腹膜恶性肿瘤患者腹腔切除术中腹腔病变形态外观与病理评估的相关性：PRECINCT研究第I期在707例患者中的结果

Correlation of Morphological Appearance of Peritoneal Lesions at Laparotomy and Disease at Pathological Assessment in Patients Undergoing Cytoreductive Surgery for Peritoneal Malignancy: Results of Phase I of the PRECINCT Study in 707 Patients

ANNALS OF SURGICAL ONCOLOGY

影响因子:3.5

分区:医学2区 / 外科2区肿瘤学3区

发表日期:2024 Dec

作者: Aditi Bhatt, Laurent Villeneuve, Armando Sardi, Amine Souadka, Alison Buseck, Brendan J Moran, Basma El Khannousi, Carlos Gonzalez de Pedro, Dario Baratti, Danielle Biacchi, David Morris, Daniel Labow, Edward A Levine, Faheez Mohamed, Gbadebo Adeleke, Gaurav Goswami, Isabelle Bonnefoy, Katherine Cummins Perry, Konstantinos I Votanopoulos, Loma Parikh, Marcello Deraco, Mohammad Alyami, Noah Cohen, Nazim Benzerdjeb, Nehal Shah, Nezha El Bahaoui, Nazanin Khajoueinejad, Pascal Rousset, Perry Shen, Shoma Barat, Sophia Stanford, Selma Khouchoua, Samantha Troob, Sakina Shaikh, Umut Sarpel, Vadim Gushchin, Vasanth Mark Samuel, Vahan Kepenekian, Paolo Sammartino, Olivier Glehen

DOI: 10.1245/s10434-024-16035-9

摘要

PRECINCT（腹膜扩散模式与系统性化疗反应在常见和非常见腹膜肿瘤中的表现）是一项前瞻性、多中心、观察性研究。本文报道了PRECINCT第I期中在经验丰富的腹膜恶性肿瘤中心记录手术腹腔癌指数（sPCI）的差异，以及形态不同的腹膜病变（PL）经组织学确认的疾病发生率。sPCI以预设格式记录，包括PL的形态外观。提供了六个预设的形态学术语。比较了手术和病理结果。2020年9月至2021年12月，10个中心共纳入707例患者。形态学细节在两个中心常规记录，包括最大结节所在结构和每个区域最大肿瘤沉积的确切大小；另外四个中心也进行了记录。最常用的形态学术语为正常腹膜（45.3%，3091例）、肿瘤结节（38.2%，2607例）以及融合性疾病（11.5%，786例）。组织学证实的疾病发生率在“肿瘤结节”中显著高于其他形态（病变评分2/3：63.1%对比1：31.5%；p<0.001）。在接受新辅助化疗的患者中，组织学确认疾病的发生率与直接手术组无显著差异（分别为47.7%与51.4%；p=0.069）。不同中心记录的sPCI存在异质性。“肿瘤结节”的组织学确认率为49.2%，可以更广泛地使用冷冻切片辅助临床决策。建议进行一项大型研究，通过图像展示不同形态外观并与病理结果进行相关性分析。

Abstract

The PRECINCT (Pattern of peritoneal dissemination and REsponse to systemic Chemotherapy IN Common and uncommon peritoneal Tumors) is a prospective, multicenter, observational study. This report from phase I of PRECINCT outlines variations in recording the surgical peritoneal cancer index (sPCI) at experienced peritoneal malignancy centers and the incidence of pathologically confirmed disease in morphologically different peritoneal lesions (PL).The sPCI was recorded in a prespecified format that included the morphological appearance of PL. Six prespecified morphological terms were provided. The surgical and pathological findings were compared.From September 2020 to December 2021, 707 patients were enrolled at 10 centers. The morphological details are routinely recorded at two centers, structure bearing the largest nodule, and exact size of the largest tumor deposit in each region at four centers each. The most common morphological terms used were normal peritoneum in 3091 (45.3%), tumor nodules in 2607 (38.2%) and confluent disease in 786 (11.5%) regions. The incidence of pathologically confirmed disease was significantly higher in 'tumor nodules' with a lesion score of 2/3 compared with a lesion score of 1 (63.1% vs. 31.5%; p < 0.001). In patients receiving neoadjuvant chemotherapy, the incidence of pathologically confirmed disease did not differ significantly from those undergoing upfront surgery [751 (47.7%) and 532 (51.4%) respectively; p = 0.069].The sPCI was recorded with heterogeneity at different centers. The incidence of pathologically confirmed disease was 49.2% in 'tumor nodules'. Frozen section could be used more liberally for these lesions to aid clinical decisions. A large-scale study involving pictorial depiction of different morphological appearances and correlation with pathological findings is indicated.