TY - JOUR
T1 - Preoperative Risk Score for Predicting Incomplete Cytoreduction
T2 - A 12-Institution Study from the US HIPEC Collaborative
AU - Zaidi, Mohammad Y.
AU - Lee, Rachel M.
AU - Gamboa, Adriana C.
AU - Speegle, Shelby
AU - Cloyd, Jordan M.
AU - Kimbrough, Charles
AU - Grotz, Travis
AU - Leiting, Jennifer
AU - Fournier, Keith
AU - Lee, Andrew J.
AU - Dineen, Sean
AU - Dessureault, Sophie
AU - Kelly, Kaitlyn J.
AU - Kotha, Nikhil V.
AU - Clarke, Callisia
AU - Gamblin, T. Clark
AU - Patel, Sameer H.
AU - Lee, Tiffany C.
AU - Hendrix, Ryan J.
AU - Lambert, Laura
AU - Ronnekleiv-Kelly, Sean
AU - Pokrzywa, Courtney
AU - Blakely, Andrew M.
AU - Lee, Byrne
AU - Johnston, Fabian M.
AU - Fackche, Nadege
AU - Russell, Maria C.
AU - Maithel, Shishir K.
AU - Staley, Charles A.
N1 - Publisher Copyright:
© 2019, Society of Surgical Oncology.
PY - 2020/1/1
Y1 - 2020/1/1
N2 - 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.
AB - 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.
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U2 - 10.1245/s10434-019-07626-y
DO - 10.1245/s10434-019-07626-y
M3 - Article
C2 - 31602579
AN - SCOPUS:85074522191
SN - 1068-9265
VL - 27
SP - 156
EP - 164
JO - Annals of surgical oncology
JF - Annals of surgical oncology
IS - 1
ER -