Local Peritoneal Carcinomatosis Research Articles

Can a morphological description of the peritoneal carcinomatosis in advanced ovarian cancer add prognostic information? Analysis of 1686 patients of the tumor bank ovarian cancer.

Peritoneal carcinomatosis in ovarian cancer is frequent and generally associated with higher stage and poorer outcome. The clinical features of peritoneal carcinomatosis are diverse and their relevance for surgical and long-term outcome remains unclear. We conducted this prospective study to describe intraoperatively the different features of peritoneal carcinomatosis(PC) and correlate them with clinicopathological features, progression-free(PFS) and overall survival (OS),. We performed a systematic analysis of all patients with documented intraoperative PC and a primary diagnosis of epithelial ovarian, tubal, or peritoneal cancer from January 2001 to September 2018. All data were evaluated by using the systematic tumor bank tool. Specific PC features included texture(soft-hard), consistency(coarse-fine or both), wet vs dry(PC with ascites vs. PC without ascites), and localization(diffuse-local). PC characteristics were then evaluated for correlation with age, FIGO-stage, histology, lymph-node involvement, grade, and presence of residual tumor at primary surgery. Moreover, the influence of PC characteristics on OS and PFS was analyzed. A total of 1686 patients with PC and primary epithelial ovarian cancer were included. Majority of the patients were characterized by diffuse PC(73.9%). The majority of peritoneal nodules were fine in texture (55.3%) and hard in consistency (87.4%). Moreover, 27.6% of patients had dry PC. Diffuse PC localization was significantly associated with higher FIGO-stage (p<0.001), high-grade (p=0.003) and serous tumors (p=0.006) as well as residual tumor as compared to local PC (p<0.001). Wet PC also significantly correlated with diffuse localization (p <0.001) and residual tumor as compared to dry PC (p<0.001). Coarse PC was significantly associated with residual tumor as compared to fine PC (p=0.044). All other PC features didn´t correlate with clinicopathological features. As for survival outcomes, diffuse peritoneal localization (p<0.001), wet PC (p<0.001), and additional lymph node involvement (p<0.001) were associated with lower OS and PFS rates. Other PC features did not significantly impact survival. Diffuse localization of peritoneal carcinomatosis was significant predictor of recurrence. Lower OS and PFS were associated with diffuse peritoneal localization, wet PC, and additional lymph node involvement. Further prospective trials are warranted with the inclusion of translational research aspects to better understand the different peritoneal carcinomatosis patterns.

Abstract B33: Ascitic IL-10 concentration is correlated to peritoneal tumor burden and a prognostic factor of peritoneal recurrence in colon cancer.

Abstract Purpose: Although immune systems response to cancer cells there are few data on the alterations of immune response to the progression of tumors. We performed this study to search the changes of cytokines in ascites during the progression of colon cancer in peritoneal cavity. Methods: Colon cancer patients were divided into four groups according to the progression status and burden of peritoneal carcinomatosis (PC stages). SE-(serosa exposure negative) is a group of patients without exposure of cancer cells to peritoneal cavity (T3 or lower T stage, n=20). SE+(serosa exposure positive) is a group of patients of T4 lesion without peritoneal metastasis (n=20). l-PC represents localized peritoneal carcinomatosis which could be removed entirely during surgery (n=8). g-PC is a group of generalized peritoneal carcinomatosis (n=7). Ascites were acquired at Douglas pouch right after laparotomy during the course of surgical operation. In five of the 7 g-PC patients, who were diagnosed as g-PC by imaging study, ascites were collected during the therapeutic tapping to relieve abdominal distension. If ascites was contaminated by blood the patient was excluded in this study. Cytokines and IDO (indoleamine deoxygenase) activity were assayed and peritoneal recurrence was surveyed. Result: IL-10 and IL-6 were increased according to the progression of PC stages (SE- &amp;lt;”SE+ &amp;lt; l-PC &amp;lt; g-PC) (p=0.000, ANOVA). Mean IL-10 and IL-6 concentrations (pg/ml) were 17.8 and 456 in SE-, 38.0 and 2,186 in SE+, 64.8 and 2,707 in l-PC and 250.7 and 19,722 in g-PC. When compared in adjacent two PC stages, IL-10 concentration was significantly higher in g-PC than in l-PC (p=0.002) and in SE+ than in SE- (p=0.025) but was not different between l-PC and SE+ (p=0.094, t-test). IL-6 as well as IDO activity was significantly higher in g-PC than in other PC stages (t-test). Interestingly, the increase of IL-10 and IL-6 are significantly correlated (r=0.858, p=0.000). However, TGF-beta, IL-17 and IL-2 as well as proinflammatory cytokines (TNF and IFN-gamma) and Th2 cytokines (IL-4, IL-5 and IL-6) had no changes during the progression of peritoneal carcinomatosis. Peritoneal recurrence, after removal of cancer cells exposed to peritoneal cavity (l-PC and SE+), were diagnosed by imaging studies in 6 of 7 l-PC and in 6 of 19 SE+ patients during the follow up period (median 10 months). Mean IL-10 concentration of patients with recurrence was 68.0 and that without recurrence was 28.3 (p=0.028, t-test). The recurrence free survival was inversely correlated to peritoneal IL-10 concentration. (r= -0.473, p=0.015). Conclusion: Peritoneal IL-10 is not only increased in peritoneal metastasis but also correlated to the progression of peritoneal metastasis, while IL-6 and IDO activity were increased only in advanced stage. And ascitic IL-10 is a candidate for the prognostic marker of peritoneal recurrence in colorectal cancers. Citation Format: Hye Seong Ahn, In Sil Choi, Junghan Song, Seung Chul Heo, Ji-Eun Kim. Ascitic IL-10 concentration is correlated to peritoneal tumor burden and a prognostic factor of peritoneal recurrence in colon cancer. [abstract]. In: Proceedings of the AACR Special Conference on Tumor Immunology: Multidisciplinary Science Driving Basic and Clinical Advances; Dec 2-5, 2012; Miami, FL. Philadelphia (PA): AACR; Cancer Res 2013;73(1 Suppl):Abstract nr B33.

