Prognostic factors of early recurrence after complete cytoreductive surgery and hyperthermic intraperitoneal chemotherapy

Table 1 Demographic and clinical data of the study population

Characteristic	All	< 1 yr group, n = 39	≥ 1 yr group, n = 41	P value
Age in yr
mean ± SD	55.21 ± 11.48	52.74 ± 12.36	57.56 ± 10.18	0.060
Median (mix, max)	58 (22, 74)	56 (22, 73)	59 (36, 74)	0.102
Sex
Male	27 (33.7)	15 (38.5)	12 (29.3)	0.480
Female	53 (66.3)	24 (61.5)	29 (70.7)
BMI in kg/m2
mean ± SD	24.20 ± 3.98	24.05 ± 4.22	24.34 ± 3.77	0.746
Hypertension	23 (28.8)	11 (28.2)	12 (29.3)	1.000
Diabetes mellitus	16 (20.0)	8 (20.5)	8 (19.5)	1.000
Clinical presentation
Primary	35 (43.7)	18 (46.2)	17 (41.5)	0.822
Recurrence	45 (56.3)	21 (53.8)	24 (58.5)
Ascites presentation	2 (2.5)	1 (2.6)	1 (2.4)	1.000
Previous systemic therapy
Never	20 (25.0)	8 (20.5)	12 (29.3)	0.443
1st line or more	60 (75.0)	31 (79.5)	29 (70.7)
Extraperitoneal oligometastasis
Liver	13 (16.3)	7 (17.9)	6 (14.6)	0.767
Lung	3 (3.8)	1 (2.6)	2 (4.9)	1.000
Extraperitoneal LN	3 (3.8)	1 (2.6)	2 (4.9)	1.000
Skin	4 (5.0)	3 (7.7)	1 (2.4)	0.353
Vagina	2 (2.5)	1 (2.6)	1 (2.4)	1.000
Cancer types				0.540
Colorectal	42 (52.5)	22 (56.4)	20 (48.8)
Ovary	22 (27.5)	9 (23.1)	13 (31.7)
Platinum-sensitive	11 (13.8)	3 (7.7)	8 (19.5)
Platinum-resistance	11 (13.8)	6 (15.4)	5 (12.2)
Gastric	12 (15.0)	7 (17.9)	5 (12.2)
Appendix, high grade	4 (5.0)	1 (2.6)	3 (7.3)
Histology grade				0.020a
1	10 (12.4)	1 (2.6)	9 (22.0)
2	25 (31.3)	14 (35.9)	11 (26.8)
3	45 (56.3)	24 (61.5)	21 (51.2)

^aP < 0.05.

Data are n (%) unless otherwise indicated. BMI: Body mass index; LN: Lymph node; SD: Standard deviation.

Table 2 Perioperative details and outcomes

Characteristic	All	< 1 yr group, n = 39	≥ 1 yr group, n = 41	P value
Surgical method
Laparoscopy	11 (13.7)	5 (12.8)	6 (14.6)	1.000
Laparotomy	69 (86.3)	34 (87.2)	35 (86.4)
Preoperative PCI	7.99 ± 5.97	9.08 ± 6.52	6.95 ± 5.26	0.112
CC score
0	63 (78.8)	25 (64.1)	38 (92.7)	0.002a
1	17 (21.2)	14 (35.9)	3 (7.3)
Residual lesion
Small bowel	6 (7.5)	4 (10.3)	2 (4.9)
Large bowel	1 (1.3)	1 (2.6)	0
Major vessels	3 (3.8)	3 (7.7)	0
Peritoneum	7 (8.8)	6 (15.4)	1 (2.4)
Pre-HIPEC chemotherapy1	41 (51.3)	24 (61.5)	17 (41.5)	0.080
Response to pre-HIPEC chemotherapy				0.121
Complete remission	0	0	0
Partial remission	15 (18.8)	8 (20.5)	7 (17.1)
Stable disease	6 (7.5)	1 (2.6)	5 (12.2)
Progression disease	16 (20.0)	11 (28.2)	5 (12.2)
CRS time in min	338.60 ± 144.80	365.50 ± 135.10	313.10 ± 150.80	0.106
Visceral organ resections
Liver	6 (7.5)	3 (7.7)	3 (7.3)	1.000
Lung wedge resection	3 (3.8)	1 (2.6)	2 (4.9)	1.000
Small bowel	23 (28.8)	13 (33.3)	10 (24.4)	0.461
Large bowel	45 (56.3)	25 (64.1)	20 (48.8)	0.184
Uterus and adnexa2
TH-BSO	7 (13.2)	2 (8.3)	5 (17.2)	0.433
BSO	3 (5.6)	1 (4.2)	2 (6.9)	1.000
HIPEC duration in min				0.603
30, oxaliplatin-based	18 (22.4)	10 (25.6)	8 (19.5)
60	31 (38.8)	16 (41.0)	15 (36.6)
90, mitomycin c	31 (38.8)	13 (33.3)	18 (43.9)
HIPEC regimens
Cisplatin-based	22 (27.5)	13 (33.3)	9 (22.0)	0.319
Non-cisplatin-based	58 (72.5)	26 (66.7)	32 (78.0)
Post-HIPEC chemotherapy3	70 (87.5)	35 (89.7)	35 (85.4)	0.738
Any postoperative complication ≥ grade 3	7 (8.8)	4 (10.3)	3 (7.3)	0.709
AKI	1 (1.3)	0	1 (2.4)
Bowel perforation	4 (5.0)	4 (10.3)	0
Others	2 (2.5)	0	2 (4.9)
Recurrent site				< 0.001a
Extraperitoneal	23 (28.8)	18 (46.2)	5 (12.2)
Intraperitoneal	26 (32.5)	9 (23.1)	17 (41.5)
Both	17 (21.3)	12 (30.8)	5 (12.2)
No recurrence	14 (17.5)	0	14 (34.1)

