Long term outcomes associated with the use of perioperative systemic chemotherapy on low grade appendiceal mucinous neoplasms with pseudomyxoma peritonei treated with cytoreductive surgery and hyperthermic intraperitoneal chemotherapy
IntroductionLow grade appendiceal mucinous neoplasms (LAMN) are indolent tumors that lack invasive potential but may present as pseudomyxoma peritonei. Cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) significantly improves both overall and recurrence free survival....
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Frontiers Media S.A.
2025-01-01
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| Series: | Frontiers in Oncology |
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| Online Access: | https://www.frontiersin.org/articles/10.3389/fonc.2024.1456920/full |
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| author | Samantha M. Ruff Gyulnara Kasumova Manoj Palavalli Oliver S. Eng Laura Lambert Callisia Clarke Sameer Patel Jula Veerapong Keith Fournier Daniel Abbott Charles Staley Travis Grotz Fabian Johnston Mustafa Raoof Sean Dineen Jordan M. Cloyd Alex C. Kim |
| author_facet | Samantha M. Ruff Gyulnara Kasumova Manoj Palavalli Oliver S. Eng Laura Lambert Callisia Clarke Sameer Patel Jula Veerapong Keith Fournier Daniel Abbott Charles Staley Travis Grotz Fabian Johnston Mustafa Raoof Sean Dineen Jordan M. Cloyd Alex C. Kim |
| author_sort | Samantha M. Ruff |
| collection | DOAJ |
| description | IntroductionLow grade appendiceal mucinous neoplasms (LAMN) are indolent tumors that lack invasive potential but may present as pseudomyxoma peritonei. Cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) significantly improves both overall and recurrence free survival. While systemic chemotherapy is generally considered ineffective for LAMN, little literature is available to support this notion. We evaluated outcomes for individuals with LAMN who did and did not receive systemic chemotherapy in combination with CRS+HIPEC.MethodsA multicenter retrospective cohort study was performed using the US HIPEC Collaborative that included patients with LAMN who underwent CRS+HIPEC. The overall survival (OS) and recurrence-free survival (RFS) of patients who did and did not receive systemic chemotherapy were compared. Survival and variables associated with survival were evaluated with the Kaplan-Meier analysis and cox regression, respectively.ResultsAmong the 529 included patients with LAMN, 63 (11.9%) received systemic chemotherapy and CRS+HIPEC, while 466 (88.1%) were treated with only CRS+HIPEC. Patients selected for systemic chemotherapy had a higher burden of disease (mean peritoneal cancer index: 18.8 +/- 8.6 versus 14.3 +/- 8.8, p<0.001). Patients who were not treated with chemotherapy had better mean OS and RFS (OS: 104.3 +/- 6.2 months, RFS: 84.9 +/- 6.6 months) compared to those who underwent systemic chemotherapy (OS: 70.2 +/- 6.8 months, RFS: 38 +/- 5.9 months, p<0.001). Increasing pre-operative CEA level (HR 1.012, p<0.001), higher completeness of cytoreduction score (reference CCR 0, CCR2 HR 34.175, p=0.001 and CCR3 HR 52.041, p=0.001), and treatment with systemic chemotherapy (HR 4.196, p=0.045) were associated with worse OS.ConclusionsIn this multicenter retrospective study, the receipt of perioperative chemotherapy was associated with worse long-term outcomes among patients with LAMN undergoing CRS-HIPEC. Systemic chemotherapy may lead to patient deconditioning and contribute to worse long-term outcomes. It should not be recommended outside of a clinical trial. |
| format | Article |
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| institution | Kabale University |
| issn | 2234-943X |
| language | English |
| publishDate | 2025-01-01 |
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| series | Frontiers in Oncology |
| spelling | doaj-art-6d8d46e4a2e140caacebf346bb63b4e42025-01-09T06:10:22ZengFrontiers Media S.A.Frontiers in Oncology2234-943X2025-01-011410.3389/fonc.2024.14569201456920Long term outcomes associated with the use of perioperative systemic chemotherapy on low grade appendiceal mucinous neoplasms with pseudomyxoma peritonei treated with cytoreductive surgery and hyperthermic intraperitoneal chemotherapySamantha M. Ruff0Gyulnara Kasumova1Manoj Palavalli2Oliver S. Eng3Laura Lambert4Callisia Clarke5Sameer Patel6Jula Veerapong7Keith Fournier8Daniel Abbott9Charles Staley10Travis Grotz11Fabian Johnston12Mustafa Raoof13Sean Dineen14Jordan M. Cloyd15Alex C. Kim16Department of Surgery, Division of Surgical Oncology, The Ohio State University Wexner Medical Center/James Comprehensive Cancer Center, Columbus, OH, United StatesDivision of Surgical Oncology, Department of Surgery, Central Maine Medical Center, Lewiston, ME, United StatesDepartment of Surgery, Division of Surgical Oncology, The Ohio State University Wexner Medical Center/James Comprehensive Cancer Center, Columbus, OH, United StatesDepartment of Surgical Oncology, University of California Irvine Medical Center, Irvine, CA, United StatesDepartment of Surgical Oncology, University of Utah, Salt Lake City, UT, United StatesDepartment of Surgical Oncology, Medical College of Wisconsin, Milwaukee, WI, United StatesDepartment of Surgical Oncology, University of Cincinnati, Cincinnati, OH, United StatesDepartment of Surgical Oncology, University of California San Diego, San Diego, CA, United StatesDepartment of Surgical Oncology, MD