Preoperative Risk Score for Predicting Incomplete Cytoreduction: A 12-Institution Study from the US HIPEC Collaborative

Mohammad Y. Zaidi, Rachel M. Lee, Adriana C. Gamboa, Shelby Speegle, Jordan M. Cloyd, Charles Kimbrough, Travis Grotz, Jennifer Leiting, Keith Fournier, Andrew J. Lee, Sean Dineen, Sophie Dessureault, Kaitlyn J. Kelly, Nikhil V. Kotha, Callisia Clarke, T. Clark Gamblin, Sameer H. Patel, Tiffany C. Lee, Ryan J. Hendrix, Laura LambertSean Ronnekleiv-Kelly, Courtney Pokrzywa, Andrew M. Blakely, Byrne Lee, Fabian M. Johnston, Nadege Fackche, Maria C. Russell, Shishir K. Maithel, Charles A. Staley

Research output: Contribution to journalArticle

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.

Original languageEnglish (US)
JournalAnnals of Surgical Oncology
DOIs
StateAccepted/In press - Jan 1 2019

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compound A 12
Odds Ratio
Mesothelioma
Drug Therapy
Appendiceal Neoplasms
Neoplasms
Carcinoembryonic Antigen
Ascites
Colorectal Neoplasms
Histology
Morbidity
Carcinoma
Antigens
Survival
Incidence

ASJC Scopus subject areas

  • Surgery
  • Oncology

Cite this

Zaidi, M. Y., Lee, R. M., Gamboa, A. C., Speegle, S., Cloyd, J. M., Kimbrough, C., ... Staley, C. A. (Accepted/In press). Preoperative Risk Score for Predicting Incomplete Cytoreduction: A 12-Institution Study from the US HIPEC Collaborative. Annals of Surgical Oncology. https://doi.org/10.1245/s10434-019-07626-y

Preoperative Risk Score for Predicting Incomplete Cytoreduction : A 12-Institution Study from the US HIPEC Collaborative. / Zaidi, Mohammad Y.; Lee, Rachel M.; Gamboa, Adriana C.; Speegle, Shelby; Cloyd, Jordan M.; Kimbrough, Charles; Grotz, Travis; Leiting, Jennifer; Fournier, Keith; Lee, Andrew J.; Dineen, Sean; Dessureault, Sophie; Kelly, Kaitlyn J.; Kotha, Nikhil V.; Clarke, Callisia; Gamblin, T. Clark; Patel, Sameer H.; Lee, Tiffany C.; Hendrix, Ryan J.; Lambert, Laura; Ronnekleiv-Kelly, Sean; Pokrzywa, Courtney; Blakely, Andrew M.; Lee, Byrne; Johnston, Fabian M.; Fackche, Nadege; Russell, Maria C.; Maithel, Shishir K.; Staley, Charles A.

In: Annals of Surgical Oncology, 01.01.2019.

Research output: Contribution to journalArticle

Zaidi, MY, Lee, RM, Gamboa, AC, Speegle, S, Cloyd, JM, Kimbrough, C, Grotz, T, Leiting, J, Fournier, K, Lee, AJ, Dineen, S, Dessureault, S, Kelly, KJ, Kotha, NV, Clarke, C, Gamblin, TC, Patel, SH, Lee, TC, Hendrix, RJ, Lambert, L, Ronnekleiv-Kelly, S, Pokrzywa, C, Blakely, AM, Lee, B, Johnston, FM, Fackche, N, Russell, MC, Maithel, SK & Staley, CA 2019, 'Preoperative Risk Score for Predicting Incomplete Cytoreduction: A 12-Institution Study from the US HIPEC Collaborative', Annals of Surgical Oncology. https://doi.org/10.1245/s10434-019-07626-y
Zaidi, Mohammad Y. ; Lee, Rachel M. ; Gamboa, Adriana C. ; Speegle, Shelby ; Cloyd, Jordan M. ; Kimbrough, Charles ; Grotz, Travis ; Leiting, Jennifer ; Fournier, Keith ; Lee, Andrew J. ; Dineen, Sean ; Dessureault, Sophie ; Kelly, Kaitlyn J. ; Kotha, Nikhil V. ; Clarke, Callisia ; Gamblin, T. Clark ; Patel, Sameer H. ; Lee, Tiffany C. ; Hendrix, Ryan J. ; Lambert, Laura ; Ronnekleiv-Kelly, Sean ; Pokrzywa, Courtney ; Blakely, Andrew M. ; Lee, Byrne ; Johnston, Fabian M. ; Fackche, Nadege ; Russell, Maria C. ; Maithel, Shishir K. ; Staley, Charles A. / Preoperative Risk Score for Predicting Incomplete Cytoreduction : A 12-Institution Study from the US HIPEC Collaborative. In: Annals of Surgical Oncology. 2019.
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title = "Preoperative Risk Score for Predicting Incomplete Cytoreduction: A 12-Institution Study from the US HIPEC Collaborative",
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.",
author = "Zaidi, {Mohammad Y.} and Lee, {Rachel M.} and Gamboa, {Adriana C.} and Shelby Speegle and Cloyd, {Jordan M.} and Charles Kimbrough and Travis Grotz and Jennifer Leiting and Keith Fournier and Lee, {Andrew J.} and Sean Dineen and Sophie Dessureault and Kelly, {Kaitlyn J.} and Kotha, {Nikhil V.} and Callisia Clarke and Gamblin, {T. Clark} and Patel, {Sameer H.} and Lee, {Tiffany C.} and Hendrix, {Ryan J.} and Laura Lambert and Sean Ronnekleiv-Kelly and Courtney Pokrzywa and Blakely, {Andrew M.} and Byrne Lee and Johnston, {Fabian M.} and Nadege Fackche and Russell, {Maria C.} and Maithel, {Shishir K.} and Staley, {Charles A.}",
year = "2019",
month = "1",
day = "1",
doi = "10.1245/s10434-019-07626-y",
language = "English (US)",
journal = "Annals of Surgical Oncology",
issn = "1068-9265",
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}

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.

PY - 2019/1/1

Y1 - 2019/1/1

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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