title: The role of baseline inflammatory-based scores and serum tumor markers to risk stratify pseudomyxoma peritonei patients treated with cytoreduction (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC).
abstract: OBJECTIVE
  Inflammation-based scores such as neutrophil-lymphocyte ratio (NLR) and Onodera nutritional index (ONI) have been identified as new prognosticators in several tumors. We conducted a prognostic analysis of these markers and performed a risk stratification of PMP patients submitted to cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC).
  
  
  METHODS
  226 patients from two peritoneal surface malignancies centers participated in this study. Cox proportional modeling was used to select predictors of overall survival (OS) among baseline inflammation-based scores, serum tumor markers, clinical and surgical variables. Risk stratification was done using conditional inference tree model.
  
  
  RESULTS
  One hundred eighty-two cases had diffuse peritoneal adenomucinosis subtype. Fifty-four cases had received previous systemic chemotherapy. The means of ONI and NLR were 51.4 (SD = 9.8) and 3.2 (SD = 2.3), respectively. Two hundred ten cases were optimally cytoreduced. Cox analysis identified completeness of cytoreduction, histological subtype, previous systemic chemotherapy, NLR, and CA 19-9 as independent prognosticators. Conditional inference tree method identified two poor prognostic subsets: NLR ≤2.7 and CA 19-9>336 (5yr-OS = 15%) and NLR >2.7 and ONI ≤42 (5yr-OS = 30%).
  
  
  CONCLUSIONS
  NLR, ONI, and CA 19-9 are new prognosticators that contributed to improve prediction of OS in PMP patients treated by CRS and HIPEC. These markers allowed a risk stratification that could optimize therapeutic management of PMP patients.
authors.affiliation: Department of Surgery, Fondazione IRCCS Istituto Nazionale Tumori Milano, via Venezian, 1, 20133 Milan, Italy.
authors.forename: S
authors.initials: S
authors.lastname: Kusamura
authors.affiliation: Department of Surgery, Fondazione IRCCS Istituto Nazionale Tumori Milano, via Venezian, 1, 20133 Milan, Italy.
authors.forename: D
authors.initials: D
authors.lastname: Baratti
authors.affiliation: University of Medicine and Pharmacy 'Gr T Popa' Iasi, Romania.
authors.forename: I
authors.initials: I
authors.lastname: Hutanu
authors.affiliation: Nutritional Unit, Department of Anaesthesiology, Fondazione IRCCS Istituto Nazionale Tumori Milano, via Venezian, 1, 20133 Milan, Italy.
authors.forename: C
authors.initials: C
authors.lastname: Gavazzi
authors.affiliation: Experimental and Laboratorial Oncology Department, Fondazione IRCCS Istituto Nazionale Tumori Milano, via Venezian, 1, 20133 Milan, Italy.
authors.forename: D
authors.initials: D
authors.lastname: Morelli
authors.affiliation: General Surgery Unit, Bentivoglio Hospital, Bologna, Italy.
authors.forename: D R
authors.initials: DR
authors.lastname: Iusco
authors.affiliation: General Surgery Unit, Bentivoglio Hospital, Bologna, Italy.
authors.forename: A
authors.initials: A
authors.lastname: Grassi
authors.affiliation: General Surgery Unit, Bentivoglio Hospital, Bologna, Italy.
authors.forename: S
authors.initials: S
authors.lastname: Bonomi
authors.affiliation: General Surgery Unit, Bentivoglio Hospital, Bologna, Italy.
authors.forename: S
authors.initials: S
authors.lastname: Virzì
authors.affiliation: Department of Anaesthesiology, Fondazione IRCCS Istituto Nazionale Tumori Milano, via Venezian, 1, 20133 Milan, Italy.
authors.forename: E
authors.initials: E
authors.lastname: Haeusler
authors.affiliation: Department of Surgery, Fondazione IRCCS Istituto Nazionale Tumori Milano, via Venezian, 1, 20133 Milan, Italy. Electronic address: marcello.deraco@istitutotumori.mi.it.
authors.forename: M
authors.initials: M
authors.lastname: Deraco
mesh_terms: D000970:Antineoplastic Agents / Q000008:administration & dosage*; D014408:Biomarkers, Tumor / Q000097:blood*; D003131:Combined Modality Therapy; D065426:Cytoreduction Surgical Procedures / Q000379:methods*; D005260:Female; D006801:Humans; D006979:Hyperthermia, Induced / Q000379:methods*; D007274:Injections, Intraperitoneal; D007558:Italy / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D010534:Peritoneal Neoplasms / Q000097:blood / Q000401:mortality / Q000628:therapy*; D011379:Prognosis; D016016:Proportional Hazards Models; D011553:Pseudomyxoma Peritonei / Q000097:blood / Q000401:mortality / Q000628:therapy*; D012189:Retrospective Studies; D018570:Risk Assessment; D015996:Survival Rate / Q000639:trends
chemical_list: D000970:Antineoplastic Agents; D014408:Biomarkers, Tumor
keywords: Cytoreductive surgery; Hyperthermic intraperitoneal chemotherapy; Inflammation-based scores; Prognosis; Pseudomyxoma peritonei