Insight into Predictors of Cytoreduction Score Following Cytoreductive Surgery-Hyperthermic Intraperitoneal Chemotherapy for Gastric Peritoneal Carcinomatosis Improves Patient Selection and Prognostic Outcomes.
Cytoreductive surgery
Gastric peritoneal metastasis
Intraperitoneal chemotherapy
Journal
Annals of surgical oncology
ISSN: 1534-4681
Titre abrégé: Ann Surg Oncol
Pays: United States
ID NLM: 9420840
Informations de publication
Date de publication:
09 Oct 2024
09 Oct 2024
Historique:
received:
20
02
2024
accepted:
23
09
2024
medline:
9
10
2024
pubmed:
9
10
2024
entrez:
9
10
2024
Statut:
aheadofprint
Résumé
Peritoneal metastases due to gastric adenocarcinoma (GCPM) carry a dismal prognosis. A promising treatment strategy is cytoreductive surgery and hyperthermic intraperitoneal chemotherapy (CRS-HIPEC), but clear eligibility criteria for GCPM are lacking. We sought to identify factors associated with overall survival (OS) following CRS-HIPEC for GCPM to help optimize patient selection and clinical outcomes. In this single-center retrospective cohort study, we examined CRS-HIPEC outcomes for patients with GCPM between 2001 and 2021. After analyzing patient demographic, clinicopathologic, and perioperative variables, we applied multivariable Cox hazard models to assess factors associated with OS. We then assessed associations between baseline predictors and prognostically important variables using multivariable logistic regression. We analyzed 55 patients with GCPM who underwent CRS-HIPEC. Median age was 54 years and 42% were female. Median peritoneal carcinomatosis index (PCI) was 8, and 75% of patients achieved a cytoreduction completeness score (CC score) of 0. Median progression-free survival (PFS) was 6.9 months, and median OS was 14.1 months. On adjusted analysis, a CC score > 0 (HR 2.3, p = 0.02) was significantly associated with worse OS. A peritoneal carcinomatosis index greater than 13 (OR 52.6, p = 0.001) and fewer lymph nodes (especially < 18) resected with the primary tumor (OR 0.86, p = 0.042) in the metachronous setting were significantly associated with incomplete macroscopic cytoreduction (CC score > 0). We demonstrated that PCI > 13 and primary lymph nodes harvested < 18 in metachronous tumors are associated with CC score > 0, which in turn portends a worse OS. Although these results warrant prospective validation, they provide insight into improved selection of patients with GCPM for CRS-HIPEC.
Sections du résumé
BACKGROUND
BACKGROUND
Peritoneal metastases due to gastric adenocarcinoma (GCPM) carry a dismal prognosis. A promising treatment strategy is cytoreductive surgery and hyperthermic intraperitoneal chemotherapy (CRS-HIPEC), but clear eligibility criteria for GCPM are lacking. We sought to identify factors associated with overall survival (OS) following CRS-HIPEC for GCPM to help optimize patient selection and clinical outcomes.
PATIENTS AND METHODS
METHODS
In this single-center retrospective cohort study, we examined CRS-HIPEC outcomes for patients with GCPM between 2001 and 2021. After analyzing patient demographic, clinicopathologic, and perioperative variables, we applied multivariable Cox hazard models to assess factors associated with OS. We then assessed associations between baseline predictors and prognostically important variables using multivariable logistic regression.
RESULTS
RESULTS
We analyzed 55 patients with GCPM who underwent CRS-HIPEC. Median age was 54 years and 42% were female. Median peritoneal carcinomatosis index (PCI) was 8, and 75% of patients achieved a cytoreduction completeness score (CC score) of 0. Median progression-free survival (PFS) was 6.9 months, and median OS was 14.1 months. On adjusted analysis, a CC score > 0 (HR 2.3, p = 0.02) was significantly associated with worse OS. A peritoneal carcinomatosis index greater than 13 (OR 52.6, p = 0.001) and fewer lymph nodes (especially < 18) resected with the primary tumor (OR 0.86, p = 0.042) in the metachronous setting were significantly associated with incomplete macroscopic cytoreduction (CC score > 0).
