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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.
  • Zaidi MY; Division of Surgical Oncology, Department of Surgery, Winship Cancer Institute, Emory University, 1365C Clifton Road, NE; Building C, 2nd Floor, Atlanta, GA, 30322, USA.
  • Lee RM; Division of Surgical Oncology, Department of Surgery, Winship Cancer Institute, Emory University, 1365C Clifton Road, NE; Building C, 2nd Floor, Atlanta, GA, 30322, USA.
  • Gamboa AC; Division of Surgical Oncology, Department of Surgery, Winship Cancer Institute, Emory University, 1365C Clifton Road, NE; Building C, 2nd Floor, Atlanta, GA, 30322, USA.
  • Speegle S; Division of Surgical Oncology, Department of Surgery, Winship Cancer Institute, Emory University, 1365C Clifton Road, NE; Building C, 2nd Floor, Atlanta, GA, 30322, USA.
  • Cloyd JM; Division of Surgical Oncology, Department of Surgery, The Ohio State University Wexner Medical Center, Columbus, OH, USA.
  • Kimbrough C; Division of Surgical Oncology, Department of Surgery, The Ohio State University Wexner Medical Center, Columbus, OH, USA.
  • Grotz T; Division of Hepatobiliary and Pancreas Surgery, Mayo Clinic, Rochester, MN, USA.
  • Leiting J; Division of Hepatobiliary and Pancreas Surgery, Mayo Clinic, Rochester, MN, USA.
  • Fournier K; Department of Surgical Oncology, University of Texas MD Anderson Cancer Center, Houston, TX, USA.
  • Lee AJ; Department of Surgical Oncology, University of Texas MD Anderson Cancer Center, Houston, TX, USA.
  • Dineen S; Department of Gastrointestinal Oncology, Moffitt Cancer Center, Department of Oncologic Sciences, Morsani College of Medicine, Tampa, FL, USA.
  • Dessureault S; Department of Gastrointestinal Oncology, Moffitt Cancer Center, Department of Oncologic Sciences, Morsani College of Medicine, Tampa, FL, USA.
  • Kelly KJ; Division of Surgical Oncology, Department of Surgery, University of California, San Diego, USA.
  • Kotha NV; Division of Surgical Oncology, Department of Surgery, University of California, San Diego, USA.
  • Clarke C; Division of Surgical Oncology, Department of Surgery, Medical College of Wisconsin, Milwaukee, USA.
  • Gamblin TC; Division of Surgical Oncology, Department of Surgery, Medical College of Wisconsin, Milwaukee, USA.
  • Patel SH; Department of Surgery, University of Cincinnati College of Medicine, Cincinnati, OH, USA.
  • Lee TC; Department of Surgery, University of Cincinnati College of Medicine, Cincinnati, OH, USA.
  • Hendrix RJ; Division of Surgical Oncology, Department of Surgery, University of Massachusetts Medical School, Worcester, MA, USA.
  • Lambert L; Section of Surgical Oncology, Huntsman Cancer Institute, University of Utah, Salt Lake City, UT, USA.
  • Ronnekleiv-Kelly S; Division of Surgical Oncology, Department of Surgery, University of Wisconsin, Madison, WI, USA.
  • Pokrzywa C; Division of Surgical Oncology, Department of Surgery, University of Wisconsin, Madison, WI, USA.
  • Blakely AM; Division of Surgical Oncology, Department of Surgery, City of Hope National Medical Center, Duarte, CA, USA.
  • Lee B; Division of Surgical Oncology, Department of Surgery, City of Hope National Medical Center, Duarte, CA, USA.
  • Johnston FM; Department of Surgery, Johns Hopkins University, Baltimore, MD, USA.
  • Fackche N; Department of Surgery, Johns Hopkins University, Baltimore, MD, USA.
  • Russell MC; Division of Surgical Oncology, Department of Surgery, Winship Cancer Institute, Emory University, 1365C Clifton Road, NE; Building C, 2nd Floor, Atlanta, GA, 30322, USA.
  • Maithel SK; Division of Surgical Oncology, Department of Surgery, Winship Cancer Institute, Emory University, 1365C Clifton Road, NE; Building C, 2nd Floor, Atlanta, GA, 30322, USA.
  • Staley CA; Division of Surgical Oncology, Department of Surgery, Winship Cancer Institute, Emory University, 1365C Clifton Road, NE; Building C, 2nd Floor, Atlanta, GA, 30322, USA. cstaley@emory.edu.
Ann Surg Oncol ; 27(1): 156-164, 2020 Jan.
Article en En | MEDLINE | ID: mdl-31602579
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.
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Texto completo: 1 Banco de datos: MEDLINE Asunto principal: Neoplasias del Apéndice / Neoplasias Peritoneales / Neoplasias Colorrectales / Procedimientos Quirúrgicos de Citorreducción / Hipertermia Inducida Tipo de estudio: Etiology_studies / Incidence_studies / Observational_studies / Prognostic_studies / Risk_factors_studies Límite: Adult / Aged / Female / Humans / Male / Middle aged País como asunto: America do norte Idioma: En Año: 2020 Tipo del documento: Article
Texto completo
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Texto completo: 1 Banco de datos: MEDLINE Asunto principal: Neoplasias del Apéndice / Neoplasias Peritoneales / Neoplasias Colorrectales / Procedimientos Quirúrgicos de Citorreducción / Hipertermia Inducida Tipo de estudio: Etiology_studies / Incidence_studies / Observational_studies / Prognostic_studies / Risk_factors_studies Límite: Adult / Aged / Female / Humans / Male / Middle aged País como asunto: America do norte Idioma: En Año: 2020 Tipo del documento: Article