Evaluation of the significance of pseudomyxoma peritonei patients based on the Peritoneal Surface Oncology Group International (PSOGI) classification

Abstract

Pseudomyxoma peritonei (PMP) is a rare disease characterized by mucinous ascites and deposits on the peritoneal surfaces. The study aimed to assess PMP patients according to the Peritoneal Surface Oncology Group International (PSOGI) classification, as a part of standardization of this rare disease. This retrospective study analyzed PMP patients who underwent surgery between January 2007 and December 2017. All histologic slides were re-evaluated and the clinical data were collected. According to the PSOGI, PMP was retrospectively classified into three categories: low-grade (LG-PMP), high-grade (HG-PMP), and signet-ring cells (SRC-PMP). The extent of peritoneal involvement was quantified by the peritoneal cancer index (PCI). The completeness of cytoreduction (CCR) was dichotomized as complete or incomplete. Fifty-seven patients were included in this study, consisted of 39 patients with LG-PMP (74.0%), 14 with HG-PMP (20.8%), and 4 with SRC-PMP (5.2%). There was no operative mortality and major complications occurred in 24 patients (31.2%). The 5-year overall survival was 56.2%±8.1% for LG-PMP, 37.5%±12.1% for HG-PMP, and 25.0%±21.7% for SRC-PMP. Concerning CCR, the 5-year overall (complete: 59.5%±8.4% vs. incomplete: 12.7%±8.1%, p=0.001) and disease-free survival (complete: 38.6%±8.9% vs. incomplete: 7.7%±6.8%, p=0.001) were significantly different. In a multivariable analysis, PSOGI classification and CCR independently correlated with survival (p=0.011 and 0.018, respectively). The PSOGI classification provides prognostic stratification, hopefully requiring further validation including every single case of PMP established as a standard criteria.