TY - JOUR
T1 - Oncologic Risk Stratification Following Cytoreductive Surgery and Hyperthermic Intraperitoneal Chemotherapy for Appendiceal Carcinomatosis
AU - Wagner, Patrick L.
AU - Austin, Frances
AU - Zenati, Mazen
AU - Jaech, Aaron
AU - Mavanur, Arun
AU - Ramalingam, Lekshmi
AU - Jones, Heather L.
AU - Holtzman, Matthew P.
AU - Ahrendt, Steven A.
AU - Zureikat, Amer H.
AU - Pingpank, James F.
AU - Zeh, Herbert J.
AU - Bartlett, David L.
AU - Choudry, Haroon A.
N1 - Publisher Copyright:
© 2016, Society of Surgical Oncology.
PY - 2016/5/1
Y1 - 2016/5/1
N2 - Introduction: Patients with peritoneal carcinomatosis (PC) of appendiceal origin demonstrate variable oncologic outcomes, despite aggressive cytoreductive surgery and hyperthermic intraperitoneal chemotherapy (CRS–HIPEC). We sought to devise a prognostic risk stratification system for oncologic outcomes following CRS–HIPEC. Methods: A total of 197 patients undergoing CRS–HIPEC for the treatment of appendiceal PC were reviewed from a prospective database. Kaplan–Meier survival curves and multivariate Cox regression models were used to identify prognostic factors affecting oncologic outcomes. Clinicopathologic variables affecting overall survival (OS) were utilized to develop a prognostic staging system and nomograms. Results: Univariate and multivariate Cox regression analysis indicated that high-grade tumor histology, lymph node metastasis, and incomplete cytoreduction were high-risk features, adversely affecting OS. Patients were stratified on the presence of high-risk features as follows: low-risk patients had no risk factors (n = 102); intermediate-risk patients had one risk factor (n = 49); and high-risk patients had more than one risk factor (n = 46). Median OS for low-risk patients was not reached, and was 43 and 22 months for intermediate-risk and high-risk patients, respectively. Five-year OS was 72, 43, and 13 % for low-, intermediate- and high-risk patients, respectively (p < 0.0003 for low vs. intermediate risk, and p = 0.06 for intermediate vs. high risk). Conclusions: We propose a three-tier staging system for appendiceal PC following CRS–HIPEC, based on histologic grade, lymph node involvement, and completeness of cytoreduction. The presence of any one or more of these high-risk features significantly decreased survival in our single-institution database and provided the basis for a prognostic staging system and corresponding nomograms.
AB - Introduction: Patients with peritoneal carcinomatosis (PC) of appendiceal origin demonstrate variable oncologic outcomes, despite aggressive cytoreductive surgery and hyperthermic intraperitoneal chemotherapy (CRS–HIPEC). We sought to devise a prognostic risk stratification system for oncologic outcomes following CRS–HIPEC. Methods: A total of 197 patients undergoing CRS–HIPEC for the treatment of appendiceal PC were reviewed from a prospective database. Kaplan–Meier survival curves and multivariate Cox regression models were used to identify prognostic factors affecting oncologic outcomes. Clinicopathologic variables affecting overall survival (OS) were utilized to develop a prognostic staging system and nomograms. Results: Univariate and multivariate Cox regression analysis indicated that high-grade tumor histology, lymph node metastasis, and incomplete cytoreduction were high-risk features, adversely affecting OS. Patients were stratified on the presence of high-risk features as follows: low-risk patients had no risk factors (n = 102); intermediate-risk patients had one risk factor (n = 49); and high-risk patients had more than one risk factor (n = 46). Median OS for low-risk patients was not reached, and was 43 and 22 months for intermediate-risk and high-risk patients, respectively. Five-year OS was 72, 43, and 13 % for low-, intermediate- and high-risk patients, respectively (p < 0.0003 for low vs. intermediate risk, and p = 0.06 for intermediate vs. high risk). Conclusions: We propose a three-tier staging system for appendiceal PC following CRS–HIPEC, based on histologic grade, lymph node involvement, and completeness of cytoreduction. The presence of any one or more of these high-risk features significantly decreased survival in our single-institution database and provided the basis for a prognostic staging system and corresponding nomograms.
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U2 - 10.1245/s10434-015-5037-7
DO - 10.1245/s10434-015-5037-7
M3 - Article
C2 - 26744106
AN - SCOPUS:84953402769
SN - 1068-9265
VL - 23
SP - 1587
EP - 1593
JO - Annals of surgical oncology
JF - Annals of surgical oncology
IS - 5
ER -