Anderson Cancer Center, Houston, TX, United StatesDepartment of Surgical Oncology, University of Wisconsin Medical Center, Madison, WI, United States0Department of Surgical Oncology, Emory University Hospital, Atlanta, GA, United States1Department of Surgery, Mayo Clinic, Rochester, MN, United States2Department of Surgical Oncology, The Johns Hopkins University, Baltimore, MD, United States3Department of Surgical Oncology, City of Hope Cancer Center, Duarte, CA, United States4Department of Surgical Oncology, Moffitt Cancer Center, Tampa, FL, United StatesDepartment of Surgery, Division of Surgical Oncology, The Ohio State University Wexner Medical Center/James Comprehensive Cancer Center, Columbus, OH, United States5Department of Surgery, Division of Surgical Oncology, University of Texas Southwestern Medical Center, Dallas, TX, United StatesIntroductionLow grade appendiceal mucinous neoplasms (LAMN) are indolent tumors that lack invasive potential but may present as pseudomyxoma peritonei. Cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) significantly improves both overall and recurrence free survival. While systemic chemotherapy is generally considered ineffective for LAMN, little literature is available to support this notion. We evaluated outcomes for individuals with LAMN who did and did not receive systemic chemotherapy in combination with CRS+HIPEC.MethodsA multicenter retrospective cohort study was performed using the US HIPEC Collaborative that included patients with LAMN who underwent CRS+HIPEC. The overall survival (OS) and recurrence-free survival (RFS) of patients who did and did not receive systemic chemotherapy were compared. Survival and variables associated with survival were evaluated with the Kaplan-Meier analysis and cox regression, respectively.ResultsAmong the 529 included patients with LAMN, 63 (11.9%) received systemic chemotherapy and CRS+HIPEC, while 466 (88.1%) were treated with only CRS+HIPEC. Patients selected for systemic chemotherapy had a higher burden of disease (mean peritoneal cancer index: 18.8 +/- 8.6 versus 14.3 +/- 8.8, p<0.001). Patients who were not treated with chemotherapy had better mean OS and RFS (OS: 104.3 +/- 6.2 months, RFS: 84.9 +/- 6.6 months) compared to those who underwent systemic chemotherapy (OS: 70.2 +/- 6.8 months, RFS: 38 +/- 5.9 months, p<0.001). Increasing pre-operative CEA level (HR 1.012, p<0.001), higher completeness of cytoreduction score (reference CCR 0, CCR2 HR 34.175, p=0.001 and CCR3 HR 52.041, p=0.001), and treatment with systemic chemotherapy (HR 4.196, p=0.045) were associated with worse OS.ConclusionsIn this multicenter retrospective study, the receipt of perioperative chemotherapy was associated with worse long-term outcomes among patients with LAMN undergoing CRS-HIPEC. Systemic chemotherapy may lead to patient deconditioning and contribute to worse long-term outcomes. It should not be recommended outside of a clinical trial.https://www.frontiersin.org/articles/10.3389/fonc.2024.1456920/fullHIPECcytoreductive surgerylow grade appendiceal mucinous neoplasmLAMNchemotherapy |
| spellingShingle | Samantha M. Ruff Gyulnara Kasumova Manoj Palavalli Oliver S. Eng Laura Lambert Callisia Clarke Sameer Patel Jula Veerapong Keith Fournier Daniel Abbott Charles Staley Travis Grotz Fabian Johnston Mustafa Raoof Sean Dineen Jordan M. Cloyd Alex C. Kim Long term outcomes associated with the use of perioperative systemic chemotherapy on low grade appendiceal mucinous neoplasms with pseudomyxoma peritonei treated with cytoreductive surgery and hyperthermic intraperitoneal chemotherapy Frontiers in Oncology HIPEC cytoreductive surgery low grade appendiceal mucinous neoplasm LAMN chemotherapy |
| title | Long term outcomes associated with the use of perioperative systemic chemotherapy on low grade appendiceal mucinous neoplasms with pseudomyxoma peritonei treated with cytoreductive surgery and hyperthermic intraperitoneal chemotherapy |
| title_full | Long term outcomes associated with the use of perioperative systemic chemotherapy on low grade appendiceal mucinous neoplasms with pseudomyxoma peritonei treated with cytoreductive surgery and hyperthermic intraperitoneal chemotherapy |
| title_fullStr | Long term outcomes associated with the use of perioperative systemic chemotherapy on low grade appendiceal mucinous neoplasms with pseudomyxoma peritonei treated with cytoreductive surgery and hyperthermic intraperitoneal chemotherapy |
| title_full_unstemmed | Long term outcomes associated with the use of perioperative systemic chemotherapy on low grade appendiceal mucinous neoplasms with pseudomyxoma peritonei treated with cytoreductive surgery and hyperthermic intraperitoneal chemotherapy |
| title_short | Long term outcomes associated with the use of perioperative systemic chemotherapy on low grade appendiceal mucinous neoplasms with pseudomyxoma peritonei treated with cytoreductive surgery and hyperthermic intraperitoneal chemotherapy |
| title_sort | long term outcomes associated with the use of perioperative systemic chemotherapy on low grade appendiceal mucinous neoplasms with pseudomyxoma peritonei treated with cytoreductive surgery and hyperthermic intraperitoneal chemotherapy |
| topic | HIPEC cytoreductive surgery low grade appendiceal mucinous neoplasm LAMN chemotherapy |
| url | https://www.frontiersin.org/articles/10.3389/fonc.2024.1456920/full |
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