Which classification system defines best prognosis of mucinous neoplasms of the appendix with peritoneal dissemination: TNM vs PSOGI?
AimsSeveral classification systems are used for pseudomyxoma peritonei. The four-tiered classification system proposed by Peritoneal Surface Oncology Group International (PSOGI) and the two-tiered proposed by the eighth edition of the American Joint Committee on Cancer (AJCC) result from evolution i...
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| Veröffentlicht in: | Journal of clinical pathology 2023-04, Vol.76 (4), p.266-273 |
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| container_title | Journal of clinical pathology |
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| creator | Martín-Román, Lorena Lozano, Pablo Gómez, Yesica Fernández-Aceñero, María Jesús Vasquez, Wenceslao Palencia, Natividad González-Bayón, Luis |
| description | AimsSeveral classification systems are used for pseudomyxoma peritonei. The four-tiered classification system proposed by Peritoneal Surface Oncology Group International (PSOGI) and the two-tiered proposed by the eighth edition of the American Joint Committee on Cancer (AJCC) result from evolution in terminology and pathological insight. The aim is to evaluate the impact of PSOGI and eighth edition of the AJCC classifications on survival.MethodsPathological slides were reviewed from a prospectively maintained database including patients treated with cytoreductive surgery and hyperthermic intraperitoneal chemotherapy for an appendiceal mucinous neoplasm with peritoneal dissemination between January 2009 and December 2019. Patients were reclassified according to PSOGI and AJCC eighth edition criteria. Survival analysis evaluated the impact of each classification system on overall survival (OS) and disease-free survival (DFS) while the concordance-index evaluated their predictive power.Results95 patients were identified; 21.1% were reclassified as acellular mucin, 55.8% as low-grade mucinous carcinoma peritonei, 8.4% as high-grade MCP (HGMCP) and 14 as HGMCP with signet ring cells. Median OS was not reached, 5-year OS and DFS were 86.1% and 51.5%, respectively. Multivariate analysis revealed significant associations with OS (PSOGI: HR 10.2, p=0.039; AJCC: HR 7.7, p=0.002) and DFS (PSOGI: HR 12.7, p=0.001; AJCC: HR 3.7, p |
| doi_str_mv | 10.1136/jclinpath-2021-207883 |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_cross</sourceid><recordid>TN_cdi_proquest_miscellaneous_2592307990</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>2887925616</sourcerecordid><originalsourceid>FETCH-LOGICAL-b379t-d4d55b75e1cf61698b52d8742e6989a4a6a6d5b0a2fa1712c346b0ebe2d8818d3</originalsourceid><addsrcrecordid>eNp9kctu1TAQhi1ERQ-FRwBZYsMm1Jc4jtkgVHGTWkCiiKXlW4iPEjvNJLR9gL43Pj2lSCzY2Jbnm3_m14_QM0peUcqb460bYprM0leMMFoO2bb8AdrQWrKqpnXzEG3IrqJk3RyixwBbQiiXlD9Ch7xAgiqxQTc_-uh67AYDELvozBJzwnANSxixD11MAbANsOBpzj9Thgg4d3hcXUx5BZxCnkrvePu79AGbaQrJxyt8GZceT2GOS07BDNhHgDDGdDvhNT7_fIZ_Af767cuHT2-eoIPODBCe3t1H6Pv7d-cnH6vTUj15e1pZLtVS-doLYaUI1HUNbVRrBfOtrFkob2Vq05jGC0sM6wyVlDleN5YEGwrV0tbzI_Ryr1vMXKzFlR4juDAMpvhYQTOhGCdSKVLQF_-g27zOqWynWdtKxUTZoFBiT7k5A8yh09McRzNfa0r0Lid9n5Pe5aT3OZW-53fqqx2Dv-_6E0wB6B6w4_bv5P-L_gbjd6Kd</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>2887925616</pqid></control><display><type>article</type><title>Which classification system defines best prognosis of mucinous neoplasms of the appendix with peritoneal dissemination: TNM vs PSOGI?