Experience of applying cytoreductive surgery and hyperthermic intraperitoneal chemotherapy for ovarian teratoma with malignant transformation and peritoneal dissemination

Figures & data

Table 1 The epidemiologic and perioperative data of the ten female patients of ovarian teratoma with malignant transformation and peritoneal dissemination

Characteristics	All patients (N=10)
Age, mean (range) (year)	45 (20–69)
PSS, n
0	2
1	2
2	6
Neoadjuvant systemic chemotherapy, n	5
Neoadjuvant intraperitoneal chemotherapy, n	1
CA125, mean (range) (U/mL) (normal 0–35 U/mL)	145.5 (3.7–816.0)
CEA, mean (range) (ng/mL) (normal 0–5 ng/mL)	93.9 (1.2–787.0)
CA19-9, mean (range) (U/mL) (normal 0–37 U/mL)	337.7 (1.0–1,498.0)
Presentation of PMP, n	8
Ascites cytology, n
No evidence of malignancy	6
Suspected malignancy or benign atypia	2
Malignancy	2
PCI, mean (range)
Pre-op	13.9 (3–24)
Post-op	1.4 (0–11)
CC score, n
0	7
1	3
2	0
3	0
HIPEC regimens, n
Docetaxel plus cisplatin	9
Docetaxel alone	1
Ostomy procedures, n
Colostomy	1
Ileal conduit urinary diversion	1
Cutaneous tube ureterostomy	1
Operation time, mean (range) (minutes)	267 (135–392)
Blood loss, mean (range) (mL)	1,299 (450–2,100)
Histopathological types of malignancies, n
Mature cystic teratoma malignant transformation	6
Mature cystic teratoma mixed YST	1
Immature teratoma	1
Immature teratoma with GTS	1
Immature teratoma mixed YST with GTS	1
Morbidity, n
Grade 0	7
Grade 1–2	3
Grade 3–5	0
Admission days, mean (range)	34.4 (14–87)
Adjuvant chemotherapy, n	6
Recurrence of disease, n	1
Disease-free survival after diagnosis, months
Mean ± SD (range)	54.3±44.9 (10–121.5)
Median	32.0
Disease-free survival after CRS-HIPEC, months
Mean ± SD (range)	36.2±41.9 (1.5–114.0)
Median	22.3

Abbreviations: CC, completeness of cytoreduction; CRS, cytoreductive surgery; GTS, growing teratoma syndrome; HIPEC, hyperthermic intraperitoneal chemotherapy; PCI, peritoneal cancer index; PD, peritoneal dissemination; PMP, pseudomyxoma peritonei; PSS, prior surgical score; YST, yolk sac tumor.

Table 2 Patient characteristics and pathological reviews

Patient no.	Age	PMP	Ovary pathology	Appendix pathology	CK20/CK7	DFS after CRS-HIPEC
1	65	+	Mature cystic teratoma with low malignant potential mucinous neoplasm	Normal	+/−	108.0
2	69	+	Mature cystic teratoma, low-grade malignant mucinous adenocarcinoma	N/A	−/+	28.0
3	59	+	Mature cystic teratoma, borderline malignant mucinous adenocarcinoma	Normal	+/+	114.0
4	20	+	Mature cystic teratoma, borderline malignant mucinous adenocarcinoma	Normal		23.0
5	30	+	Mature cystic teratoma, adenocarcinoma, mixed Yolk sac tumor	Normal	+/−	6.5 *Recurrence
6	55	+	Mature cystic teratoma, adenocarcinoma	Normal		1.5
7	32	+	Immature teratoma, mucinous adenocarcinoma	N/A		48.0
8	47	+	Mature cystic teratoma, borderline malignant mucinous adenocarcinoma	Normal	+/+	21.5
9	46	−	Immature teratoma, post-C/T growth teratoma syndrome	N/A		7.5
10	27	−	Immature teratoma, mixed Yolk sac tumor, post-C/T growth teratoma syndrome	N/A		3.5

Abbreviations: CRS-HIPEC, cytoreductive surgery and hyperthermia intraperitoneal chemotherapy; DFS, disease-free survival; N/A, not available; PMP, pseudomyxoma peritonei.

Figure 1 Comparison of survival curve of HIPEC group vs non-HIPEC standard treatment group; The HIPEC group showed a higher 5-year DFS rate (88%) than the standard group (40%) (P=0.119).

Abbreviations: HIPEC, hyperthermic intraperitoneal chemotherapy; DFS, disease-free survival.