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Annals of Surgical Oncology
Published in: Annals of Surgical Oncology 1/2020

01-01-2020 | Ascites | Peritoneal Surface Malignancy

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

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

Published in: Annals of Surgical Oncology | Issue 1/2020

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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.
Footnotes
1
Emory University, The Ohio State University, University of California San Diego, University of Cincinnati, City of Hope National Medical Center, Johns Hopkins University, University of Massachusetts, Mayo Clinic, Medical College of Wisconsin, Moffitt Cancer Center, University of Texas MD Anderson Cancer Center, and University of Wisconsin.
 
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Metadata
Title
Preoperative Risk Score for Predicting Incomplete Cytoreduction: A 12-Institution Study from the US HIPEC Collaborative
Authors
Mohammad Y. Zaidi, MD, MS
Rachel M. Lee, MD, MSPH
Adriana C. Gamboa, MD
Shelby Speegle, MS
Jordan M. Cloyd, MD
Charles Kimbrough, MD
Travis Grotz, MD
Jennifer Leiting, MD
Keith Fournier, MD
Andrew J. Lee, MD
Sean Dineen, MD
Sophie Dessureault, MD, PhD
Kaitlyn J. Kelly, MD
Nikhil V. Kotha, BS
Callisia Clarke, MD
T. Clark Gamblin, MD
Sameer H. Patel, MD
Tiffany C. Lee, MD
Ryan J. Hendrix, MD
Laura Lambert, MD
Sean Ronnekleiv-Kelly, MD
Courtney Pokrzywa, MD
Andrew M. Blakely, MD
Byrne Lee, MD
Fabian M. Johnston, MD, MHS
Nadege Fackche, MD
Maria C. Russell, MD
Shishir K. Maithel, MD
Charles A. Staley III, MD, FACS
Publication date
01-01-2020
Publisher
Springer International Publishing
Published in
Annals of Surgical Oncology / Issue 1/2020
Print ISSN: 1068-9265
Electronic ISSN: 1534-4681
DOI
https://doi.org/10.1245/s10434-019-07626-y

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