Palliative Resection for Advanced Gastric and Junctional Adenocarcinoma: Which Patients will Benefit from Surgery?

Whereas palliative chemotherapy offers a median survival of approximately 10months in advanced gastric and junctional adenocarcinoma (AGJA), the survival impact of primary tumor resection is controversial. Our purpose was to identify which AGJA patients benefit from palliative resection. In 3,202 AGJA patients scheduled for surgery in 21 French centers between 1997 and 2010, prognostic factors were identified in palliative group and the impact of each combination of these factors on survival was studied. Surgery was defined as palliative due to solid organ metastasis (5.6%), localized (4.6%) or diffuse (2.3%) peritoneal carcinomatosis (PC), or incomplete tumoral resection (12.8%). Median survival of AGJA patients resected with a palliative intent (n=677) was longer than in nonresected patients (n=532; 11.9 vs. 8.5months, P<0.001). Multivariable analyses identified ASA score III-IV (P<0.001) as a predictor of postoperative mortality and solid organ metastasis (P=0.009), localized PC (P=0.004), diffuse PC (P=0.046), and signet ring cell histology (SRC; P=0.02) as predictors of survival. Only ASA I-II patients with incomplete resection without metastasis or PC, one site solid organ metastasis without PC, or localized PC without SRC had a survival benefit after palliative surgery with median survivals from 12.0 to 18.3months. Nonresected ASA I-II patients with same risk factors had median survivals from 3.5 to 8.8months (P<0.05 for each). In AGJA, patient and tumor-related factors should be used to select candidates for palliative surgery in association with chemotherapy.

Multidisciplinary therapy for treatment of patients with peritoneal carcinomatosis from gastric cancer.

There is no standard treatment for peritoneal carcinomatosis (PC) from gastric cancer. A novel multidisciplinary treatment combining bidirectional chemotherapy [neoadjuvant intraperitoneal-systemic chemotherapy protocol (NIPS)], peritonectomy, hyperthermic intraperitoneal chemoperfusion (HIPEC) and early postoperative intraperitoneal chemotherapy has been developed. In this article, we assess the indications, safety and efficacy of this treatment, review the relevant studies and introduce our experiences. The aims of NIPS are stage reduction, the eradication of peritoneal free cancer cells, and an increased incidence of complete cytoreduction (CC-0) for PC. A complete response after NIPS was obtained in 15 (50%) out of 30 patients with PC. Thus, a significantly high incidence of CC-0 can be obtained in patients with a peritoneal cancer index (PCI) ≤ 6. Using a multivariate analysis to examine the survival benefit, CC-0 and NIPS are identified as significant indicators of a good outcome. However, the high morbidity and mortality rates associated with peritonectomy and perioperative chemotherapy make stringent patient selection important. The best indications for multidisciplinary therapy are localized PC (PCI ≤ 6) from resectable gastric cancer that can be completely removed during a peritonectomy. NIPS and complete cytoreduction are essential treatment modalities for improving the survival of patients with PC from gastric cancer.

