Mohammad Y Zaidi1, Rachel M Lee1, Adriana C Gamboa1, Shelby Speegle1, Jordan M Cloyd2, Charles Kimbrough2, Travis Grotz3, Jennifer Leiting3, Keith Fournier4, Andrew J Lee4, Sean Dineen5, Sophie Dessureault5, Kaitlyn J Kelly6, Nikhil V Kotha6, Callisia Clarke7, T Clark Gamblin7, Sameer H Patel8, Tiffany C Lee8, Ryan J Hendrix9, Laura Lambert10, Sean Ronnekleiv-Kelly11, Courtney Pokrzywa11, Andrew M Blakely12, Byrne Lee12, Fabian M Johnston13, Nadege Fackche13, Maria C Russell1, Shishir K Maithel1, Charles A Staley14. 1. Division of Surgical Oncology, Department of Surgery, Winship Cancer Institute, Emory University, 1365C Clifton Road, NE; Building C, 2nd Floor, Atlanta, GA, 30322, USA. 2. Division of Surgical Oncology, Department of Surgery, The Ohio State University Wexner Medical Center, Columbus, OH, USA. 3. Division of Hepatobiliary and Pancreas Surgery, Mayo Clinic, Rochester, MN, USA. 4. Department of Surgical Oncology, University of Texas MD Anderson Cancer Center, Houston, TX, USA. 5. Department of Gastrointestinal Oncology, Moffitt Cancer Center, Department of Oncologic Sciences, Morsani College of Medicine, Tampa, FL, USA. 6. Division of Surgical Oncology, Department of Surgery, University of California, San Diego, USA. 7. Division of Surgical Oncology, Department of Surgery, Medical College of Wisconsin, Milwaukee, USA. 8. Department of Surgery, University of Cincinnati College of Medicine, Cincinnati, OH, USA. 9. Division of Surgical Oncology, Department of Surgery, University of Massachusetts Medical School, Worcester, MA, USA. 10. Section of Surgical Oncology, Huntsman Cancer Institute, University of Utah, Salt Lake City, UT, USA. 11. Division of Surgical Oncology, Department of Surgery, University of Wisconsin, Madison, WI, USA. 12. Division of Surgical Oncology, Department of Surgery, City of Hope National Medical Center, Duarte, CA, USA. 13. Department of Surgery, Johns Hopkins University, Baltimore, MD, USA. 14. Division of Surgical Oncology, Department of Surgery, Winship Cancer Institute, Emory University, 1365C Clifton Road, NE; Building C, 2nd Floor, Atlanta, GA, 30322, USA. cstaley@emory.edu.
Abstract
BACKGROUND: For patients with peritoneal carcinomatosis undergoing cytoreductive surgery with heated intraperitoneal chemotherapy (CRS/HIPEC), incomplete cytoreduction (CCR2/3) confers morbidity without survival benefit. The aim of this study is to identify preoperative factors which predict CCR2/3. METHODS: All patients who underwent curative-intent CRS/HIPEC of low/high-grade appendiceal, colorectal, or peritoneal mesothelioma cancers in the 12-institution US HIPEC Collaborative from 2000 to 2017 were included (n = 2027). The primary aim is to create an incomplete-cytoreduction risk score (ICRS) to predict CCR2/3 CRS utilizing preoperative data. ICRS was created from a randomly selected cohort of 50% of patients (derivation cohort) and verified on the remaining patients (validation cohort). RESULTS: Within our derivation cohort (n = 998), histology was low-grade appendiceal neoplasms in 30%, high-grade appendiceal tumor in 41%, colorectal tumor in 22%, and peritoneal mesothelioma in 8%. CCR0/1 was achieved in 816 patients and CCR 2/3 in 116 patients. On multivariable analysis, preoperative factors associated with incomplete cytoreduction were male gender [odds ratio (OR) 3.4, p = 0.007], presence of ascites (OR 2.8, p = 0.028), cancer antigen (CA)-125 ≥ 40 U/mL (OR 3.4, p = 0.012), and carcinoembryonic antigen (CEA) ≥ 4.2 ng/mL (OR 3.2, p = 0.029). Each preoperative factor was assigned a score of 0 or 1 to form an ICRS from 0 to 4. Scores were grouped as zero (0), low (1-2), or high (3-4). Incidence of CCR2/3 progressively increased by risk group from 1.6% in zero to 13% in low and 39% in high. When ICRS was applied to the validation cohort (n = 1029), this relationship was maintained. CONCLUSION: The incomplete cytoreduction risk score incorporates preoperative factors to accurately stratify the risk of CCR2/3 resection in CRS/HIPEC. This score should not be used in isolation, however, to exclude patients from surgery.
