title: Development of a Prognostic Nomogram for Patients with Peritoneally Metastasized Colorectal Cancer Treated with Cytoreductive Surgery and HIPEC.
abstract: With the introduction of cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC), long-term survival can be achieved in selected patients with colorectal peritoneal metastases (PM). Patient selection and outcome may be improved significantly with a tool that adequately predicts survival in these patients. This study was designed to validate the peritoneal surface disease severity score (PSDSS) in patients with colorectal PM treated with CRS + HIPEC. If performance of the PSDSS was suboptimal (c < 0.7), we aimed to develop a new prognostic model.
  
  
  
  Patients were included if they had colorectal PM and underwent CRS + HIPEC with intended complete cytoreduction in a Dutch tertiary hospital between 2007 and 2015. Statistical analyses were performed with R-software.
  
  
  
  A total of 200 patients underwent CRS + HIPEC. External validation of the PSDSS showed a Harrell's c statistic of 0.62. After analysis, four parameters appeared prognostically relevant factors for overall survival: age, PCI score, locoregional lymph node status, and signet ring cell histology. The weighted relevance of these parameters was turned into a prognostic nomogram that we termed colorectal peritoneal metastases prognostic surgical score (COMPASS). The COMPASS differentiated well and showed a Harrell's c statistic of 0.72 with a calibration plot showing good agreement.
  
  
  
  This study externally validated the PSDSS and developed a new prognostic score, the COMPASS. This pre-cytoreduction nomogram was more accurate than PSDSS in predicting survival of patients undergoing CRS + HIPEC. It can be used as tool to assist in the decision about continuing cytoreduction and HIPEC and can provide valuable information in the follow-up period after CRS + HIPEC.
authors.affiliation: Department of Surgical Oncology, Catharina Hospital Eindhoven, Eindhoven, The Netherlands. geert.simkens@catharinaziekenhuis.nl.
authors.forename: Geert A
authors.initials: GA
authors.lastname: Simkens
authors.affiliation: Department of Surgical Oncology, Catharina Hospital Eindhoven, Eindhoven, The Netherlands.
authors.forename: Thijs R
authors.initials: TR
authors.lastname: van Oudheusden
authors.affiliation: Department of Public Health, Erasmus MC - University Medical Center, Rotterdam, The Netherlands.
authors.forename: Daan
authors.initials: D
authors.lastname: Nieboer
authors.affiliation: Department of Public Health, Erasmus MC - University Medical Center, Rotterdam, The Netherlands.
authors.forename: Ewout W
authors.initials: EW
authors.lastname: Steyerberg
authors.affiliation: Department of Surgical Oncology, Catharina Hospital Eindhoven, Eindhoven, The Netherlands.
authors.forename: Harm J
authors.initials: HJ
authors.lastname: Rutten
authors.affiliation: Department of Surgical Oncology, Catharina Hospital Eindhoven, Eindhoven, The Netherlands.
authors.forename: Misha D
authors.initials: MD
authors.lastname: Luyer
authors.affiliation: Department of Surgical Oncology, Catharina Hospital Eindhoven, Eindhoven, The Netherlands.
authors.forename: Simon W
authors.initials: SW
authors.lastname: Nienhuijs
authors.affiliation: Department of Surgical Oncology, Catharina Hospital Eindhoven, Eindhoven, The Netherlands.
authors.forename: Ignace H
authors.initials: IH
authors.lastname: de Hingh
mesh_terms: D000367:Age Factors; D000368:Aged; D000970:Antineoplastic Agents / Q000008:administration & dosage*; D018279:Carcinoma, Signet Ring Cell / Q000556:secondary / Q000628:therapy*; D015179:Colorectal Neoplasms / Q000473:pathology*; D065426:Cytoreduction Surgical Procedures; D005260:Female; D006801:Humans; D006979:Hyperthermia, Induced; D053208:Kaplan-Meier Estimate; D008207:Lymphatic Metastasis; D008297:Male; D008875:Middle Aged; D049451:Nomograms; D010534:Peritoneal Neoplasms / Q000473:pathology / Q000556:secondary / Q000628:therapy*; D011379:Prognosis; D016016:Proportional Hazards Models; D012720:Severity of Illness Index; D015996:Survival Rate
chemical_list: D000970:Antineoplastic Agents