Signet Ring Cell Histology is an Independent Predictor of Poor Prognosis in Gastric Adenocarcinoma Regardless of Tumoral Clinical Presentation

To test the hypothesis that signet ring cell (SRC) histology has a negative prognostic value in patients with gastric adenocarcinoma (ADC). In western countries, gastric ADC with SRC often occurs after the disease has advanced. Consequently, the prognosis of SRC is generally regarded as poor, although survival studies comparing SRC and non-SRC have yielded inconsistent results. : An intent to treat analysis was performed among 215 patients with gastric ADC scheduled for surgical resection from 1996 to 2007. Of these, 180 patients underwent the resection and 35 were not resected due to diffuse metastatic illness. From 59 resected patients with SRC (SRC group), control non-SRC resected patients matched by age, gender, American Society of Anaesthesiologists (ASA) classification, tumoral location, and pTNM stage were randomly selected by computer (non-SRC group: n = 100) during the same study period. The overall median survival was 21 months, which was significantly higher in resected compared to non-resected patients (31 vs. 5 months, P < 0.001). In non-resected patients, SRC histological subtype was associated with higher rates of diffuse peritoneal carcinomatosis (90.1% vs. 62.5%, P = 0.053) and neoplastic ascitis (63.6% vs. 34.7%, P = 0.059) and poorer median survival (5 vs. 7 months, P = 0.062). For resected patients, the 2 groups (SRC and non-SRC) were comparable regarding matching variables, demographic variables, and postoperative course. The median survival was significantly lower for SRC patients (21 vs. 44 months, P = 0.004). SRC resected patients exhibited higher rates of localized peritoneal carcinomatosis (P = 0.013) and lymph node involvement (P < 0.001) at diagnosis, lower R0 resection rate (P = 0.019) and earlier tumor relapse (P = 0.009), which was generally in a peritoneal carcinomatosis form (P = 0.011). By multivariate analysis, we concluded that SRC histology was independently associated with a dismal prognosis after adjustment on confounding variables (hazard ratio = 1.5, 95% confidence interval 1.1-2.0, P = 0.004). The prognostic role of SRC was maintained after exclusion of patients with advanced stage at initial diagnosis such as localized peritoneal carcinomatosis or lymph node invasion. This study is currently the best evidence showing that SRC is a major and independent predictor of poor prognosis due to specific characteristics such as more infiltrating tumors showing affinity for lymphatic tissue accompanied by a higher rate of peritoneal carcinomatosis. Our results suggest the need for a specific therapeutic strategy for such tumors.

Hyperthermic intraperitoneal chemotherapy and cytoreductive surgery for peritoneal carcinomatosis of colorectal origin: a novel treatment strategy with promising results in selected patients

Peritoneal carcinomatosis is a major cause of treatment failure in colorectal cancer with few options for treatment. Recent reports, including a single randomized trial, suggest that localized peritoneal carcinomatosis, in the absence of other metastases, could be considered regional metastatic disease analogous to liver metastases, and thus amenable to locoregional therapy. Optimal treatment involves complete tumour removal by complex surgical techniques, combined with hyperthermic intraperitoneal chemotherapy (HIPEC). This treatment strategy has significant morbidity and mortality risks and careful selection is essential to avoid futile procedures. The best results are achieved in patients with limited disease who have complete macroscopic tumour removal, when the primary and peritoneal metastases are removed synchronously, and when the primary tumour is a cancer of the appendix. Improvements in cross-sectional imaging and increasing utilization of laparoscopy in colorectal cancer surgery may help in detecting suitable cases for these techniques. Selected patients with localized disease have been shown to have good outcomes with prolonged survival and perhaps a possibility of cure.

Cancer de la vésicule biliaire révélé par un ictère dû a un thrombus tumoral endobiliaire

Main bile duct neoplasic thrombosis is a rare cause of jaundice in case of gallbladder cancer. We report the case of 27-year-old woman in whom the endoluminal biopsy of biliary thrombus confirmed the suspected diagnosis of gallbladder cancer. An initial laparoscopic exploration found a localized peritoneal carcinomatosis. However, in this exceptional situation with an unknown prognostic, a surgical procedure has been performed including hepatectomy IV–V with biliary principal bile duct removal, hepatico-jejunal anastomosis (Roux-en-Y), with complete resection of localized peritoneal carcinomatosis. Post-operative course were uneventful and this patient was asymptomatic under chemotherapy with a six month follow-up.