Identifying variables that predict poor tumor biology and suboptimal outcomes in patients treated with cytoreduction and HIPEC.
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709 Background: Cytoreduction with HIPEC has improved survival in select group of patients with peritoneal carcinomatosis. Despite rigorous selection criteria, some patients invariably perform worse than others and are presumed to conceal poor tumor biology. Methods: A single institution analysis of all patients presenting with peritoneal carcinomatosis between 2003 and 2014. All patients who underwent CRS with HIPEC were included in the analyses. Clinical variables deemed high risk for poor outcome were categorized as ‘poor tumor biology’ and analyzed using the multivariate association for survival outcomes. Results: Based on pre-defined criteria, 160 patients (M: 68, F: 92; median age, 53 years) were identified and included in this study. The most common site of tumor origin was appendix (n=73, 45.6%), and the most common histology subtype was adenocarcinoma (n=91, 56.9%). Patients presenting with ascites (n=39, 24.3%, p<0.001) and perforation (n=18, 11.2%, p=0.036) performed poorly, while age (young versus old), gender and the timing of surgery from diagnosis did not affect survival outcomes (p>0.05). Patients who received pre-operative chemotherapy (n=77, 48%, p=0.007), complete cytoreduction (n=115, 71.9%, p=0.02) and fewer number of gastrointestinal anastomoses (=<1, p=0.005) during surgery performed better; however, patients who developed intra-abdominal abscess, anastomotic leak, fistula and bowel obstruction in the immediate peri-operative period (n=30, 18.8%, p<0.001) saw significant decline in survival outcome. The median overall survival and progression free survival in our patient cohort were 68.0 months (CI, 46.8-NR) and 19.3 months (CI, 14.7-37.4), respectively; but patients with colorectal adenocarcinoma, ascites, perforation and bowel complications performed poorly and were assumed to harbor poor biology. Conclusions: A thorough understanding of the presenting symptoms and peri-operative clinical variables can identify patients with poor tumor biology. These patients are unlikely to have significant improvement in outcome, and cytoreduction with HIPEC can be considered palliative in these patients.
