术前风险评分预测不完全肿瘤细胞减灭术：来自美国 HIPEC 协作组的 12 家机构研究。
Preoperative Risk Score for Predicting Incomplete Cytoreduction: A 12-Institution Study from the US HIPEC Collaborative.
机构信息
Division of Surgical Oncology, Department of Surgery, Winship Cancer Institute, Emory University, 1365C Clifton Road, NE; Building C, 2nd Floor, Atlanta, GA, 30322, USA.
Division of Surgical Oncology, Department of Surgery, The Ohio State University Wexner Medical Center, Columbus, OH, USA.
出版信息
Ann Surg Oncol. 2020 Jan;27(1):156-164. doi: 10.1245/s10434-019-07626-y. Epub 2019 Oct 10.
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.
背景
对于接受细胞减灭术联合腹腔热灌注化疗（CRS/HIPEC）的腹膜癌患者，不完全细胞减灭术（CCR2/3）会导致发病率增加而无生存获益。本研究旨在确定预测 CCR2/3 的术前因素。
方法
纳入了 2000 年至 2017 年在美国 HIPEC 协作组的 12 个机构中接受低级别/高级别阑尾、结直肠或腹膜间皮瘤癌症根治性 CRS/HIPEC 的所有患者（n=2027）。主要目的是利用术前数据创建一个不完全细胞减灭术风险评分（ICRS）来预测 CCR2/3 的 CRS。ICRS 是从随机选择的 50%的患者（推导队列）中创建的，并在其余患者（验证队列）中进行验证。
结果
在我们的推导队列（n=998）中，组织学为低级别阑尾肿瘤 30%，高级别阑尾肿瘤 41%，结直肠肿瘤 22%，腹膜间皮瘤 8%。816 例患者达到 CCR0/1，116 例患者达到 CCR 2/3。多变量分析显示，与不完全细胞减灭术相关的术前因素包括男性（比值比 [OR] 3.4，p=0.007）、腹水存在（OR 2.8，p=0.028）、癌症抗原 125（CA-125）≥40 U/mL（OR 3.4，p=0.012）和癌胚抗原（CEA）≥4.2 ng/mL（OR 3.2，p=0.029）。每个术前因素都被赋予 0 或 1 的分数，以形成 0 至 4 的 ICRS。分数分为零（0）、低（1-2）或高（3-4）。风险组的 CCR2/3 发生率逐渐增加，从零组的 1.6%到低组的 13%和高组的 39%。当 ICRS 应用于验证队列（n=1029）时，这种关系仍然存在。
结论
不完全细胞减灭术风险评分纳入了术前因素，可准确分层 CRS/HIPEC 中 CCR2/3 切除的风险。然而，该评分不应单独用于排除手术患者。
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