Retrospective Cohort Study
Copyright ©The Author(s) 2024. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Sep 26, 2024; 12(27): 6057-6069
Published online Sep 26, 2024. doi: 10.12998/wjcc.v12.i27.6057
Prognostic factors of early recurrence after complete cytoreductive surgery and hyperthermic intraperitoneal chemotherapy
Chao-Yu Chen, Tzu-Hao Huang, Li-Wen Lee, Jrhau Lung, Yu-Che Ou, Chien-Hui Hung, Huei-Chieh Chuang, Min-Chi Chen, Ting-Yao Wang
Chao-Yu Chen, Yu-Che Ou, Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital, Chiayi 613, Taiwan
Chao-Yu Chen, Chien-Hui Hung, Graduate Institute of Clinical Medical Sciences, College of Medicine, Chang Gung University, Taoyuan 333, Taiwan
Chao-Yu Chen, Ting-Yao Wang, Department of Early Childhood Care and Education, Shu-Zen Junior College of Medicine and Management, Kaohsiung 821, Taiwan
Tzu-Hao Huang, Division of General Surgery, Department of Surgery, Chang Gung Memorial Hospital, Chiayi 613, Taiwan
Li-Wen Lee, Department of Diagnostic Radiology, Chang Gung Memorial Hospital, Chiayi 613, Taiwan
Li-Wen Lee, Jrhau Lung, College of Medicine, Chang Gung University, Taoyuan 333, Taiwan
Jrhau Lung, Department of Medical Research and Development, Chang Gung Memorial Hospital, Chiayi 613, Taiwan
Yu-Che Ou, Department of Obstetrics and Gynecology, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung 833, Taiwan
Huei-Chieh Chuang, Department of Anatomic Pathology, Chang Gung Memorial Hospital, Chiayi 613, Taiwan
Min-Chi Chen, Department of Public Health, Chang Gung University, Taoyuan 333, Taiwan
Ting-Yao Wang, Division of Hematology and Oncology, Department of Internal Medicine, Chang Gung Memorial Hospital, Chiayi 613, Taiwan
Author contributions: Chen CY and Wang TY designed the research; Chen CY, Chen MC, and Lung J conducted the research; Chen MC and Wang TY analyzed the data; Chen CY, Wang TY, and Chen MC wrote the paper; Huang TH, Lee LW, Ou YC, Hung CH, and Chuang HC provided critical revision of the manuscript; Chen CY had primary responsibility for final content; and all authors read and approved the final manuscript.
Supported by the Chang Gung Medical Foundation, No. CMRPG6L0091, No. CMRPG6L0092, and No. CMRPG6L0093.
Institutional review board statement: The study was approved by the Institutional Review Board of Chang Gung Memorial Hospital (Approval No. 202001607A3).
Informed consent statement: The Institutional Review Board of Chang Gung Memorial Hospital approves the waiver of the informed consent form.
Conflict-of-interest statement: The authors have no relevant financial or non-financial interests to disclose.
Data sharing statement: The data that support the findings of this study are available on request from the corresponding author. The data are not publicly available due to privacy or ethical restrictions.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Ting-Yao Wang, MD, Chief Physician, Division of Hematology and Oncology, Department of Internal Medicine, Chang Gung Memorial Hospital, No. 8 Sec. W. Jiapu Road, Chiayi 613, Taiwan. tywang.onco@gmail.com
Received: June 4, 2024
Revised: June 25, 2024
Accepted: July 15, 2024
Published online: September 26, 2024
Processing time: 54 Days and 18.5 Hours
Abstract
BACKGROUND

Although cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) offer the potential for long-term survival in peritoneal carcinomatosis, outcomes following CRS/HIPEC vary significantly.

AIM

To identify the clinical factors associated with progression-free survival (PFS) after complete CRS/HIPEC in patients with colorectal/high-grade appendiceal, ovarian, and gastric cancers.

METHODS

We retrospectively evaluated the risk of recurrence within 1 year after CRS/HIPEC and its impact on overall survival (OS) in patients recruited between 2015 and 2020. Logistic regression models were used to assess the prognostic factors for the risk of recurrence within 1 year. Kaplan–Meier survival curves and Cox proportional hazards models were used to evaluate the association between recurrence and OS.

RESULTS

Of the 80 enrolled patients, 39 had an unfavorable PFS (< 1 year) and 41 had a favorable PFS (≥ 1 year). Simple logistic models revealed that the patients with a completeness of cytoreduction score of 0 (CC-0) or length of CRS ≤ 6 h had a favorable PFS [odds ratio (OR) = 0.141, P = 0.004; and OR = 0.361, P = 0.027, respectively]. In multiple logistic regression, achieving CC-0 was the strongest prognostic factor for a favorable PFS (OR = 0.131, P = 0.005). A peritoneal cancer index score > 12 was associated with a lower rate of achieving CC-0 (P = 0.027). The favorable PFS group had a significantly longer OS (median 81.7 mo vs 17.0 mo, P < 0.001).

CONCLUSION

Achieving CC-0 was associated with a lower early recurrence rate and improved long-term survival. This study underscores the importance of selecting appropriate candidates for CRS/HIPEC to manage peritoneal carcinomatosis.

Keywords: Peritoneal metastasis, Cytoreductive surgery, Hyperthermic intraperitoneal chemotherapy, Predictor, Recurrence

Core Tip: Cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) can extend survival in peritoneal carcinomatosis, but outcomes vary. This study examined factors affecting progression-free survival (PFS) after CRS/HIPEC in patients with colorectal, high-grade appendiceal, ovarian, and gastric cancers. Evaluating the results of 80 patients from 2015-2020 showed that those with a completeness of cytoreduction score of 0 (CC-0) or surgery duration ≤ 6 h had better PFS. Achieving CC-0 was the key predictor of favorable PFS and longer overall survival. The study highlights the importance of patient selection for optimal CRS/HIPEC outcomes.