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. 2021 Dec;28(13):9116-9125.
doi: 10.1245/s10434-021-10289-3. Epub 2021 Jul 5.

Definition and Prediction of Early Recurrence and Mortality Following Cytoreductive Surgery and Hyperthermic Intraperitoneal Chemotherapy for Colorectal Peritoneal Metastases: Towards Predicting Oncologic Futility Preoperatively

Caroline J Rieser  1 , Heather Jones  2 , Lauren B Hall  2 , Eliza Kang  2 , Shannon Altpeter  2 , Amer H Zureikat  2 , Matthew P Holtzman  2 , Andrew Lee  2 , Melanie Ongchin  2 , James F Pingpank  2 , M Haroon A Choudry  2 , David L Bartlett  3
Affiliations

Definition and Prediction of Early Recurrence and Mortality Following Cytoreductive Surgery and Hyperthermic Intraperitoneal Chemotherapy for Colorectal Peritoneal Metastases: Towards Predicting Oncologic Futility Preoperatively

Caroline J Rieser et al. Ann Surg Oncol. 2021 Dec.

Abstract

Introduction: Early recurrence (ER) is a significant challenge for patients with colorectal peritoneal metastases (CRPM) following cytoreductive surgery with hyperthermic intraperitoneal chemotherapy (CRS HIPEC). Preoperative risk stratification for ER would improve preoperative decision making.

Methods: We conducted a retrospective study examining patients who underwent CRS HIPEC for CRPM from 2000 to 2018. Optimal definition of ER was determined via minimum p-value approach based on differentiation of post-recurrence survival. Risk factors for ER were assessed in a derivation cohort by uni- and multivariate logistic regression. A predictive score for ER was generated using preoperative variables and validated in an independent cohort.

Results: 384 patients were analyzed, 316 (82%) had documented recurrence. Optimal length of post-operative RFS to distinguish ER (n = 144, 46%) vs. late recurrence (LR) (n = 172, 63%) was 8 mos (p<0.01). ER patients had shorter median OS post-CRS-HIPEC (13.6 vs. 39.4 mos, p<0.01). Preoperative BMI (OR 1.88), liver lesions (OR 1.89), progression on chemotherapy (OR 2.14), positive lymph nodes (OR 2.47) and PCI score (16-20: OR 1.7; >20: OR 4.37) were significant predictors of ER (all p<0.05). Using this model, patients were assigned risk scores from 0 to 9. Intermediate (scores 4-6) and high-risk patients (score 7-9) had observed rates of ER of 56% and 79% and overall 2-year survival rates of 27% and 0% respectively. The model showed fair discrimination (AUC 0.72) and good calibration (Hosmer-Lemeshow GOF p = 0.68).

Conclusions: ER predicts markedly worse OS following surgery. Preoperative factors can accurately stratify risk for ER and identify patients in whom CRS-HIPEC for CPRM is futile.

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Figures

Figure 1:
Figure 1:
Study flow diagram. Early recurrence defined as recurrence within 8 months of cytoreductive surgery and hyperthermic intraperitoneal chemotherapy.
Figure 2:
Figure 2:
Percent of patients with early recurrence (ER; recurrence within 8 months of cytoreductive surgery and hyperthermic intraperitoneal chemotherapy) by score total within the derivation cohort. Patients with scores of 0–3 defined as low risk, 4–6 intermediate risk, and 7+ as high risk.
See this image and copyright information in PMC

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