The impact of HIPEC vs. EPIC for the treatment of mucinous appendiceal carcinoma: a study from the US HIPEC collaborative,International Journal of Hyperthermia

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The impact of HIPEC vs. EPIC for the treatment of mucinous appendiceal carcinoma: a study from the US HIPEC collaborative
International Journal of Hyperthermia ( IF 3.0 ) Pub Date : 2020-10-12 , DOI: 10.1080/02656736.2020.1819571
Jennifer L Leiting ₁ , Courtney N Day ₂ , William S Harmsen ₂ , Jordan M Cloyd ₃ , Sherif Abdel-Misih ₃ , Keith Fournier ₄ , Andrew J Lee ₄ , Sean Dineen ₅ , Sophie Dessureault ₅ , Jula Veerapongh ₆ , Joel M Baumgartner ₆ , Callisia Clarke ₇ , Harveshp Mogal ₇ , Maria C Russell ₈ , Mohammad Y Zaidi ₈ , Sameer H Patel ₉ , Mackenzie C Morris ₉ , Ryan J Hendrix ₁₀ , Laura A Lambert ₁₁ , Daniel E Abbott ₁₂ , Courtney Pokrzywa ₁₂ , Mustafa Raoof ₁₃ , Oliver Eng ₁₃ , Fabian M Johnston ₁₄ , Jonathan Greer ₁₄ , Travis E Grotz ₁

Affiliation

Division of Hepatobiliary and Pancreas Surgery, Mayo Clinic, Rochester, MN, USA.
Division of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, MN, USA.
Department of Surgery, Division of Surgical Oncology, The Ohio State University Wexner Medical Center, Columbus, OH, USA.
Department of Surgical Oncology, University of Texas MD Anderson Cancer Center, Houston, TX, USA.
Department of Gastrointestinal Oncology, Moffitt Cancer Center, Morsani College of Medicine, Tampa, FL, USA.
Department of Surgery, Division of Surgical Oncology, University of California, San Diego, CA, USA.
Department of Surgery, Division of Surgical Oncology, Medical College of Wisconsin, Milwaukee, WI, USA.
Division of Surgical Oncology, Winship Cancer Institute, Emory University, Atlanta, GA, USA.
Department of Surgery, University of Cincinnati College of Medicine, Cincinnati, OH, USA.
Department of Surgery, Division of Surgical Oncology, University of Massachusetts Medical School, Worcester, MA, USA.
Peritoneal Surface Malignancy Program Section of Surgical Oncology, Huntsman Cancer Institute, University of Utah, Salt Lake City, UT, USA.
Department of Surgery, Division of Surgical Oncology, University of Wisconsin, Madison, WI, USA.
Department of Surgery, Division of Surgical Oncology, City of Hope National Medical Center, Duarte, CA, USA.
Department of Surgery, Johns Hopkins University, Baltimore, MD, USA.

Abstract

Introduction

Mucinous appendiceal carcinoma is a rare malignancy that commonly spreads to the peritoneum leading to peritoneal metastases. Complete cytoreduction with perioperative intraperitoneal chemotherapy (PIC) is the mainstay of treatment, administered as either hyperthermic intra peritoneal chemotherapy (HIPEC) or early post-operative intraperitoneal chemotherapy (EPIC). Our goal was to assess the perioperative and long term survival outcomes associated with these two PIC methods.

Materials and methods

Patients with mucinous appendiceal carcinoma were identified in the US HIPEC Collaborative database from 12 academic institutions. Patient demographics, clinical characteristics, and survival outcomes were compared among patients who underwent HIPEC vs. EPIC with inverse probability weighting (IPW) used for adjustment.

Results

Among 921 patients with mucinous appendiceal carcinoma, 9% underwent EPIC while 91% underwent HIPEC. There was no difference in Grade III–V complications between the two groups (18.5% for HIPEC vs. 15.0% for EPIC, p=.43) though patients who underwent HIPEC had higher rates of readmissions (21.2% vs. 8.8%, p<.01). Additionally, PIC method was not an independent predictor for overall survival (OS) or recurrence-free survival (RFS) after adjustment on multivariable analysis.

Conclusions

Among patients with mucinous appendiceal carcinoma, both EPIC and HIPEC appear to be associated with similar perioperative and long-term outcomes.

中文翻译：

HIPEC与EPIC对粘液性阑尾癌治疗的影响：美国HIPEC合作研究

摘要

介绍

粘液性阑尾癌是一种罕见的恶性肿瘤，通常扩散到腹膜导致腹膜转移。围手术期腹膜内化疗（PIC）完全减少细胞凋亡是治疗的主要手段，可以采用腹膜内高温化疗（HIPEC）或术后早期腹膜内化疗（EPIC）进行治疗。我们的目标是评估与这两种PIC方法相关的围手术期和长期生存结果。

材料和方法

在美国HIPEC合作数据库中从12个学术机构中鉴定出粘液性阑尾癌患者。比较接受HIPEC与EPIC的患者的人口统计学，临床特征和生存结局，并采用逆概率加权（IPW）进行调整。

结果

在921例黏液性阑尾癌患者中，有9％进行了EPIC，而91％进行了HIPEC。两组之间的III–V级并发症无差异（HIPEC为18.5％，EPIC为15.0％，p = .43），尽管接受HIPEC的患者再入院率更高（21.2％对8.8％，p <.01）。此外，在对多变量分析进行调整后，PIC方法并不是整体生存期（OS）或无复发生存期（RFS）的独立预测指标。