Samer A Naffouje1, Kiara A Tulla1, George I Salti2,3. 1. Department of General Surgery, University of Illinois Hospital and Health Sciences System, Chicago, IL, USA. 2. Division of Surgical Oncology, University of Illinois Hospital and Health Sciences System, Chicago, IL, USA. 3. Department of Surgical Oncology, Edward Cancer Center, Naperville, IL, USA.
Abstract
BACKGROUND: With the introduction of cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC), long-term survival can be achieved in selected patients with peritoneal surface malignancy. In patients with peritoneal sarcomatosis (PS), CRS/HIPEC remains a topic of debate. It is important that patient selection and outcome be improved with a tool that better predicts survival in such patients. To this end, we devised a Simplified Peritoneal Sarcomatosis Score (SPSS) adopted from the previously-described peritoneal surface disease severity score (PSDSS). METHODS: Patients were included if they were diagnosed with PS and underwent CRS/HIPEC with intended complete cytoreduction between 2007 and 2017. To calculate SPSS, we recorded symptoms (none =0, present =1), peritoneal carcinomatosis index (PCI) (≤10=0, >10=1), and grade of tumor (low =0, high =1). Thus, SPSS ranged from 0 to 3. SPSS-L (low) included patients with score of 0-1; SPSS-H (high) included patients with scores 2-3. Survival curves were generated using Kaplan-Meier method according to the two tiers of SPSS. RESULTS: Twenty-five patients were included. Mean age was 51.84±10.75 years. Median follow-up was 18 months. Compared to SPSS-H, SPSS-L patients had a longer median overall survival (OS) (36±16 vs. 16±6 months, respectively; P=0.021) and a longer median disease-free survival (DFS) (36±16 vs. 16±6 months, respectively; P<0.001). On multivariate analysis, advanced disease (SPSS-H) was an independent predictor of OS (P=0.020) and DFS (P=0.018). CONCLUSIONS: SPSS can be used as a tool for patient selection for surgery, prognosis prediction, and stratification into clinical trials of PS patients.
BACKGROUND: With the introduction of cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC), long-term survival can be achieved in selected patients with peritoneal surface malignancy. In patients with peritoneal sarcomatosis (PS), CRS/HIPEC remains a topic of debate. It is important that patient selection and outcome be improved with a tool that better predicts survival in such patients. To this end, we devised a Simplified Peritoneal Sarcomatosis Score (SPSS) adopted from the previously-described peritoneal surface disease severity score (PSDSS). METHODS: Patients were included if they were diagnosed with PS and underwent CRS/HIPEC with intended complete cytoreduction between 2007 and 2017. To calculate SPSS, we recorded symptoms (none =0, present =1), peritoneal carcinomatosis index (PCI) (≤10=0, >10=1), and grade of tumor (low =0, high =1). Thus, SPSS ranged from 0 to 3. SPSS-L (low) included patients with score of 0-1; SPSS-H (high) included patients with scores 2-3. Survival curves were generated using Kaplan-Meier method according to the two tiers of SPSS. RESULTS: Twenty-five patients were included. Mean age was 51.84±10.75 years. Median follow-up was 18 months. Compared to SPSS-H, SPSS-L patients had a longer median overall survival (OS) (36±16 vs. 16±6 months, respectively; P=0.021) and a longer median disease-free survival (DFS) (36±16 vs. 16±6 months, respectively; P<0.001). On multivariate analysis, advanced disease (SPSS-H) was an independent predictor of OS (P=0.020) and DFS (P=0.018). CONCLUSIONS: SPSS can be used as a tool for patient selection for surgery, prognosis prediction, and stratification into clinical trials of PS patients.
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