^aP < 0.05.

¹Within 6 mo before hyperthermic intraperitoneal chemotherapy (HIPEC).

²Female only.

³Within 6 mo after HIPEC.

Data are n (%) or mean ± standard deviation. AKI: Acute kidney injury; BSO: Bilateral salpingo-oophorectomy; CC: Completeness of cytoreduction; CRS: Cytoreductive surgery; HIPEC: Hyperthermic intraperitoneal chemotherapy; PCI: Peritoneal cancer index; TH-BSO: Total hysterectomy with bilateral salpingo-oophorectomy.

Table 3 Analysis of the risk of recurrence within 1 year using a simple logistic regression model

Parameter	Crude OR (95%CI)	P value
Age in yr
≥ 55	0.546 (0.222, 1.343)	0.188
< 55	1.000
Sex
Female	0.662 (0.261, 1.681)	0.386
Male	1.000
Previous systemic therapy
Any	1.603 (0.574, 4.482)	0.368
Never	1.000
Clinical presentation
Primary	1.210 (0.500, 2.931)	0.673
Recurrence	1.000
Cancer type
Ovary	0.646 (0.239, 1.746)	0.389
GI	1.000
CC score
0	0.141 (0.037, 0.541)	0.004a
1	1.000
PCI score
1-7	0.444 (0.180, 1.095)	0.078
8-39	1.000
HIPEC regimen
Cisplatin	1.778 (0.657, 4.809)	0.257
Non-cisplatin	1.000
HIPEC duration in min
≤ 60	1.565 (0.632, 3.879)	0.333
90	1.000
Extraperitoneal oligometastasis
Any	1.071 (0.401, 2.830)	0.890
None	1.000
Surgical method
Laparoscopy	0.858 (0.239, 3.077)	0.814
Laparotomy	1.000
Histology grade
Grade 1/2	0.656 (0.270, 1.597)	0.353
Grade 3	1.000
Pre-HIPEC chemotherapy1
Yes	2.259 (0.922, 5.532)	0.075
No	1.000
Post-HIPEC chemotherapy2
Yes	1.500 (0.389, 5.781)	0.556
No	1.000
CRS time in h
≤ 6	0.361 (0.146, 0.892)	0.027a
> 6	1.000
Bowel resection
Yes	2.143 (0.858, 5.351)	0.103
No	1.000

^aP < 0.05.

¹Within 6 mo before hyperthermic intraperitoneal chemotherapy (HIPEC).

²Within 6 mo after HIPEC.

CC: Completeness of cytoreduction; CI: Confidence interval; CRS: Cytoreductive surgery; GI: gastrointestinal cancers, including gastric, colorectal and appendiceal cancers; HIPEC: Hyperthermic intraperitoneal chemotherapy; OR: Odds ratio; PCI: Peritoneal cancer index.

Table 4 Analysis of the risk of recurrence within one year using a multiple logistic regression model

Parameters	Overall	P value	Ovarian cancer	P value	GI cancers	P value
	Adjusted OR		Adjusted OR		Adjusted OR
Age in yr
≥ 55	0.496	0.157	0.097	0.114	0.528	0.293
< 55	1.000		1.000		1.000
Sex
Female	1.091	0.872	-		0.566	0.375
Male	1.000		-		1.000
CC score
0	0.130	0.005a	0.239	0.332	0.046	0.008
1	1.000		1.000		1.000
Pre-HIPEC chemotherapy
Yes			22.932	0.042a	-
No			1.000		-
Platinum-response1
Resistant			7.133	0.153	-
Sensitive			1.000		-

^aP < 0.05.

¹Adjusted for platinum-response only in the subgroup of ovarian cancer.

CI: Confidence interval; CC: Completeness of cytoreduction; GI: gastrointestinal cancers, including gastric, colorectal and appendiceal cancers; HIPEC: Hyperthermic intraperitoneal chemotherapy; OR: Odds ratio.