</title><source>MEDLINE</source><source>PubMed Central</source><creator>Martín-Román, Lorena ; Lozano, Pablo ; Gómez, Yesica ; Fernández-Aceñero, María Jesús ; Vasquez, Wenceslao ; Palencia, Natividad ; González-Bayón, Luis</creator><creatorcontrib>Martín-Román, Lorena ; Lozano, Pablo ; Gómez, Yesica ; Fernández-Aceñero, María Jesús ; Vasquez, Wenceslao ; Palencia, Natividad ; González-Bayón, Luis</creatorcontrib><description>AimsSeveral classification systems are used for pseudomyxoma peritonei. The four-tiered classification system proposed by Peritoneal Surface Oncology Group International (PSOGI) and the two-tiered proposed by the eighth edition of the American Joint Committee on Cancer (AJCC) result from evolution in terminology and pathological insight. The aim is to evaluate the impact of PSOGI and eighth edition of the AJCC classifications on survival.MethodsPathological slides were reviewed from a prospectively maintained database including patients treated with cytoreductive surgery and hyperthermic intraperitoneal chemotherapy for an appendiceal mucinous neoplasm with peritoneal dissemination between January 2009 and December 2019. Patients were reclassified according to PSOGI and AJCC eighth edition criteria. Survival analysis evaluated the impact of each classification system on overall survival (OS) and disease-free survival (DFS) while the concordance-index evaluated their predictive power.Results95 patients were identified; 21.1% were reclassified as acellular mucin, 55.8% as low-grade mucinous carcinoma peritonei, 8.4% as high-grade MCP (HGMCP) and 14 as HGMCP with signet ring cells. Median OS was not reached, 5-year OS and DFS were 86.1% and 51.5%, respectively. Multivariate analysis revealed significant associations with OS (PSOGI: HR 10.2, p=0.039; AJCC: HR 7.7, p=0.002) and DFS (PSOGI: HR 12.7, p=0.001; AJCC: HR 3.7, p<0.001). The predictive capacity of both classification systems was unacceptable for OS and DFS (concordance-index values <0.7).ConclusionsBoth classification systems behaved similarly when stratifying our series into prognostic groups. The PSOGI classification provides better histopathological description, but histology alone is insufficient for adequate patient prognostication.</description><identifier>ISSN: 0021-9746</identifier><identifier>EISSN: 1472-4146</identifier><identifier>DOI: 10.1136/jclinpath-2021-207883</identifier><identifier>PMID: 34725195</identifier><language>eng</language><publisher>England: BMJ Publishing Group Ltd and Association of Clinical Pathologists</publisher><subject>Antigens ; Appendiceal Neoplasms - pathology ; Appendiceal Neoplasms - therapy ; appendix ; Appendix - pathology ; Cancer ; Chemotherapy ; Classification ; Histology ; Humans ; Medical prognosis ; Missing data ; neoplasms ; Neoplasms, Cystic, Mucinous, and Serous ; Oncology ; Original research ; Pathology ; Peritoneal Neoplasms - pathology ; Peritoneal Neoplasms - therapy ; peritoneum ; Prognosis ; Pseudomyxoma Peritonei - therapy ; regional perfusion ; Retrospective Studies ; Statistical analysis ; Surgical outcomes ; Survival analysis ; Survival Rate ; Terminology ; Tumors</subject><ispartof>Journal of clinical pathology, 2023-04, Vol.76 (4), p.266-273</ispartof><rights>Author(s) (or their employer(s)) 2021. No commercial re-use. See rights and permissions. Published by BMJ.</rights><rights>Author(s) (or their employer(s)) 2023. No commercial re-use. See rights and permissions. Published by BMJ.</rights><rights>2023 Author(s) (or their employer(s)) 2023. No commercial re-use. See rights and permissions. Published by BMJ.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-b379t-d4d55b75e1cf61698b52d8742e6989a4a6a6d5b0a2fa1712c346b0ebe2d8818d3</citedby><cites>FETCH-LOGICAL-b379t-d4d55b75e1cf61698b52d8742e6989a4a6a6d5b0a2fa1712c346b0ebe2d8818d3</cites><orcidid>0000-0003-0423-910X</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,780,784,27923,27924</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/34725195$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Martín-Román, Lorena</creatorcontrib><creatorcontrib>Lozano, Pablo</creatorcontrib><creatorcontrib>Gómez, Yesica</creatorcontrib><creatorcontrib>Fernández-Aceñero, María Jesús</creatorcontrib><creatorcontrib>Vasquez, Wenceslao</creatorcontrib><creatorcontrib>Palencia, Natividad</creatorcontrib><creatorcontrib>González-Bayón, Luis</creatorcontrib><title>Which classification system defines best prognosis of mucinous neoplasms of the appendix with peritoneal dissemination: TNM vs PSOGI?