A Simplified Preoperative Assessment Predicts Complete Cytoreduction and Outcomes in Patients with Low-Grade Mucinous Adenocarcinoma of the Appendix.

Abstract

BACKGROUND:

Complete cytoreduction with hyperthermic intraperitoneal chemotherapy (CRS/HIPEC) has been shown to improve survival in patients with low-grade mucinous adenocarcinoma (LGMA). However, incomplete cytoreduction exposes patients to significant morbidity without a similar survival benefit. Preoperative assessment of the ability to achieve CRS is therefore a critical step in selecting patients for CRS/HIPEC.

OBJECTIVE:

The aim of this study was to develop and validate a preoperative scoring system to accurately predict the ability to achieve complete cytoreduction in patients with LGMA of the appendix.

METHODS:

A simplified preoperative assessment for appendix tumor (SPAAT) score was developed based on computed tomography scan findings thought to predict incomplete cytoreduction. We applied the SPAAT score to patients with LGMA to determine the ability of the score to predict complete cytoreduction. This scoring system was then applied to a separate cohort of patients from a different institution. Sensitivity and specificity were determined for the SPAAT score. Survival was calculated and correlated with the SPAAT score and the completeness of cytoreduction score.

RESULTS:

A SPAAT score of <3 is a significant predictor of complete cytoreduction in the derivation cohort. In the validation cohort, 40 of 42 patients with a SPAAT score <3 achieved a complete cytoreduction, for a positive predictive value of 95.2 % and a negative predictive value of 100 %. Additionally, the SPAAT score was a significant predictor of disease-free survival.

CONCLUSIONS:

The SPAAT score is a useful tool in the preoperative assessment of patients with LGMA who are under consideration for cytoreductive surgery. Prospective analysis of this scoring system is warranted to appropriately select patients who will benefit from CRS/HIPEC.

• Authors: Sean P Dineen, Richard E Royal, Marybeth S Hughes, Tara Sagebiel, Priya Bhosale, Michael Overman, Aurelio Matamoros, Paul F Mansfield, Keith F Fournier
• Journal: Annals of surgical oncology (Ann Surg Oncol) Vol. 22 Issue 11 Pg. 3640-6 (Oct 2015) ISSN: 1534-4681 [Electronic] United States
• PMID: 25698402 (Publication Type: Journal Article, Research Support, Non-U.S. Gov't, Validation Study)

Chemical References

• Antineoplastic Agents

Topics

• Adenocarcinoma, Mucinous (diagnostic imaging, secondary, surgery)
• Antineoplastic Agents (administration & dosage)
• Appendiceal Neoplasms (diagnostic imaging, pathology, surgery)
• Cytoreduction Surgical Procedures
• Disease-Free Survival
• Humans
• Hyperthermia, Induced
• Middle Aged
• Neoplasm Grading
• Neoplasm, Residual
• Patient Selection
• Peritoneal Neoplasms (diagnostic imaging, secondary, therapy)
• Predictive Value of Tests
• Preoperative Period
• Pseudomyxoma Peritonei (diagnostic imaging, etiology, therapy)
• Survival Rate
• Tomography, X-Ray Computed
• Treatment Outcome