1
|
Levine EA. Is a Prognostic Nomogram for Complete Cytoreductive Surgery and Hyperthermic Intraperitoneal Chemotherapy for Pseudomyxoma Peritonei Useful? JAMA Surg 2023; 158:531. [PMID: 36920379 DOI: 10.1001/jamasurg.2023.0119] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/16/2023]
Affiliation(s)
- Edward A Levine
- Surgical Oncology Service, Wake Forest University, Winston-Salem, North Carolina
| |
Collapse
|
2
|
Beal EW, Srinivas S, Shen C, Kim A, Johnston FM, Greer J, Abbott DE, Pokrzywa C, Raoof M, Grotz TE, Leiting JL, Fournier K, Dineen S, Powers B, Veerapong J, Kothari A, Maduekew U, Maithel S, Wilson GC, Patel SH, Lambert L, Abdel-Misih S, Cloyd JM. Conditional Survival Following Cytoreductive Surgery with Hyperthermic Intraperitoneal Chemotherapy for Peritoneal Surface Malignancies: An Analysis from the US HIPEC Collaborative. Ann Surg Oncol 2023; 30:1840-1849. [PMID: 36310315 DOI: 10.1245/s10434-022-12753-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Accepted: 10/19/2022] [Indexed: 11/18/2022]
Abstract
INTRODUCTION The long-term prognosis of patients who undergo cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) for peritoneal surface malignancies (PSM) varies considerably on the basis of histological and operative factors. While overall survival (OS) estimates are used to inform adjuvant therapy and surveillance strategies, conditional survival may provide more clinically relevant estimates of prognosis by accounting for disease-free time elapsed. PATIENTS AND METHODS All patients from 12 academic institutions who underwent CRS ± HIPEC for PSM from 2000 to 2017 were retrospectively analyzed. OS and disease-free survival (DFS) rates were calculated using the Kaplan-Meier method while conditional overall (COS) and conditional disease-free survival (CDFS) rates were calculated at 1, 2, or 3 years from surgery for different tumor histologies. RESULTS Overall, 1610 patients underwent CRS ± HIPEC. Among patients with benign appendiceal mucinous tumors (N = 460), 5-year OS and COS at 3 years were 92.1% and 96.3% (Δ4.2%), respectively. For patients with well-differentiated appendiceal cancers (N = 400), 5-year OS and COS at 3 years were 76.3% and 88.3% (Δ12.0%), respectively. For patients with high-grade appendiceal cancers (N = 258), 5-year OS and COS at 3 years were 43.8% and 75.4% (Δ31.6%), respectively. For patients with colorectal cancers (N = 362), 5-year OS and COS at 3 years were 31.8% and 67.3% (Δ35.5%), respectively. For patients with peritoneal mesothelioma (N = 130), 5-year OS and COS at 3 years were 67.6% and 89.7% (Δ22.1%), respectively. Similar trends were observed for DFS/CDFS. CONCLUSION The conditional survival of patients undergoing CRS ± HIPEC for PSM is associated with tumor histology. COS and CDFS provide a more accurate, dynamic estimate of survival than OS and DFS, especially for patients with more aggressive histologies.
Collapse
Affiliation(s)
- Eliza W Beal
- The Ohio State University Comprehensive Cancer Center, Columbus, OH, USA
| | - Shruthi Srinivas
- The Ohio State University Comprehensive Cancer Center, Columbus, OH, USA
| | - Chengli Shen
- The Ohio State University Comprehensive Cancer Center, Columbus, OH, USA
| | - Alex Kim
- The Ohio State University Comprehensive Cancer Center, Columbus, OH, USA
| | | | | | | | | | | | | | | | | | | | | | | | - Anai Kothari
- Medical College of Wisconsin, Milwaukee, WI, USA
| | | | | | | | | | - Laura Lambert
- University of Massachusetts Memorial Medical Center, Worcester, MA, USA
| | - Sherif Abdel-Misih
- The Ohio State University Comprehensive Cancer Center, Columbus, OH, USA
| | - Jordan M Cloyd
- The Ohio State University Comprehensive Cancer Center, Columbus, OH, USA.
