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Impact of Aggressive Histology and Location of Primary Tumor on the Efficacy of Surgical Therapy for Peritoneal Carcinomatosis of Colorectal Origin

  • Regional Cancer Therapies
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Background

Cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemoperfusion (HIPEC) for peritoneal carcinomatosis (PC) of colorectal origin increases survival (OS) compared to systemic chemotherapy alone. Signet ring histology demonstrates aggressive behavior with poor survival. We sought to determine whether CRS/HIPEC increases survival in this subset of patients.

Methods

We reviewed 67 patients with PC of appendiceal (AP, n = 37) or colorectal origin (CRC, n = 30) with signet cell histology from a prospective database between May 2001 and August 2011. Survival analysis and multivariate Cox regression were used to determine prognostic factors for survival.

Results

Complete CRS (CC-0/1) was achieved in 77 % (CRC) and 73 % (AP) of patients. Progression-free survival (PFS) and OS were 9 and 12 months in CRC and 12 and 21 months in AP patients. In the CRC group, univariate predictors of poor survival included female gender, age, American Society of Anesthesiologists score, preoperative albumin, completeness of cytoreduction, and morbidity. In a multivariate Cox regression model, incomplete cytoreduction (CC-2/3) and female gender were joint significant predictors of poor survival. In the AP group, significant univariate predictors of poor survival included higher EBL and PCI score. In a multivariate Cox regression model, blood loss of >500 ml and a body mass index of <25 kg/m2 were joint significant predictors of poor survival.

Conclusions

AP signet cell tumors demonstrate a more favorable outcome than CRC signet cell tumors after CRC/HIPEC for carcinomatosis, suggesting an underlying difference in biology. CRS/HIPEC does not confer survival benefit in colorectal signet ring carcinomatosis unless complete cytoreduction can be achieved, whereas appendiceal signet ring carcinomatosis may benefit, regardless of resectability.

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Disclosure

The authors declare no conflict of interest.

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Authors and Affiliations

  1. Division of Surgical Oncology, University of Pittsburgh, Pittsburgh, PA, USA

    Joshua Winer MD, Lekshmi Ramalingam MD, Heather Jones MPA-C, Amer Zureikat MD, Matthew Holtzman MD, Kenneth Lee MD, Steven Ahrendt MD, James Pingpank MD, Herbert J. Zeh MD, David L. Bartlett MD & Haroon A. Choudry MD

  2. Department of Epidemiology, University of Pittsburgh, Pittsburgh, PA, USA

    Mazen Zenati MD, PhD

Authors
  1. Joshua Winer MD
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  2. Mazen Zenati MD, PhD
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  3. Lekshmi Ramalingam MD
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  4. Heather Jones MPA-C
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  5. Amer Zureikat MD
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  6. Matthew Holtzman MD
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Correspondence to David L. Bartlett MD or Haroon A. Choudry MD.

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Winer, J., Zenati, M., Ramalingam, L. et al. Impact of Aggressive Histology and Location of Primary Tumor on the Efficacy of Surgical Therapy for Peritoneal Carcinomatosis of Colorectal Origin. Ann Surg Oncol 21, 1456–1462 (2014). https://doi.org/10.1245/s10434-013-3328-4

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  • DOI: https://doi.org/10.1245/s10434-013-3328-4

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