</title><title>Journal of clinical pathology</title><addtitle>J Clin Pathol</addtitle><addtitle>J Clin Pathol</addtitle><description>AimsSeveral classification systems are used for pseudomyxoma peritonei. The four-tiered classification system proposed by Peritoneal Surface Oncology Group International (PSOGI) and the two-tiered proposed by the eighth edition of the American Joint Committee on Cancer (AJCC) result from evolution in terminology and pathological insight. The aim is to evaluate the impact of PSOGI and eighth edition of the AJCC classifications on survival.MethodsPathological slides were reviewed from a prospectively maintained database including patients treated with cytoreductive surgery and hyperthermic intraperitoneal chemotherapy for an appendiceal mucinous neoplasm with peritoneal dissemination between January 2009 and December 2019. Patients were reclassified according to PSOGI and AJCC eighth edition criteria. Survival analysis evaluated the impact of each classification system on overall survival (OS) and disease-free survival (DFS) while the concordance-index evaluated their predictive power.Results95 patients were identified; 21.1% were reclassified as acellular mucin, 55.8% as low-grade mucinous carcinoma peritonei, 8.4% as high-grade MCP (HGMCP) and 14 as HGMCP with signet ring cells. Median OS was not reached, 5-year OS and DFS were 86.1% and 51.5%, respectively. Multivariate analysis revealed significant associations with OS (PSOGI: HR 10.2, p=0.039; AJCC: HR 7.7, p=0.002) and DFS (PSOGI: HR 12.7, p=0.001; AJCC: HR 3.7, p<0.001). The predictive capacity of both classification systems was unacceptable for OS and DFS (concordance-index values <0.7).ConclusionsBoth classification systems behaved similarly when stratifying our series into prognostic groups. The PSOGI classification provides better histopathological description, but histology alone is insufficient for adequate patient prognostication.</description><subject>Antigens</subject><subject>Appendiceal Neoplasms - pathology</subject><subject>Appendiceal Neoplasms - therapy</subject><subject>appendix</subject><subject>Appendix - pathology</subject><subject>Cancer</subject><subject>Chemotherapy</subject><subject>Classification</subject><subject>Histology</subject><subject>Humans</subject><subject>Medical prognosis</subject><subject>Missing data</subject><subject>neoplasms</subject><subject>Neoplasms, Cystic, Mucinous, and Serous</subject><subject>Oncology</subject><subject>Original research</subject><subject>Pathology</subject><subject>Peritoneal Neoplasms - pathology</subject><subject>Peritoneal Neoplasms - therapy</subject><subject>peritoneum</subject><subject>Prognosis</subject><subject>Pseudomyxoma Peritonei - therapy</subject><subject>regional perfusion</subject><subject>Retrospective Studies</subject><subject>Statistical analysis</subject><subject>Surgical outcomes</subject><subject>Survival analysis</subject><subject>Survival Rate</subject><subject>Terminology</subject><subject>Tumors</subject><issn>0021-9746</issn><issn>1472-4146</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2023</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><sourceid>ABUWG</sourceid><sourceid>AFKRA</sourceid><sourceid>AZQEC</sourceid><sourceid>BENPR</sourceid><sourceid>CCPQU</sourceid><sourceid>DWQXO</sourceid><sourceid>GNUQQ</sourceid><recordid>eNp9kctu1TAQhi1ERQ-FRwBZYsMm1Jc4jtkgVHGTWkCiiKXlW4iPEjvNJLR9gL43Pj2lSCzY2Jbnm3_m14_QM0peUcqb460bYprM0leMMFoO2bb8AdrQWrKqpnXzEG3IrqJk3RyixwBbQiiXlD9Ch7xAgiqxQTc_-uh67AYDELvozBJzwnANSxixD11MAbANsOBpzj9Thgg4d3hcXUx5BZxCnkrvePu79AGbaQrJxyt8GZceT2GOS07BDNhHgDDGdDvhNT7_fIZ_Af767cuHT2-eoIPODBCe3t1H6Pv7d-cnH6vTUj15e1pZLtVS-doLYaUI1HUNbVRrBfOtrFkob2Vq05jGC0sM6wyVlDleN5YEGwrV0tbzI_Ryr1vMXKzFlR4juDAMpvhYQTOhGCdSKVLQF_-g27zOqWynWdtKxUTZoFBiT7k5A8yh09McRzNfa0r0Lid9n5Pe5aT3OZW-53fqqx2Dv-_6E0wB6B6w4_bv5P-L_gbjd6Kd</recordid><startdate>20230401</startdate><enddate>20230401</enddate><creator>Martín-Román, Lorena</creator><creator>Lozano, Pablo</creator><creator>Gómez, Yesica</creator><creator>Fernández-Aceñero, María