| |
Collapse
|
3
|
Moaven O, Votanopoulos KI, Shen P, Mansfield P, Bartlett DL, Russell G, McQuellon R, Stewart JH, Levine EA. Health-Related Quality of Life After Cytoreductive Surgery/HIPEC for Mucinous Appendiceal Cancer: Results of a Multicenter Randomized Trial Comparing Oxaliplatin and Mitomycin. Ann Surg Oncol 2019; 27:772-780. [PMID: 31720933 DOI: 10.1245/s10434-019-08064-6] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2019] [Indexed: 01/01/2023]
Abstract
BACKGROUND This study evaluated health-related quality of life (HRQOL) using patient-reported outcomes in subjects with mucinous appendiceal neoplasms who underwent cytoreductive surgery (CRS) with hyperthermic intraperitoneal chemotherapy (HIPEC) as part of a randomized trial comparing mitomycin with oxaliplatin. METHODS In this prospective multicenter study, 121 mucinous appendiceal cancer patients, with evidence of peritoneal dissemination who underwent CRS, were randomized to receive mitomycin (divided 40 mg) or oxaliplatin (200 mg/m2) for HIPEC. The Functional Assessment of Cancer Therapy Neurotoxicity (FACT-G/NTX) questionnaire was utilized to assess HRQOL. The Trial Outcome Index (TOI) is a summary index responsive to changes in physical/functional outcomes. Repeated measures mixed models with an unstructured variance matrix were applied to assess changes in HRQOL longitudinally. RESULTS Baseline questionnaire compliance was 95.9%. Baseline physical well-being (PWB) was independently associated with overall survival (hazard ratio 0.79, 95% confidence interval 0.66-0.96; p = 0.017). The TOI was significantly lower in the mitomycin group compared with the oxaliplatin arm at 12 weeks (p = 0.044; score difference 6.35) and 24 weeks after surgery (p = 0.049; score difference 5.61). At 12 weeks after surgery, declines from baseline were significant in the TOI (p = 0.004; score decline 8.99), PWB (p < 0.001; score decline 2.83), and FWB (p < 0.001; score decline 3.42) in the mitomycin group but not the oxaliplatin group. CONCLUSIONS Compared with mitomycin, HIPEC perfusion with oxaliplatin results in significantly better physical and functional outcomes. With similar survival outcomes and complication rates, oxaliplatin should be considered as the chemoperfusion agent of choice in mucinous appendiceal cancer patients undergoing CRS/HIPEC.
Collapse
Affiliation(s)
- Omeed Moaven
- Department of Surgery, Wake Forest University, Winston Salem, NC, USA
| | | | - Perry Shen
- Department of Surgery, Wake Forest University, Winston Salem, NC, USA
| | - Paul Mansfield
- Department of Surgical Oncology, MD Anderson Cancer Center, Houston, TX, USA
| | - David L Bartlett
- Department of Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Greg Russell
- Department of Surgery, Wake Forest University, Winston Salem, NC, USA
| | - Richard McQuellon
- Department of Surgery, Wake Forest University, Winston Salem, NC, USA
| | - John H Stewart
- Department of Surgery, University of Illinois, Chicago, IL, USA
| | - Edward A Levine
- Department of Surgery, Wake Forest University, Winston Salem, NC, USA. .,Section of Surgical Oncology, Department of General Surgery, Wake Forest Baptist Health, Winston Salem, NC, USA.
