title: Hyperthermic Intraperitoneal Chemotherapy Following Cytoreductive Surgery Improves Outcome in Patients With Primary Appendiceal Mucinous Adenocarcinoma: A Pooled Analysis From Three Tertiary Care Centers.
abstract: OBJECTIVE
  Appendiceal mucinous neoplasms (AMN) are a rare heterogeneous group of diseases. In the absence of randomized trials, AMN management is controversial. The goal of this study was to evaluate the impact of hyperthermic intraperitoneal chemotherapy (HIPEC) after cytoreductive surgery on survival in AMN patients.
  
  
  METHODS
  Patient data including demographics, pathology, type of therapy, and outcomes were collected from Emory University, the Ohio State University, and Wayne State University databases. One of the three centers did not use HIPEC. Statistical analysis evaluating overall survival (OS) of AMN patients was performed.
  
  
  RESULTS
  Between 1990 and 2010, 163 AMN patients were identified. Histology showed 60 patients had diffuse peritoneal adenomucinosis, 88 had peritoneal mucinous carcinomatosis (PMCA), and 15 had PMCA with indeterminate or discordant features. Complete surgical resection was achieved in 76 patients. HIPEC was used in 79 patients. The median OS was 77 months for patients who received HIPEC compared with 25 months for patients who did not (p < .001). In multivariable analysis, histopathologic subtype (p < .001), complete surgical resection (p < .001), and HIPEC (p < .001) were independent predictors for improved OS. A survival advantage for AMN patients treated at HIPEC-treating centers was observed (p = .0026). After adjusting for HIPEC therapy, no significant survival difference was observed between the non-HIPEC-treating center and the HIPEC-treating centers (p = .094).
  
