Department of Abdominal Surgery, University Hospitals of Leuven, Louvain, Belgium.
Interuniversity Institute for Biostatistics and Statistical Bioinformatics, KU of Leuven, Louvain, Belgium.
Ann Surg Oncol. 2017 Nov;24(12):3604-3608. doi: 10.1245/s10434-017-6042-9. Epub 2017 Sep 11.
To optimize outcome, selection of patients for cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) is critical. Recently, Simkens et al.7 evaluated the peritoneal surface disease severity score (PSDSS) and suggested a new prognostic nomogram, the colorectal peritoneal metastases prognostic surgical score (COMPASS) based on age, peritoneal carcinomatosis index score, locoregional lymph node status, and signet ring cell histology. This COMPASS nomogram had better discriminative ability according to the Harrell c-index than PSDSS (c = 0.72 vs. 0.62). This study aimed to validate the COMPASS nomogram externally.
Data were retrieved from a prospectively maintained database, and all patients who underwent surgery between May 2005 and May 2016 were included in the study. For each patient, the PSDSS and COMPASS were calculated and then divided into subgroups. The discriminative ability of both scores for overall survival were quantified using Harrell c indices.
A total of 153 patients underwent CRS + HIPEC for peritoneal carcinomatosis (PC) of colorectal cancer. The median overall survival (OS) was 46 months, and the mean PSDSS was 7.8 ± 3.7. When the PSDSS was divided into subgroups, the c index was 0.67. The mean COMPASS was 55.5 ± 25.6. When the patients were divided into four groups according to cutpoints of Simkens et al.7 a c index of 0.72 was obtained, showing its significant superiority over the discriminative ability of the PSDSS (p = 0.016).
External validation of the COMPASS confirms its moderate to good discriminative ability and its superiority over the PSDSS. Nevertheless, discrimination with the COMPASS score remains suboptimal, and further research on prognostic variables is essential for optimal patient selection.
为了优化结果，细胞减灭术（CRS）和腹腔热灌注化疗（HIPEC）的患者选择至关重要。最近，Simkens 等人评估了腹膜表面疾病严重程度评分（PSDSS），并基于年龄、腹膜癌病指数评分、局部区域淋巴结状态和印戒细胞组织学提出了一种新的预后列线图，即结直肠腹膜转移预后手术评分（COMPASS）。根据 Harrell c 指数，该 COMPASS 列线图比 PSDSS 具有更好的区分能力（c=0.72 比 0.62）。本研究旨在对 COMPASS 列线图进行外部验证。
从一个前瞻性维护的数据库中检索数据，所有在 2005 年 5 月至 2016 年 5 月期间接受手术的患者均纳入本研究。为每位患者计算 PSDSS 和 COMPASS，并进行分组。使用 Harrell c 指数量化两种评分对总生存的预测能力。
共 153 例结直肠癌腹膜转移患者接受 CRS+HIPEC 治疗。中位总生存（OS）为 46 个月，平均 PSDSS 为 7.8±3.7。当 PSDSS 分组时，c 指数为 0.67。平均 COMPASS 为 55.5±25.6。根据 Simkens 等人的切点将患者分为四组，获得了 0.72 的 c 指数，显示其显著优于 PSDSS 的区分能力（p=0.016）。
对 COMPASS 的外部验证证实了其具有中等至良好的区分能力，并且优于 PSDSS。然而，COMPASS 评分的区分能力仍然不够理想，需要进一步研究预后变量，以实现最佳患者选择。