| |
Collapse
|
4
|
Preoperative assessment of splenic involvement in patients with peritoneal carcinomatosis with CT and MR imaging. Eur J Radiol 2019; 110:60-65. [DOI: 10.1016/j.ejrad.2018.11.022] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2018] [Revised: 11/14/2018] [Accepted: 11/19/2018] [Indexed: 01/01/2023]
|
5
|
Dong J, Zhu Y, Ma F, Ren Y, Lu J, Wang Z, Qin L, Wu R, Lv Y. Conditional disease-free survival after liver transplantation for hepatocellular carcinoma: A two-center experience. Medicine (Baltimore) 2016; 95:e4383. [PMID: 27495049 PMCID: PMC4979803 DOI: 10.1097/md.0000000000004383] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Traditionally, survival estimates following liver transplantation (LT) of hepatocellular carcinoma (HCC) patients were calculated as survival from the surgery date, but future survival probabilities can change over time and conditional disease-free survival (CDFS) may provide patients and clinicians with more accurate prognostic information. This study aimed to assess CDFS in HCC patients after LT.Three hundred eighty-four HCC patients who underwent LT were included. Disease-free survival (DFS) was calculated using the Kaplan-Meier analysis. The 3-year CDFS, which represents the probability of remaining disease free for an additional 3 years, was calculated.1-, 3-, and 5-year DFS rates after LT were 69.9%, 45.8%, and 39.0 %, respectively. Based on the concept of CDFS, the probability of surviving an additional 3 years given that the patient was disease free at 1 year, 3 years, and 5 years were 58.4%, 76.9%, and 83.1%, respectively. Multivariate analysis indicated that larger tumor size (hazard ratio [HR], 1.509; 95% CI, 1.146-1.985; P = 0.003) was associated with poorer DFS. Patients with worse prognostic features at baseline demonstrated the greater increase in CDFS over time.Survival estimates following liver transplantation of HCC patients change according to survival time accrued since surgery. CDFS estimates improved dramatically over time especially among patients with worse prognostic features at the time of surgery. CDFS may be a useful tool in counseling patients with HCC, as it is a more accurate assessment of future survival for those patients who have already survived a certain amount of time.
Collapse
Affiliation(s)
- Jian Dong
- Department of Hepatobiliary Surgery, First Affiliated Hospital of Medical College, Xi’an Jiaotong University
- Institute of Advanced Surgical Technology and Engineering, First Affiliated Hospital of Medical College, Xi’an Jiaotong University, Xi’an, Shaanxi Province
| | - Ying Zhu
- Department of Surgery, Huashan Hospital
| | - Feng Ma
- Department of Hepatobiliary Surgery, First Affiliated Hospital of Medical College, Xi’an Jiaotong University
- Institute of Advanced Surgical Technology and Engineering, First Affiliated Hospital of Medical College, Xi’an Jiaotong University, Xi’an, Shaanxi Province
| | - Yifang Ren
- Department of Hepatobiliary Surgery, First Affiliated Hospital of Medical College, Xi’an Jiaotong University
- Institute of Advanced Surgical Technology and Engineering, First Affiliated Hospital of Medical College, Xi’an Jiaotong University, Xi’an, Shaanxi Province
| | - Jianwen Lu
- Department of Hepatobiliary Surgery, First Affiliated Hospital of Medical College, Xi’an Jiaotong University
- Institute of Advanced Surgical Technology and Engineering, First Affiliated Hospital of Medical College, Xi’an Jiaotong University, Xi’an, Shaanxi Province
| | - Zhengxin Wang
- Department of Surgery, Huashan Hospital
- Cancer Metastasis Institute, Fudan University, Shanghai, P.R. China
| | - Lunxiu Qin
- Department of Surgery, Huashan Hospital
- Cancer Metastasis Institute, Fudan University, Shanghai, P.R. China
| | - Rongqian Wu
- Department of Hepatobiliary Surgery, First Affiliated Hospital of Medical College, Xi’an Jiaotong University
- Institute of Advanced Surgical Technology and Engineering, First Affiliated Hospital of Medical College, Xi’an Jiaotong University, Xi’an, Shaanxi Province
- Correspondence: Rongqian Wu or Yi Lv, Department of Hepatobiliary Surgery, First Affiliated Hospital, Xi’an Jiaotong University, No. 277, West Yanta Road, Xi’an 710061, Shaanxi Province, P.R. China (e-mail: or )
| | - Yi Lv
- Department of Hepatobiliary Surgery, First Affiliated Hospital of Medical College, Xi’an Jiaotong University
- Institute of Advanced Surgical Technology and Engineering, First Affiliated Hospital of Medical College, Xi’an Jiaotong University, Xi’an, Shaanxi Province
- Correspondence: Rongqian Wu or Yi Lv, Department of Hepatobiliary Surgery, First Affiliated Hospital, Xi’an Jiaotong University, No. 277, West Yanta Road, Xi’an 710061, Shaanxi Province, P.R. China (e-mail: or )
| |
Collapse
|