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Annals of Surgical Oncology
Published in: Annals of Surgical Oncology 5/2015

01-05-2015 | Regional Cancer Therapies

Predictors of Progression in High-Grade Appendiceal or Colorectal Peritoneal Carcinomatosis After Cytoreductive Surgery and Hyperthermic Intraperitoneal Chemotherapy

Authors: Joel M. Baumgartner, MD, Laura Tobin, MPH, Sean F. Heavey, BS, Kaitlyn J. Kelly, MD, Eric J. Roeland, MD, Andrew M. Lowy, MD

Published in: Annals of Surgical Oncology | Issue 5/2015

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Abstract

Background

Long-term survival of patients with appendiceal or colorectal peritoneal carcinomatosis (PC) may be achieved by combining cytoreductive surgery with hyperthermic intraperitoneal chemotherapy (CRS/HIPEC). Unfortunately, such favorable outcomes are realized in a minority of patients. Given the morbidity of the CRS/HIPEC and the uncertain role of postresection systemic therapy, it is important that prognostic factors in high-grade PC be clearly defined.

Methods

This single center, retrospective, cohort study examined the outcomes of CRS/HIPEC performed on patients with high-grade PC secondary to appendiceal or colorectal adenocarcinoma between 2007 and 2013. Cox regression analysis was utilized to evaluate the association between potential prognostic factors [age, sex, primary site, lymph node (LN) status, peritoneal cancer index (PCI) score, completeness of cytoreduction score (CC score), number of visceral resections, and systemic chemotherapy] and progression-free survival (PFS).

Results

A total of 70 patients with high-grade appendiceal or colorectal PC underwent CRS/HIPEC during the study period; 82.9 % underwent complete (CC-0) cytoreduction with a median PFS of 9.7 months. Positive LNs at the time of CRS/HIPEC were predictors of worse PFS on univariate and multivariate analysis. No association was demonstrated between pre- or post-HIPEC systemic chemotherapy and PFS.

Conclusions

High-grade PC secondary to appendiceal or colorectal adenocarcinoma can be managed with CRS/HIPEC. The number of LN metastases at the time of CRS/HIPEC is the strongest predictor of progression and must be considered when determining patient eligibility for this aggressive treatment.
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Metadata
Title
Predictors of Progression in High-Grade Appendiceal or Colorectal Peritoneal Carcinomatosis After Cytoreductive Surgery and Hyperthermic Intraperitoneal Chemotherapy
Authors
Joel M. Baumgartner, MD
Laura Tobin, MPH
Sean F. Heavey, BS
Kaitlyn J. Kelly, MD
Eric J. Roeland, MD
Andrew M. Lowy, MD
Publication date
01-05-2015
Publisher
Springer US
Published in
Annals of Surgical Oncology / Issue 5/2015
Print ISSN: 1068-9265
Electronic ISSN: 1534-4681
DOI
https://doi.org/10.1245/s10434-014-3985-y

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