CONCLUSIONS
CONCLUSIONS
We demonstrated that PCI > 13 and primary lymph nodes harvested < 18 in metachronous tumors are associated with CC score > 0, which in turn portends a worse OS. Although these results warrant prospective validation, they provide insight into improved selection of patients with GCPM for CRS-HIPEC.
Identifiants
pubmed: 39382749
doi: 10.1245/s10434-024-16328-z
pii: 10.1245/s10434-024-16328-z
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Informations de copyright
© 2024. Society of Surgical Oncology.
Références
Thrift AP, El-Serag HB. Burden of gastric cancer. Clin Gastroenterol Hepatol. 2020;18(3):534–42. https://doi.org/10.1016/j.cgh.2019.07.045 .
doi: 10.1016/j.cgh.2019.07.045
pubmed: 31362118
Wang Z, Graham DY, Khan A, et al. Incidence of gastric cancer in the USA during 1999 to 2013: a 50-state analysis. Int J Epidemiol. 2018;47(3):966–975. https://doi.org/10.1093/ije/dyy055
Thrift AP, Nguyen TH. Gastric cancer epidemiology. Gastrointest Endosc Clin N Am. 2021;31(3):425–39. https://doi.org/10.1016/j.giec.2021.03.001 .
doi: 10.1016/j.giec.2021.03.001
pubmed: 34053631
Sung H, Ferlay J, Siegel RL, et al. Global cancer statistics 2020: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin. 2021;71(3):209–49. https://doi.org/10.3322/caac.21660 .
doi: 10.3322/caac.21660
pubmed: 33538338
Fock KM. Review article: the epidemiology and prevention of gastric cancer. Aliment Pharmacol Ther. 2014;40(3):250–60. https://doi.org/10.1111/apt.12814 .
doi: 10.1111/apt.12814
pubmed: 24912650
Zhang JF, Lv L, Zhao S, Zhou Q, Jiang CG. Hyperthermic intraperitoneal chemotherapy (HIPEC) combined with surgery: a 12-year meta-analysis of this promising treatment strategy for advanced gastric cancer at different stages. Ann Surg Oncol. 2022;29(5):3170–86. https://doi.org/10.1245/s10434-021-11316-z .
doi: 10.1245/s10434-021-11316-z
pubmed: 35175455
Martins M, Santos-Sousa H, Araujo F, Nogueiro J, Sousa-Pinto B. Impact of cytoreductive surgery with hyperthermic intraperitoneal chemotherapy in the treatment of gastric cancer with peritoneal carcinomatosis: a systematic review and meta-analysis. Ann Surg Oncol. 2022;29(12):7528–37. https://doi.org/10.1245/s10434-022-12312-7 .
doi: 10.1245/s10434-022-12312-7
pubmed: 35930109
Manzanedo I, Pereira F, Rihuete Caro C, et al. Cytoreductive surgery and hyperthermic intraperitoneal chemotherapy (HIPEC) for gastric cancer with peritoneal carcinomatosis: multicenter study of Spanish Group of Peritoneal Oncologic Surgery (GECOP). Ann Surg Oncol. 2019;26(8):2615–21. https://doi.org/10.1245/s10434-019-07450-4 .
doi: 10.1245/s10434-019-07450-4
pubmed: 31115852
Rijken A, Lurvink RJ, Luyer MDP, et al. The burden of peritoneal metastases from gastric cancer: a systematic review on the incidence, risk factors and survival. J Clin Med. 2021;10(21) https://doi.org/10.3390/jcm10214882
Gamboa AC, Winer JH. Cytoreductive surgery and hyperthermic intraperitoneal chemotherapy for gastric cancer. Cancers (Basel). 2019;11(11) https://doi.org/10.3390/cancers11111662
Ishigami H, Fujiwara Y, Fukushima R, et al. Phase III trial comparing intraperitoneal and intravenous paclitaxel plus S-1 versus cisplatin plus S-1 in patients with gastric cancer with peritoneal metastasis: PHOENIX-GC Trial. J Clin Oncol. 2018;36(19):1922-1929. https://doi.org/10.1200/JCO.2018.77.8613
Verwaal VJ, Bruin S, Boot H, van Slooten G, van Tinteren H. 8-year follow-up of randomized trial: cytoreduction and hyperthermic intraperitoneal chemotherapy versus systemic chemotherapy in patients with peritoneal carcinomatosis of colorectal cancer. Ann Surg Oncol. 2008;15(9):2426–32. https://doi.org/10.1245/s10434-008-9966-2 .