BACKGROUND: For patients with peritoneal carcinomatosis undergoing cytoreductive surgery with heated intraperitoneal chemotherapy (CRS/HIPEC), incomplete cytoreduction (CCR2/3) confers morbidity without survival benefit. The aim of this study is to identify preoperative factors which predict CCR2/3. METHODS: All patients who underwent curative-intent CRS/HIPEC of low/high-grade appendiceal, colorectal, or peritoneal mesothelioma cancers in the 12-institution US HIPEC Collaborative from 2000 to 2017 were included (n = 2027). The primary aim is to create an incomplete-cytoreduction risk score (ICRS) to predict CCR2/3CRS utilizing preoperative data. ICRS was created from a randomly selected cohort of 50% of patients (derivation cohort) and verified on the remaining patients (validation cohort). RESULTS: Within our derivation cohort (n = 998), histology was low-grade appendiceal neoplasms in 30%, high-grade appendiceal tumor in 41%, colorectal tumor in 22%, and peritoneal mesothelioma in 8%. CCR0/1 was achieved in 816 patients and CCR 2/3 in 116 patients. On multivariable analysis, preoperative factors associated with incomplete cytoreduction were male gender [odds ratio (OR) 3.4, p = 0.007], presence of ascites (OR 2.8, p = 0.028), cancer antigen (CA)-125 ≥ 40 U/mL (OR 3.4, p = 0.012), and carcinoembryonic antigen (CEA) ≥ 4.2 ng/mL (OR 3.2, p = 0.029). Each preoperative factor was assigned a score of 0 or 1 to form an ICRS from 0 to 4. Scores were grouped as zero (0), low (1-2), or high (3-4). Incidence of CCR2/3 progressively increased by risk group from 1.6% in zero to 13% in low and 39% in high. When ICRS was applied to the validation cohort (n = 1029), this relationship was maintained. CONCLUSION: The incomplete cytoreduction risk score incorporates preoperative factors to accurately stratify the risk of CCR2/3 resection in CRS/HIPEC. This score should not be used in isolation, however, to exclude patients from surgery.
Authors: Daniel Solomon; Natasha L DeNicola; Yael Feferman; Eliahu Bekhor; Marina L Reppucci; Daniela Feingold; Samantha N Aycart; Deepa R Magge; Benjamin J Golas; Daniel M Labow; Umut Sarpel Journal: Ann Surg Oncol Date: 2019-01-14 Impact factor: 5.344
Authors: C Pablo Carmignani; Regina Hampton; Christina E Sugarbaker; David Chang; Paul H Sugarbaker Journal: J Surg Oncol Date: 2004-09-15 Impact factor: 3.454
Authors: Vic J Verwaal; Serge van Ruth; Eeclo de Bree; Gooike W van Sloothen; Harm van Tinteren; Henk Boot; Frans A N Zoetmulder Journal: J Clin Oncol Date: 2003-10-15 Impact factor: 44.544
Authors: Sean P Dineen; Richard E Royal; Marybeth S Hughes; Tara Sagebiel; Priya Bhosale; Michael Overman; Aurelio Matamoros; Paul F Mansfield; Keith F Fournier Journal: Ann Surg Oncol Date: 2015-02-20 Impact factor: 5.344
Authors: Anna Coghill; Julian Sanchez; Sweta Sinha; Jennifer B Permuth; Danielle Laskowitz; Benjamin D Powers; Sean P Dineen Journal: Cancer Rep (Hoboken) Date: 2022-07-22