Peritoneal disseminations from appendiceal vs. colorectal mucinous adenocarcinoma. An Italian multicentric comparative study.
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Baratti Dario, Valle Mario, Tonello Marco, Di Giorgio Andrea, Lippolis Piero Vincenzo, Robella Manuela, Marrelli Daniele, D'Acapito Fabrizio, Ansaloni Luca, Sammartino Paolo, Sassaroli Cinzia, De Manzoni Giovanni, Macrì Antonio, Graziosi Luigina, Coccolini Federico, Gelmini Roberta, Vaira Marco, Celotti Andrea, Nava Francesca Laura, Cavalleri Tommaso, Corona Francesco, Abatini Carlo, Bertolucci Andrea, Carbone Ludovico, Framarini Massimo, Fugazzola Paola, Ghaly Ahmed, Casella Francesco, Macrì Ferdinando, Noventa Chiara, Sommariva Antonio, Deraco Marcello
Аннотация
METHODS: Prospectively collected data for 402 patients treated for MACA (n = 218) or MCRC (n = 184) in 17 Italian centers were retrospectively analyzed.
RESULTS: Colorectal origin was associated with lower peritoneal cancer index (PCI) (P < 0.001), lower rates of signet-ring cells histology (P = 0.016), T4a/b primaries (P < 0.001), negative nodes (P < 0.001), synchronous metastases (P < 0.001), microsatellite stability (P = 0.009), wild-type KRAS (P < 0.001) and BRAF (P < 0.001), but not wild-type NRAS (P = 0.999), incomplete cytoreduction (P = 0.014), and perioperative systemic anticancer treatments (s-ACT) (P < 0.001). Median follow-up was 70.5 months (95% confidence interval [CI] = 45.8-92.3) for MACA, and 40.2 months (95%CI = 35.4-55.2) for MCRC. Five-year overall survival was 58.9% (95%CI = 51.3-67.5) for MACA, and 35.4% (95%CI = 27.1-46.2) for MCRC (P < 0.001). Appendiceal origin correlated with better prognosis at multivariate analysis (hazard-ratio 2.52; 95%CI = 1.50-4.25; P < 0.001). Five-year cumulative incidence of distant relapses was higher for MCRC: 42.6% (95%CI = 30.8-52.4) vs. 28.1% (95%CI = 19.7-35.7) (P = 0.032). Incidence of peritoneal relapse was not different (P = 0.706). PCI correlated with survival in MCRC (P < 0.001), but not in MACA. Perioperative s-ACT correlated with worse prognosis in MACA (P = 0.024), but not in MCRC (P = 0.920).
CONCLUSIONS: Peritoneal disseminations from MACA are associated with distinct clinical-biological features, better prognosis and lower incidence of systemic relapses, suggesting that MCRC and MACA are different entities. MACA should not be excluded from CRS/HIPEC based only on higher PCI. The role of s-ACT remain unclear.