doi: 10.1245/s10434-008-9966-2
pubmed: 18521686
Yang XJ, Huang CQ, Suo T, et al. Cytoreductive surgery and hyperthermic intraperitoneal chemotherapy improves survival of patients with peritoneal carcinomatosis from gastric cancer: final results of a phase III randomized clinical trial. Ann Surg Oncol. 2011;18(6):1575–81. https://doi.org/10.1245/s10434-011-1631-5 .
doi: 10.1245/s10434-011-1631-5
pubmed: 21431408
pmcid: 3087875
Bonnot PE, Piessen G, Kepenekian V, et al. Cytoreductive surgery with or without hyperthermic intraperitoneal chemotherapy for gastric cancer with peritoneal metastases (CYTO-CHIP study): a propensity score analysis. J Clin Oncol. 2019;37(23):2028-2040. https://doi.org/10.1200/JCO.18.01688
Bhatt A, Goere D. Cytoreductive surgery plus HIPEC for peritoneal metastases from colorectal cancer. Indian J Surg Oncol. 2016;7(2):177–87. https://doi.org/10.1007/s13193-016-0499-z .
doi: 10.1007/s13193-016-0499-z
pubmed: 27065708
pmcid: 4818622
Oh SY, Kwon HC, Lee S, et al. A phase II study of oxaliplatin with low-dose leucovorin and bolus and continuous infusion 5-fluorouracil (modified FOLFOX-4) for gastric cancer patients with malignant ascites. Jpn J Clin Oncol. 2007;37(12):930–5. https://doi.org/10.1093/jjco/hym131 .
doi: 10.1093/jjco/hym131
pubmed: 18211984
Spiliotis J, Halkia E, de Bree E. Treatment of peritoneal surface malignancies with hyperthermic intraperitoneal chemotherapy-current perspectives. Curr Oncol. 2016;23(3):e266–75. https://doi.org/10.3747/co.23.2831 .
doi: 10.3747/co.23.2831
pubmed: 27330364
Zhuang X, He Y, Ma W. Prophylactic hyperthermic intraperitoneal chemotherapy may benefit the long-term survival of patients after radical gastric cancer surgery. Sci Rep. 2022;12(1):2583. https://doi.org/10.1038/s41598-022-06417-y
Green BL, Blumenthaler AN, Gamble LA, et al. Cytoreduction and HIPEC for gastric carcinomatosis: multi-institutional analysis of two phase II clinical trials. Ann Surg Oncol. 2023;30(3):1852–60. https://doi.org/10.1245/s10434-022-12761-0 .
doi: 10.1245/s10434-022-12761-0
pubmed: 36348206
Hotopp T. HIPEC and CRS in peritoneal metastatic gastric cancer—who really benefits? Surg Oncol. 2019;28:159–66. https://doi.org/10.1016/j.suronc.2019.01.005 .
doi: 10.1016/j.suronc.2019.01.005
pubmed: 30851894
Glehen O, Gilly FN, Arvieux C, et al. Peritoneal carcinomatosis from gastric cancer: a multi-institutional study of 159 patients treated by cytoreductive surgery combined with perioperative intraperitoneal chemotherapy. Ann Surg Oncol. 2010;17(9):2370–7. https://doi.org/10.1245/s10434-010-1039-7 .
doi: 10.1245/s10434-010-1039-7
pubmed: 20336386
Sun BJ, Lee B. Review of regional therapies for gastric cancer with peritoneal metastases. Cancers (Basel). 2022;14(3). https://doi.org/10.3390/cancers14030570
Rau B, Lang H, Koenigsrainer A, et al. Effect of hyperthermic intraperitoneal chemotherapy on cytoreductive surgery in gastric cancer with synchronous peritoneal metastases: the phase III GASTRIPEC-I trial. J Clin Oncol. 2024;42(2):146-156. https://doi.org/10.1200/JCO.22.02867
Ji ZH, Yu Y, Liu G, et al. Peritoneal cancer index (PCI) based patient selecting strategy for complete cytoreductive surgery plus hyperthermic intraperitoneal chemotherapy in gastric cancer with peritoneal metastasis: a single-center retrospective analysis of 125 patients. Eur J Surg Oncol. 2021;47(6):1411–9. https://doi.org/10.1016/j.ejso.2020.11.139 .
