Preoperative Risk Score for Predicting Incomplete Cytoreduction: A 12-Institution Study from the US HIPEC Collaborative

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.

Publication types

  • Multicenter Study

MeSH terms

  • Adult
  • Aged
  • Appendiceal Neoplasms / mortality*
  • Appendiceal Neoplasms / therapy
  • Cohort Studies
  • Colorectal Neoplasms / mortality*
  • Colorectal Neoplasms / therapy
  • Combined Modality Therapy
  • Cytoreduction Surgical Procedures / methods*
  • Female
  • Humans
  • Hyperthermia, Induced / methods*
  • Male
  • Mesothelioma / mortality
  • Mesothelioma / therapy
  • Middle Aged
  • Neoplasms, Glandular and Epithelial / mortality
  • Neoplasms, Glandular and Epithelial / therapy
  • Peritoneal Neoplasms / mortality*
  • Peritoneal Neoplasms / therapy
  • Predictive Value of Tests
  • Preoperative Period
  • Prognosis
  • Retrospective Studies
  • Risk Factors
  • Survival Rate
  • United States