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Signet ring cell features with peritoneal carcinomatosis in patients undergoing cytoreductive surgery and hyperthermic intraperitoneal chemotherapy are associated with poor overall survival
Author(s) -
Solomon Daniel,
DeNicola Natasha,
Feingold Daniela,
Liu Peter H,
Aycart Samantha,
Golas Benjamin J,
Sarpel Umut,
Labow Daniel M,
Magge Deepa R.
Publication year - 2019
Publication title -
journal of surgical oncology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.201
H-Index - 111
eISSN - 1096-9098
pISSN - 0022-4790
DOI - 10.1002/jso.25379
Subject(s) - medicine , hyperthermic intraperitoneal chemotherapy , signet ring cell , conventional pci , gastroenterology , colorectal cancer , cytoreductive surgery , oncology , chemotherapy , population , peritoneal carcinomatosis , cancer , signet ring cell carcinoma , surgery , adenocarcinoma , ovarian cancer , environmental health , myocardial infarction
Background Cytoreductive surgery and hyperthermic intraperitoneal chemotherapy (CRS/HIPEC) is effective in select patients with peritoneal carcinomatosis (PC). Signet ring cell (SRC) pathology is associated with poor prognosis. The role of CRS/HIPEC in this population is unclear. Methods Patients diagnosed with PC due to appendiceal (AC), colorectal (CRC), and gastric cancer (GC) undergoing CRS/HIPEC 2007‐2016 were included. Results A total of 268 patients were referred for CRS/HIPEC. Of the 204 patients who underwent complete CRS/HIPEC, 101 (49.5%) had AC, 85 (41.7%) CRC, and 18 (8.8%) GC. Patients with GC had higher rates of SRC pathology than AC and CRC: 12 (66.7%) vs 16 (15.8%) and 10 (11.7%). The 3‐year survival rate after CRS/HIPEC was 5.7% for the SRC group and 66.1% for the non‐SRC group ( P < 0.001). This was true for both AC and CRC subgroups ( P < 0.001 for both). Overall, patients with SRC were more likely to have a peritoneal carcinomatosis index (PCI) score > 15 ( P = 0.046). Upon multivariate analysis of the SRC population, PCI > 20 ( P = 0.007) and GC ( P = 0.008) were found to be independent predictors of poor overall survival. Conclusions Performing CRS/HIPEC for PC from gastrointestinal malignancies presenting SRC features is recommended on patients with select diseases of appendiceal and colorectal origins.