doi: 10.1016/j.ejso.2020.11.139
pubmed: 33293213
Yonemura Y, Prabhu A, Sako S, et al. Long term survival after cytoreductive surgery combined with perioperative chemotherapy in gastric cancer patients with peritoneal metastasis. Cancers (Basel). 2020;12(1) https://doi.org/10.3390/cancers12010116
Manzanedo I, Pereira F, Perez-Viejo E, Serrano A. Gastric cancer with peritoneal metastases: current status and prospects for treatment. Cancers (Basel). 2023;15(6). https://doi.org/10.3390/cancers15061777
Ye Z, Yu P, Cao Y, et al. Prediction of peritoneal cancer index and prognosis in peritoneal metastasis of gastric cancer using NLR-PLR-DDI score: a retrospective study. Cancer Manag Res. 2022;14:177–87. https://doi.org/10.2147/CMAR.S343467 .
doi: 10.2147/CMAR.S343467
pubmed: 35046725
pmcid: 8763204
Coccolini F, Catena F, Glehen O, et al. Complete versus incomplete cytoreduction in peritoneal carcinosis from gastric cancer, with consideration to PCI cut-off. Systematic review and meta-analysis. Eur J Surg Oncol. 2015;41(7):911-9. https://doi.org/10.1016/j.ejso.2015.03.231
Chicago Consensus Working Group. The Chicago Consensus on peritoneal surface malignancies: management of gastric metastases. Cancer. 2020;126(11):2541–6. https://doi.org/10.1002/cncr.32868 .
doi: 10.1002/cncr.32868
Baumgartner JM, Tobin L, Heavey SF, Kelly KJ, Roeland EJ, Lowy AM. Predictors of progression in high-grade appendiceal or colorectal peritoneal carcinomatosis after cytoreductive surgery and hyperthermic intraperitoneal chemotherapy. Ann Surg Oncol. 2015;22(5):1716–21. https://doi.org/10.1245/s10434-014-3985-y .
doi: 10.1245/s10434-014-3985-y
pubmed: 25145504
Zhang N, Bai H, Deng J, et al. Impact of examined lymph node count on staging and long-term survival of patients with node-negative stage III gastric cancer: a retrospective study using a Chinese multi-institutional registry with Surveillance, Epidemiology, and End Results (SEER) data validation. Ann Transl Med. 2020;8(17):1075. https://doi.org/10.21037/atm-20-1358a .
doi: 10.21037/atm-20-1358a
pubmed: 33145294
pmcid: 7575951
Chen XJ, Wei CZ, Lin J, et al. Prognostic significance of PD-L1 expression in gastric cancer patients with peritoneal metastasis. Biomedicines. 2023;11(7) https://doi.org/10.3390/biomedicines11072003
Qi C, Chong X, Zhou T, et al. Clinicopathological significance and immunotherapeutic outcome of claudin 18.2 expression in advanced gastric cancer: a retrospective study. Chin J Cancer Res. 2024;36(1):78-89. https://doi.org/10.21147/j.issn.1000-9604.2024.01.08
Wang S, Zheng G, Chen L, Xiong B. Effect of HER-2/neu over-expression on prognosis in gastric cancer: a meta-analysis. Asian Pac J Cancer Prev. 2011;12(6):1417–23.
pubmed: 22229170
Koemans WJ, van der Kaaij RT, Boot H, et al. Cytoreductive surgery and hyperthermic intraperitoneal chemotherapy versus palliative systemic chemotherapy in stomach cancer patients with peritoneal dissemination, the study protocol of a multicentre randomised controlled trial (PERISCOPE II). BMC Cancer. 2019;19(1):420. https://doi.org/10.1186/s12885-019-5640-2
Glehen O, Passot G, Villeneuve L, et al. GASTRICHIP: D2 resection and hyperthermic intraperitoneal chemotherapy in locally advanced gastric carcinoma: a randomized and multicenter phase III study. BMC Cancer. 2014;14:183. https://doi.org/10.1186/1471-2407-14-183