Clinical Analysis And Literature Study Of 41 Cases Of Peritoneal Pseudomyxoma

BackgroundPseudomyxoma peritonei(PMP)is a rare disease.Due to its lack of specific clinical and imaging manifestations,specific laboratory examination and clinical rarity,the preoperative diagnosis rate is low,which may cause misdiagnosis.The biopsy of the lesion which by laparoscopy or laparotomy is the only way to diagnose.The main treatment is Cytoreductive(CRS)combined with Hyperthermic introperitomic Chemotherapy(HIPEC).It's a histologically low-grade malignant disease,however secretes yellow jelly due to its mucinous tumor cells.The liquid is easy to be implanted and metastasized in the abdominal cavity,so the recurrence rate is high,and it generally dies from complications such as intestinal obstruction,intestinal fistula,cachexia,and multiple organ failure.Foreign literature reports that preoperative tumor marker levels,pathological types,age of onset,adjuvant therapy can affect the prognosis of patients with PMP.ObjectTo improve the clinical understanding,the level of diagnosis and treatment ofPMP,summarize the survival of patients with PMP treated by CRS combined with HIPEC,thus explore the factors which affect the survival prognosis of patients with PMP.MethodsRetrospective analysis of clinical data of 41 patients with PMP confirmed by surgery and pathology from October 2004 to January 2019 in the First Affiliated Hospital of Zhengzhou University,summarizing the imaging features of PMP patients,and To evaluate the diagnostic value of preoperative tumor marker levels,ascites examination,and ultrasound-guided intraperitoneal mass puncture for patients with PMP.Univariate and multivariate statistical methods were used to analyze the effects of gender,age,adjuvant therapy,preoperative tumor marker levels,and pathological type on survival and prognosis of PMP patients.Results1.Among the 41 patients in this group,the male to female ratio was 1:1.9,and the average age was 63 years.Clinical symptoms and signs are not specific.Imaging examination,elevated preoperative tumor markers,ascites cytology,and ultrasound-guided abdominal mass puncture have certain diagnostic value.Ultrasound-guided abdominal mass puncture or surgical biopsy can confirm the disease.The main treatment is CRS combined with HIPEC.2.There were 13 patients died during the observation period.The 5-year survival rate was 83%,the 10-year survival rate was 37%,and the median survival period was112 months.Univariate analysis showed that the pathological type was disseminated peritonealadenomucinosi(DPAM)(P=0.024),and the preoperative tumor marker level(P=0.036)had statistical significance for postoperative survival.Gender(P=0.222),age of onset(P=0.972),and postoperative treatment(P=0.280)were not statistically significant for postoperative survival.Multivariate analysis showed that pathological type(P=0.012)and preoperative tumor marker level(P=0.022)could be used as independent prognostic factors affecting overall survival.ConcludesImaging examination,abdominocentesis,tumor marker level,ultrasound-guided abdominal mass biopsy have certain diagnostic value for the disease.Laparoscopic or laparotomy for pathological biopsy is the main method for the diagnosis of this disease,CRS combined with HIPEC is currently the main treatment for PMP.The pathological type is peritoneal mucinous carcinomatosis(PMCA)and an intermediate type(PMCA I/D)between peritoneal mucinous deposition disease and peritoneal mucinous carcinoma suggest a poor prognosis.Gender,age of onset,and postoperative treatment are not significantly associated with prognosis in patients with PMP.