Dineen Sean P, Royal Richard E, Hughes Marybeth S, Sagebiel Tara, Bhosale Priya, Overman Michael, Matamoros Aurelio, Mansfield Paul F, Fournier Keith F
Department of Surgical Oncology, MD Anderson Cancer Center, Houston, TX, USA.
Division of Gastrointestinal Oncology, National Cancer Institute, Bethesda, MD, USA.
Ann Surg Oncol. 2015 Oct;22(11):3640-6. doi: 10.1245/s10434-015-4446-y. Epub 2015 Feb 20.
Complete cytoreduction with hyperthermic intraperitoneal chemotherapy (CRS/HIPEC) has been shown to improve survival in patients with low-grade mucinous adenocarcinoma (LGMA). However, incomplete cytoreduction exposes patients to significant morbidity without a similar survival benefit. Preoperative assessment of the ability to achieve CRS is therefore a critical step in selecting patients for CRS/HIPEC.
The aim of this study was to develop and validate a preoperative scoring system to accurately predict the ability to achieve complete cytoreduction in patients with LGMA of the appendix.
A simplified preoperative assessment for appendix tumor (SPAAT) score was developed based on computed tomography scan findings thought to predict incomplete cytoreduction. We applied the SPAAT score to patients with LGMA to determine the ability of the score to predict complete cytoreduction. This scoring system was then applied to a separate cohort of patients from a different institution. Sensitivity and specificity were determined for the SPAAT score. Survival was calculated and correlated with the SPAAT score and the completeness of cytoreduction score.
A SPAAT score of <3 is a significant predictor of complete cytoreduction in the derivation cohort. In the validation cohort, 40 of 42 patients with a SPAAT score <3 achieved a complete cytoreduction, for a positive predictive value of 95.2 % and a negative predictive value of 100 %. Additionally, the SPAAT score was a significant predictor of disease-free survival.
The SPAAT score is a useful tool in the preoperative assessment of patients with LGMA who are under consideration for cytoreductive surgery. Prospective analysis of this scoring system is warranted to appropriately select patients who will benefit from CRS/HIPEC.
已证明采用腹腔热灌注化疗的完全细胞减灭术（CRS/HIPEC）可提高低级别黏液腺癌（LGMA）患者的生存率。然而，不完全细胞减灭术会使患者面临严重的发病率，却没有类似的生存获益。因此，术前评估实现CRS的能力是选择适合CRS/HIPEC患者的关键步骤。
本研究的目的是开发并验证一种术前评分系统，以准确预测阑尾LGMA患者实现完全细胞减灭的能力。
基于被认为可预测不完全细胞减灭的计算机断层扫描结果，开发了一种简化的阑尾肿瘤术前评估（SPAAT）评分。我们将SPAAT评分应用于LGMA患者，以确定该评分预测完全细胞减灭的能力。然后将该评分系统应用于来自不同机构的另一组患者。确定了SPAAT评分的敏感性和特异性。计算生存率，并将其与SPAAT评分和细胞减灭评分的完整性相关联。
在推导队列中，SPAAT评分<3是完全细胞减灭的重要预测指标。在验证队列中，42例SPAAT评分<3的患者中有40例实现了完全细胞减灭，阳性预测值为95.2%，阴性预测值为100%。此外，SPAAT评分是无病生存的重要预测指标。
SPAAT评分是术前评估考虑进行细胞减灭手术的LGMA患者的有用工具。有必要对该评分系统进行前瞻性分析，以适当选择将从CRS/HIPEC中获益的患者。
