title: Curative Surgical Resection as a Component of Multimodality Therapy for Peritoneal Metastases from Goblet Cell Carcinoids.
abstract: The impact of histopathologic features on oncologic outcomes for patients with peritoneal metastases from goblet cell carcinoid (GCC) undergoing multimodality therapy, including cytoreductive surgery with hyperthermic intraperitoneal chemoperfusion (CRS-HIPEC), is unknown.
  
  
  
  This study prospectively analyzed 43 patients with GCC undergoing CRS-HIPEC between 2005 and 2013. Pathology slides were re-reviewed to classify GCC into histologic subtypes according to the Tang classification. Kaplan-Meier survival curves and multivariate Cox-regression models identified prognostic factors affecting oncologic outcomes.
  
  
  
  The 43 patients in this study underwent 50 CRS-HIPEC procedures for peritoneal metastases from GCC, and the majority received neoadjuvant and/or adjuvant systemic chemotherapy. The GCC demonstrated an aggressive phenotype with frequent lymph node and peritoneal metastases without systemic dissemination. The majority of the patients had Tang B GCC. The estimated median overall survival times after surgery for the patients with Tang A, B, and C GCC were respectively 59, 22, and 13 months. In a multivariate Cox-regression analysis, poor survival was associated with patients who had Tang B or C GCC, those undergoing incomplete macroscopic resection, and those with symptoms at the time of CRS-HIPEC. The patients with Tang A GCC demonstrated oncologic outcomes similar to those with intermediate-grade (American Joint Committee on Cancer [AJCC] grade 2) disseminated mucinous appendiceal neoplasms, whereas the patients with Tang B and C GCC demonstrated survival rates similar to or worse than those with high-grade (AJCC grade 3) disseminated mucinous appendiceal neoplasms.
  
  
  
  Tang classification is an independent prognostic factor for poor survival after multimodality therapy for GCC. Patients with Tang C GCC demonstrate limited survival and are not ideal candidates for a surgical approach.
authors.affiliation: Division of Surgical Oncology, University of Pittsburgh, Pittsburgh, USA.
authors.forename: Michal
authors.initials: M
authors.lastname: Radomski
authors.affiliation: Department of Pathology, University of Pittsburgh, Pittsburgh, USA.
authors.forename: Reetesh K
authors.initials: RK
authors.lastname: Pai
authors.affiliation: The University of Pittsburgh Cancer Institute Biostatistics Facility, Pittsburgh, USA.
authors.forename: Yongli
authors.initials: Y
authors.lastname: Shuai
authors.affiliation: Division of Surgical Oncology, University of Pittsburgh, Pittsburgh, USA.
authors.forename: Lekshmi
authors.initials: L
authors.lastname: Ramalingam
authors.affiliation: Division of Surgical Oncology, University of Pittsburgh, Pittsburgh, USA.
authors.forename: Heather
authors.initials: H
authors.lastname: Jones
authors.affiliation: Division of Surgical Oncology, University of Pittsburgh, Pittsburgh, USA.
authors.forename: Matthew P
authors.initials: MP
authors.lastname: Holtzman
authors.affiliation: Division of Surgical Oncology, University of Pittsburgh, Pittsburgh, USA.
authors.forename: Steven A
authors.initials: SA
authors.lastname: Ahrendt
authors.affiliation: Division of Surgical Oncology, University of Pittsburgh, Pittsburgh, USA.
authors.forename: James F
authors.initials: JF
authors.lastname: Pingpank
authors.affiliation: Division of Surgical Oncology, University of Pittsburgh, Pittsburgh, USA.
authors.forename: Herbert J
authors.initials: HJ
authors.lastname: Zeh
authors.affiliation: Division of Surgical Oncology, University of Pittsburgh, Pittsburgh, USA.
authors.forename: David L
authors.initials: DL
authors.lastname: Bartlett
authors.affiliation: Division of Surgical Oncology, University of Pittsburgh, Pittsburgh, USA. choudrymh@upmc.edu.
authors.forename: Haroon A
authors.initials: HA
authors.lastname: Choudry
mesh_terms: D000970:Antineoplastic Agents / Q000008:administration & dosage; D001063:Appendiceal Neoplasms / Q000145:classification / Q000473:pathology*; D002276:Carcinoid Tumor / Q000145:classification / Q000473:pathology* / Q000556:secondary / Q000628:therapy*; D017024:Chemotherapy, Adjuvant; D003131:Combined Modality Therapy / Q000379:methods; D065426:Cytoreduction Surgical Procedures; D005260:Female; D020397:Goblet Cells; D006801:Humans; D006979:Hyperthermia, Induced; D053208:Kaplan-Meier Estimate; D008207:Lymphatic Metastasis; D008297:Male; D008875:Middle Aged; D020360:Neoadjuvant Therapy; D010534:Peritoneal Neoplasms / Q000145:classification / Q000473:pathology* / Q000556:secondary / Q000628:therapy*; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D015996:Survival Rate
chemical_list: D000970:Antineoplastic Agents