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Peritoneal metastasis histological grade independently predicts outcome in pseudomyxoma peritonei treated with curative surgery
Hasan, A. Chakrabarty, B. Kearsey, C. Nagaraju, R. Wilson, M. Renehan, A. Fish, R. Sutton, P. Wild, J. Selvasekar, C.
Hasan, A.
Chakrabarty, B.
Kearsey, C.
Nagaraju, R.
Wilson, M.
Renehan, A.
Fish, R.
Sutton, P.
Wild, J.
Selvasekar, C.
Abstract
Background Pseudomyxoma Peritonei is characterised by peritoneal metastasis from appendiceal mucinous neoplasms (AMN). The PSOGI classification (2016) categorises PMP into acellular mucin (AM), low-grade mucinous carcinoma peritonei (LGMCP), and high-grade mucinous carcinoma peritonei (HGMCP). This study aimed to determine long-term prognosis based on this classification. Materials and methods Pathology review from PMP patients with AMNs undergoing cytoreductive surgery and heated intraperitoneal chemotherapy (CRS + HIPEC) with curative intent over a 15-year period (2006-2021) was undertaken. Patients underwent standardised surveillance. Cox proportional hazards regression models, log-rank test, and Kaplan-Meier method were used to assess overall (OS) and disease-free survival (DFS) based on histopathological peritoneal metastasis grade. DFS was only calculated for patients who had a complete cytoreduction. Results 290 PMP patients were identified (AM = 34%, LGMCP = 59%, HGMCP = 7%) with median follow-up of 49 months. Median age was 59 years (range: 22-79), M: F of 1:2.5, peritoneal cancer index median of 18 (range: 0-39). Univariate OS hazard ratio (HR) is 2.75 for LGMCP vs AM (95% CI: 1.05 -7.21, p < 0.040) and 14.29 for HGMCP vs AM (95% CI: 3.92- 52.11, p < 0.001). DFS HR = 5.15 for LGMCP (95% CI: 2.19-12.10, p < 0.001) and 4.16 for HGMCP (95% CI: 1.03-16.80, p < 0.045) with an overall peritoneal metastasis p value < 0.001. Multivariate OS analysis showed that peritoneal histology for HGMCP remained a significant predictor of poor prognosis for OS (HR: 5.54, 95% CI: 1.32-23.25, p = 0.019), whilst LGMCP did not demonstrate a significant association (HR: 1.59, 95% CI: 0.59-4.26, p = 0.359). Discussion Peritoneal metastasis histopathological grade predicts outcome for patients with PMP from AMN following CRS + HIPEC independent of primary histology.
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Date
2026
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Article
Citation
Hasan A, Chakrabarty B, Kearsey C, Nagaraju R, Wilson M, Renehan A, et al. Peritoneal metastasis histological grade independently predicts outcome in pseudomyxoma peritonei treated with curative surgery. Clinical & Translational Oncology. 2026 JAN 20.