach statistical significance (p = 0.149). Completeness of cytoreduction and PCI > 22 correlated with prognosis in both models.

Conclusions

AC and SRC-PMP pathological categories of the PSOGI classification identified two subsets of patients with favorable and exceedingly dismal prognosis, respectively. It remains unclear whether the PSOGI classification might provide better prognostic stratification than the current WHO classification. Further studies in larger prospective series are needed.

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Acknowledgments

This study was supported, in part, by grants from the Italian Association for Cancer Research (AIRC) and the Italian Health Minister.

Disclosure

The authors have no financial interests to disclose.

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Authors and Affiliations

  1. Peritoneal Malignancy Program, Department of Surgery, National Cancer Institute, Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy

    Dario Baratti MD, Shigeki Kusamura PhD, Federica Bruno MD, Marcello Guaglio MD & Marcello Deraco MD

  2. Department of Pathology, National Cancer Institute, Milan, Italy

    Massimo Milione MD

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  1. Dario Baratti MD
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  2. Shigeki Kusamura PhD
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  3. Massimo Milione MD
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  4. Federica Bruno MD
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  6. Marcello Deraco MD
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Correspondence to Dario Baratti MD.

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Baratti, D., Kusamura, S., Milione, M. et al. Validation of the Recent PSOGI Pathological Classification of Pseudomyxoma Peritonei in a Single-Center Series of 265 Patients Treated by Cytoreductive Surgery and Hyperthermic Intraperitoneal Chemotherapy. Ann Surg Oncol 25, 404–413 (2018). https://doi.org/10.1245/s10434-017-6252-1

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