Image pro plus hematoxylin and eosin
![image pro plus hematoxylin and eosin image pro plus hematoxylin and eosin](https://www.jcancer.org/v09/p1568/jcav09p1568g002.jpg)
Based mainly on the number of tumor cells and morphology of tumor nests, atypia, mitotic figures, and the form of surrounding invasion, PMP is divided into four different prognostic groups: acellular mucin, low-grade PMP (LG-PMP), high-grade PMP (HG-PMP) and HG-PMP with signet ring cells. The histopathological classification and grading of PMP are of vital importance for disease assessment. In addition, the Peritoneal Surface Oncology Group International (PSOGI) consensus on the pathological types of PMP in 2016 ended the controversy and set standards on pathological classification and diagnostic terms of PMP. As a rare clinical tumor syndrome with an indolent clinical course and lack of pathognomonic symptoms, PMP is difficult to diagnose in the early stage, leading to missed diagnosis and misdiagnosis. Currently, cytoreductive surgery (CRS) plus hyperthermic intraperitoneal chemotherapy (HIPEC) is the standard treatment, which can significantly prolong survival. Pseudomyxoma peritonei (PMP) is a malignant clinical syndrome characterized by the accumulation and redistribution of copious mucus produced by mucinous tumor cells in the peritoneal cavity, with typical clinical manifestations including mucinous ascites, peritoneal implantation, omental cake, and ovarian involvement. The TSR could be a new independent prognosticator for PMP. Multivariate analysis showed that preoperative CEA, vascular tumor emboli and the TSR were independent prognostic factors. Univariate analysis showed that preoperative carcinoembryonic antigen (CEA), preoperative carbohydrate antigen 19–9, pathological type, vascular tumor emboli and TSR influenced the prognosis of PMP patients ( P < 0.05). The TSR was closely related to histopathological type ( P < 0.001) and Ki67 label index ( P < 0.001). The cutoff value of TSR was 10% based on the receiver operating characteristic (ROC) curve and X-Tile analysis. The range of TSR was 2 - 24% (median: 8%). The immunohistochemical results showed that the Ki67 label index was 50% in 14 cases (28.0%). There were 4 (8.0%) patients with vascular tumor emboli, 3 (6.0%) patients with nerve invasion, and 5 (10.0%) patients with lymph node metastasis. 25 (50.0%) patients were diagnosed with low-grade PMP (LG-PMP), and 25 (50.0%) were diagnosed with high-grade PMP (HG-PMP). ResultsĪmong the 50 PMP patients included, there were 27 males (54.0%) and 23 females (46.0%), with a median age of 55 (range: 31–76) years. Then the relationship between TSR and the clinicopathological characteristics, immunohistochemical characteristics and prognosis of PMP was analyzed. The TSR of postoperative pathological images was quantitatively analyzed by Image-Pro Plus.
![image pro plus hematoxylin and eosin image pro plus hematoxylin and eosin](https://www.science.org/cms/10.1126/sciadv.abc8145/asset/3e6bb4e3-a16c-4057-aa7b-5d50da74c358/assets/images/large/sciadv.abc8145-f2.jpg)
PMP patients with complete data who underwent cytoreductive surgery plus hyperthermic intraperitoneal chemotherapy were enrolled. This study explored the relationship between TSR and the pathological characteristics and prognosis of PMP. The tumor-stroma ratio (TSR) is a promising prognostic parameter based on the tumor and stroma. In-depth pathological analysis is essential to assess tumor biological behaviors, assist treatment decision, and predict the clinical prognosis of PMP. As a rare clinical tumor syndrome with an indolent clinical course and lack of pathognomonic symptoms, pseudomyxoma peritonei (PMP) is usually diagnosed at an advanced stage.