title: Early recurrence of pseudomyxoma peritonei following treatment failure of cytoreductive surgery and perioperative intraperitoneal chemotherapy is indicative of a poor survival outcome.
abstract: BACKGROUND
  The aim of this study was to identify predictors of early recurrence to optimize outcomes.
  
  
  METHODS
  A comparison of clinicopathological factors between patients who developed early recurrence (≤12 months) and late recurrence (>12 months) was performed to identify predictors of treatment failure through univariate and multivariate analyses. Survival parameters were estimated using the Kaplan-Meier method.
  
  
  RESULTS
  A total of 113 patients with a median PCI of 24 (range, 2-39) underwent cytoreductive surgery. The median progression-free and overall survival was 48 and 104 months, respectively. Multivariate analysis identified prior operations >1, ≥10 units of fresh frozen plasma (FFP) transfusion, incomplete cytoreduction and not undergoing definitive cytoreductive surgery within 12 months of diagnosis as predictors for disease recurrence. Twenty of 41 patients (49%) developed early recurrence. The median overall survival of patients who developed early recurrence was 38 months and in patients who did not develop early recurrence was 97 months (P = 0.002). Subgroup analysis of patients with recurrence identified the male gender (P = 0.028), elevated CA 125 (P = 0.037), having elevated carcinoembryonic antigen (CEA), CA 125 and CA 19-9 (P = 0.029), peritoneal cancer index >25 (P = 0.020), incomplete cytoreduction (P = 0.020), >6 units of blood transfusion (P = 0.020) and >10 units of FFP transfusion (P = 0.009) as factors associated with early recurrence.
  
  
  CONCLUSIONS
  Early recurrence of pseudomyxoma peritonei occurs despite achieving high rates of oncologically optimal cytoreduction. The clinicopathologic factors associated with early recurrence identified in this study may inform us about patients at greatest risk of treatment failure during the post cytoreduction follow-up.
authors.affiliation: UNSW Department of Surgery, Hepatobiliary and Surgical Oncology Unit, St George Hospital, Sydney, NSW, 2217, Australia.
authors.forename: Terence C
authors.initials: TC
authors.lastname: Chua
authors.forename: Winston
authors.initials: W
authors.lastname: Liauw
authors.forename: David L
authors.initials: DL
authors.lastname: Morris
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000903:Antibiotics, Antineoplastic / Q000627:therapeutic use; D000964:Antimetabolites, Antineoplastic / Q000627:therapeutic use; D001803:Blood Transfusion; D018394:CA-125 Antigen / Q000097:blood; D018395:CA-19-9 Antigen / Q000097:blood; D002272:Carcinoembryonic Antigen / Q000097:blood; D018572:Disease-Free Survival; D005260:Female; D005472:Fluorouracil / Q000627:therapeutic use; D006801:Humans; D007263:Infusions, Parenteral; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D016685:Mitomycin / Q000627:therapeutic use; D015999:Multivariate Analysis; D009364:Neoplasm Recurrence, Local / Q000175:diagnosis*; D010534:Peritoneal Neoplasms / Q000097:blood / Q000188:drug therapy / Q000601:surgery*; D010949:Plasma; D011237:Predictive Value of Tests; D016016:Proportional Hazards Models; D011553:Pseudomyxoma Peritonei / Q000097:blood / Q000188:drug therapy / Q000601:surgery*; D012189:Retrospective Studies; D012737:Sex Factors; D013997:Time Factors; D017211:Treatment Failure; D055815:Young Adult
chemical_list: D000903:Antibiotics, Antineoplastic; D000964:Antimetabolites, Antineoplastic; D018394:CA-125 Antigen; D018395:CA-19-9 Antigen; D002272:Carcinoembryonic Antigen; D016685:Mitomycin; D005472:Fluorouracil