  
  CONCLUSIONS
  The addition of HIPEC to cytoreductive surgery likely provides a survival advantage and should be considered in the treatment strategy for AMN.
authors.affiliation: Department of Hematology and Oncology, Winship Cancer Institute, Division of Surgical Oncology, Winship Cancer Institute, and Department of Biostatistics, Emory University, Atlanta, Georgia, USA; Divisions of Hematology Oncology and Surgical Oncology, The Ohio State University, Columbus, Ohio, USA; Division of Hematology Oncology, Karmanos Cancer Center, Wayne State University, Detroit, Michigan, USA.
authors.forename: Walid L
authors.initials: WL
authors.lastname: Shaib
authors.affiliation: Department of Hematology and Oncology, Winship Cancer Institute, Division of Surgical Oncology, Winship Cancer Institute, and Department of Biostatistics, Emory University, Atlanta, Georgia, USA; Divisions of Hematology Oncology and Surgical Oncology, The Ohio State University, Columbus, Ohio, USA; Division of Hematology Oncology, Karmanos Cancer Center, Wayne State University, Detroit, Michigan, USA.
authors.forename: Ludmila Katherine
authors.initials: LK
authors.lastname: Martin
authors.affiliation: Department of Hematology and Oncology, Winship Cancer Institute, Division of Surgical Oncology, Winship Cancer Institute, and Department of Biostatistics, Emory University, Atlanta, Georgia, USA; Divisions of Hematology Oncology and Surgical Oncology, The Ohio State University, Columbus, Ohio, USA; Division of Hematology Oncology, Karmanos Cancer Center, Wayne State University, Detroit, Michigan, USA.
authors.forename: Minsing
authors.initials: M
authors.lastname: Choi
authors.affiliation: Department of Hematology and Oncology, Winship Cancer Institute, Division of Surgical Oncology, Winship Cancer Institute, and Department of Biostatistics, Emory University, Atlanta, Georgia, USA; Divisions of Hematology Oncology and Surgical Oncology, The Ohio State University, Columbus, Ohio, USA; Division of Hematology Oncology, Karmanos Cancer Center, Wayne State University, Detroit, Michigan, USA.
authors.forename: Zhengjia
authors.initials: Z
authors.lastname: Chen
authors.affiliation: Department of Hematology and Oncology, Winship Cancer Institute, Division of Surgical Oncology, Winship Cancer Institute, and Department of Biostatistics, Emory University, Atlanta, Georgia, USA; Divisions of Hematology Oncology and Surgical Oncology, The Ohio State University, Columbus, Ohio, USA; Division of Hematology Oncology, Karmanos Cancer Center, Wayne State University, Detroit, Michigan, USA.
authors.forename: Kavya
authors.initials: K
authors.lastname: Krishna
authors.affiliation: Department of Hematology and Oncology, Winship Cancer Institute, Division of Surgical Oncology, Winship Cancer Institute, and Department of Biostatistics, Emory University, Atlanta, Georgia, USA; Divisions of Hematology Oncology and Surgical Oncology, The Ohio State University, Columbus, Ohio, USA; Division of Hematology Oncology, Karmanos Cancer Center, Wayne State University, Detroit, Michigan, USA.
authors.forename: Sungjin
authors.initials: S
authors.lastname: Kim
authors.affiliation: Department of Hematology and Oncology, Winship Cancer Institute, Division of Surgical Oncology, Winship Cancer Institute, and Department of Biostatistics, Emory University, Atlanta, Georgia, USA; Divisions of Hematology Oncology and Surgical Oncology, The Ohio State University, Columbus, Ohio, USA; Division of Hematology Oncology, Karmanos Cancer Center, Wayne State University, Detroit, Michigan, USA.
authors.forename: Edith
authors.initials: E
authors.lastname: Brutcher
authors.affiliation: Department of Hematology and Oncology, Winship Cancer Institute, Division of Surgical Oncology, Winship Cancer Institute, and Department of Biostatistics, Emory University, Atlanta, Georgia, USA; Divisions of Hematology Oncology and Surgical Oncology, The Ohio State University, Columbus, Ohio, USA; Division of Hematology Oncology, Karmanos Cancer Center, Wayne State University, Detroit, Michigan, USA.
authors.forename: Charles
authors.initials: C
authors.lastname: Staley
authors.affiliation: Department of Hematology and Oncology, Winship Cancer Institute, Division of Surgical Oncology, Winship Cancer Institute, and Department of Biostatistics, Emory University, Atlanta, Georgia, USA; Divisions of Hematology Oncology and Surgical Oncology, The Ohio State University, Columbus, Ohio, USA; Division of Hematology Oncology, Karmanos Cancer Center, Wayne State University, Detroit, Michigan, USA.
authors.forename: Shishir K
authors.initials: SK
authors.lastname: Maithel
authors.affiliation: Department of Hematology and Oncology, Winship Cancer Institute, Division of Surgical Oncology, Winship Cancer Institute, and Department of Biostatistics, Emory University, Atlanta, Georgia, USA; Divisions of Hematology Oncology and Surgical Oncology, The Ohio State University, Columbus, Ohio, USA; Division of Hematology Oncology, Karmanos Cancer Center, Wayne State University, Detroit, Michigan, USA.
authors.forename: Philip
authors.initials: P
authors.lastname: Philip
authors.affiliation: Department of Hematology and Oncology, Winship Cancer Institute, Division of Surgical Oncology, Winship Cancer Institute, and Department of Biostatistics, Emory University, Atlanta, Georgia, USA; Divisions of Hematology Oncology and Surgical Oncology, The Ohio State University, Columbus, Ohio, USA; Division of Hematology Oncology, Karmanos Cancer Center, Wayne State University, Detroit, Michigan, USA.
authors.forename: Sherif
authors.initials: S
authors.lastname: Abdel-Misih
authors.affiliation: Department of Hematology and Oncology, Winship Cancer Institute, Division of Surgical Oncology, Winship Cancer Institute, and Department of Biostatistics, Emory University, Atlanta, Georgia, USA; Divisions of Hematology Oncology and Surgical Oncology, The Ohio State University, Columbus, Ohio, USA; Division of Hematology Oncology, Karmanos Cancer Center, Wayne State University, Detroit, Michigan, USA.
authors.forename: Tanios S
authors.initials: TS
authors.lastname: Bekaii-Saab
authors.affiliation: Department of Hematology and Oncology, Winship Cancer Institute, Division of Surgical Oncology, Winship Cancer Institute, and Department of Biostatistics, Emory University, Atlanta, Georgia, USA; Divisions of Hematology Oncology and Surgical Oncology, The Ohio State University, Columbus, Ohio, USA; Division of Hematology Oncology, Karmanos Cancer Center, Wayne State University, Detroit, Michigan, USA bassel.el-rayes@emoryhealthcare.org.
authors.forename: Bassel F
authors.initials: BF
authors.lastname: El-Rayes
mesh_terms: D002288:Adenocarcinoma, Mucinous / Q000188:drug therapy* / Q000601:surgery; D000328:Adult; D000368:Aged; D001063:Appendiceal Neoplasms / Q000188:drug therapy* / Q000601:surgery; D065426:Cytoreduction Surgical Procedures / Q000379:methods*; D005260:Female; D005334:Fever / Q000628:therapy*; D006801:Humans; D007274:Injections, Intraperitoneal; D008297:Male; D008875:Middle Aged; D062606:Tertiary Care Centers; D016896:Treatment Outcome
keywords: Appendiceal mucinous carcinoma; Hyperthermic intraperitoneal chemotherapy; Survival