Jesús</creator><creator>Vasquez, Wenceslao</creator><creator>Palencia, Natividad</creator><creator>González-Bayón, Luis</creator><general>BMJ Publishing Group Ltd and Association of Clinical Pathologists</general><general>BMJ Publishing Group LTD</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>7X7</scope><scope>7XB</scope><scope>88E</scope><scope>88I</scope><scope>8AF</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>AZQEC</scope><scope>BENPR</scope><scope>BTHHO</scope><scope>CCPQU</scope><scope>DWQXO</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>GNUQQ</scope><scope>HCIFZ</scope><scope>K9.</scope><scope>M0S</scope><scope>M1P</scope><scope>M2P</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>PRINS</scope><scope>Q9U</scope><scope>7X8</scope><orcidid>https://orcid.org/0000-0003-0423-910X</orcidid></search><sort><creationdate>20230401</creationdate><title>Which classification system defines best prognosis of mucinous neoplasms of the appendix with peritoneal dissemination: TNM vs PSOGI?</title><author>Martín-Román, Lorena ; Lozano, Pablo ; Gómez, Yesica ; Fernández-Aceñero, María Jesús ; Vasquez, Wenceslao ; Palencia, Natividad ; González-Bayón, Luis</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-b379t-d4d55b75e1cf61698b52d8742e6989a4a6a6d5b0a2fa1712c346b0ebe2d8818d3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2023</creationdate><topic>Antigens</topic><topic>Appendiceal Neoplasms - pathology</topic><topic>Appendiceal Neoplasms - therapy</topic><topic>appendix</topic><topic>Appendix - pathology</topic><topic>Cancer</topic><topic>Chemotherapy</topic><topic>Classification</topic><topic>Histology</topic><topic>Humans</topic><topic>Medical prognosis</topic><topic>Missing data</topic><topic>neoplasms</topic><topic>Neoplasms, Cystic, Mucinous, and Serous</topic><topic>Oncology</topic><topic>Original research</topic><topic>Pathology</topic><topic>Peritoneal Neoplasms - pathology</topic><topic>Peritoneal Neoplasms - therapy</topic><topic>peritoneum</topic><topic>Prognosis</topic><topic>Pseudomyxoma Peritonei - therapy</topic><topic>regional perfusion</topic><topic>Retrospective Studies</topic><topic>Statistical analysis</topic><topic>Surgical outcomes</topic><topic>Survival analysis</topic><topic>Survival Rate</topic><topic>Terminology</topic><topic>Tumors</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Martín-Román, Lorena</creatorcontrib><creatorcontrib>Lozano, Pablo</creatorcontrib><creatorcontrib>Gómez, Yesica</creatorcontrib><creatorcontrib>Fernández-Aceñero, María Jesús</creatorcontrib><creatorcontrib>Vasquez, Wenceslao</creatorcontrib><creatorcontrib>Palencia, Natividad</creatorcontrib><creatorcontrib>González-Bayón, Luis</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Central (Corporate)</collection><collection>Health & Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Medical Database (Alumni Edition)</collection><collection>Science Database (Alumni Edition)</collection><collection>STEM Database</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>ProQuest Central (Alumni Edition)</collection><collection>ProQuest Central UK/Ireland</collection><collection>ProQuest Central Essentials</collection><collection>ProQuest Central</collection><collection>BMJ Journals</collection><collection>ProQuest One Community College</collection><collection>ProQuest Central Korea</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>ProQuest Central Student</collection><collection>SciTech Premium Collection</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Health & Medical Collection (Alumni Edition)</collection><collection>Medical Database</collection><collection>Science Database</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>ProQuest Central China</collection><collection>ProQuest Central Basic</collection><collection>MEDLINE - Academic</collection><jtitle>Journal of clinical pathology</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Martín-Román, Lorena</au><au>Lozano, Pablo</au><au>Gómez, Yesica</au><au>Fernández-Aceñero, María Jesús</au><au>Vasquez, Wenceslao</au><au>Palencia, Natividad</au><au>González-Bayón, Luis</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Which classification system defines best prognosis of mucinous neoplasms of the appendix with peritoneal dissemination: TNM vs PSOGI?</atitle><jtitle>Journal of clinical pathology</jtitle><stitle>J Clin Pathol</stitle><addtitle>J Clin Pathol</addtitle><date>2023-04-01</date><risdate>2023</risdate><volume>76</volume><issue>4</issue><spage>266</spage><epage>273</epage><pages>266-273</pages><issn>0021-9746</issn><eissn>1472-4146</eissn><abstract>AimsSeveral classification systems are used for pseudomyxoma peritonei. The four-tiered classification system proposed by Peritoneal Surface Oncology Group International (PSOGI) and the two-tiered proposed by the eighth edition of the American Joint Committee on Cancer (AJCC) result from evolution in terminology and pathological insight. The aim is to evaluate the impact of PSOGI and eighth edition of the AJCC classifications on survival.MethodsPathological slides were reviewed from a prospectively maintained database including patients treated with cytoreductive surgery and hyperthermic intraperitoneal chemotherapy for an appendiceal mucinous neoplasm with peritoneal dissemination between January 2009 and December 2019. Patients were reclassified according to PSOGI and AJCC eighth edition criteria. Survival analysis evaluated the impact of each classification system on overall survival (OS) and disease-free survival (DFS) while the concordance-index evaluated their predictive power.Results95 patients were identified; 21.1% were reclassified as acellular mucin, 55.8% as low-grade mucinous carcinoma peritonei, 8.4% as high-grade MCP (HGMCP) and 14 as HGMCP with signet ring cells. Median OS was not reached, 5-year OS and DFS were 86.1% and 51.5%, respectively. Multivariate analysis revealed significant associations with OS (PSOGI: HR 10.2, p=0.039; AJCC: HR 7.7, p=0.002) and DFS (PSOGI: HR 12.7, p=0.001; AJCC: HR 3.7, p<0.001). The predictive capacity of both classification systems was unacceptable for OS and DFS (concordance-index values <0.7).ConclusionsBoth classification systems behaved similarly when stratifying our series into prognostic groups. The PSOGI classification provides better histopathological description, but histology alone is insufficient for adequate patient prognostication.</abstract><cop>England</cop><pub>BMJ Publishing Group Ltd and Association of Clinical Pathologists</pub><pmid>34725195</pmid><doi>10.1136/jclinpath-2021-207883</doi><tpages>8</tpages><orcidid>https://orcid.org/0000-0003-0423-910X</orcidid></addata></record> |
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| subjects | Antigens Appendiceal Neoplasms - pathology Appendiceal Neoplasms - therapy appendix Appendix - pathology Cancer Chemotherapy Classification Histology Humans Medical prognosis Missing data neoplasms Neoplasms, Cystic, Mucinous, and Serous Oncology Original research Pathology Peritoneal Neoplasms - pathology Peritoneal Neoplasms - therapy peritoneum Prognosis Pseudomyxoma Peritonei - therapy regional perfusion Retrospective Studies Statistical analysis Surgical outcomes Survival analysis Survival Rate Terminology Tumors |
| title | Which classification system defines best prognosis of mucinous neoplasms of the appendix with peritoneal dissemination: TNM vs PSOGI? |
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