Incorporation of the 8th Edition AJCC/TNM Staging of Carcinoma of the Appendix into the Esquivel Peritoneal Surface Disease Severity Score (E-PSDSS) in 229 Patients with Mucinous Appendiceal Neoplasms
Introduction: A practical staging classification that has prognostic significance in mucinous appendiceal neoplasms represents an unmet need in oncology. The purpose of this study is to present a second edition of the PSDSS in mucinous appendiceal neoplasms with or without peritoneal dissemination based on the AJCC/TNM 8th edition. Materials and Methods: We analyzed 229 patients based on the AJCC/TNM 8th edition incorporating G (grade) and E (extent of disease). The impact of these 5 clinicopathological variables (T, N, M, G, E) is scored as stages 0 to IV and is reported as the Esquivel Peritoneal Surface Disease Severity Score (E-PSDSS). Results: One hundred and seventy-three patients underwent cytoreductive surgery (CRS) and HIPEC. There were 30 (13.1%), 56 (24.4%), 48 (20.9%), 20 (8.7%) and 75 (32.7%) patients with E-PSDSS 0, I, II, III, and IV, respectively. Five-year overall survival was 100%, 100%, 84.46%, 52.29% and 12.92% for E-PSDSS 0, I, II, III and IV, respectively (p < 0.0001). On multivariate analysis, sex (p = 0.0462) and E-PSDSS stage [0, I, II, III, IV] (HR 0 vs IV NR, HR 1 vs IV NR, HR II vs IV 0.072 [95% CI 0.028, 0.189], HR III vs IV 0.353 [95% CI 0.158, 0.791]; p < 0.0001) were identified as independent predictors of survival. Conclusion: The E-PSDSS combines specimen examination and reporting according to the College of American Pathologists with the pTNM requirements from the AJCC staging manual. It represents an important prognostic indicator in patients with mucinous appendiceal neoplasms.
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