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 journalArticlepeer-review


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)
Pages (from-to)156-164
Number of pages9
JournalAnnals of surgical oncology
Issue number1
StatePublished - Jan 1 2020

ASJC Scopus subject areas

  • Surgery
  • Oncology


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