P.R.O.P.S. — A novel Pre-Operative Predictive Score for unresectability in patients with colorectal peritoneal metastases being considered for cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC)

Abstract

Background Twenty to thirty percent of planned cytoreductive surgery and hyperthermic intraperitoneal chemotherapy (CRS and HIPEC) procedures are abandoned intra-operatively. Pre-operative factors associated with unresectability identified previously were used to develop a Pre-Operative Predictive Score (PROPS), which was compared with current selection criteria—Peritoneal Surface Disease Severity Score (PSDSS), Verwaal’s Prognostic Score (PS) and Colorectal Peritoneal Metastases Prognostic Surgical Score (COMPASS), to determine which score provides the best prediction for unresectability. Methods Fifty-six patients with peritoneal metastases of colorectal origin were included. Beta-coefficient values of significant variables ( p < 0.05) were determined from multivariate analysis to develop PROPS. PROPS, PSDSS, PS and COMPASS were compared using a receiver operating characteristic curve to calculate its accuracy, sensitivity and specificity. Results PROPS consisted of nine patient and tumour factors which were categorised into three groups: (i) poor tumour biology: previous inadequate resection, underwent multiple lines of chemotherapy and poorly differentiated or signet cell histology; (ii) heavy tumour burden: abdominal distension, palpable abdominal mass and computed tomography findings of ascites, small bowel disease and/or omental thickening; and (iii) active tumour proliferation: elevated tumour markers. Overall, PROPS achieved 86% accuracy with 100% sensitivity and 68% specificity, PSDSS achieved 85% accuracy with 100% sensitivity and 63% specificity, PS achieved 73% accuracy with 100% sensitivity and 68% specificity and COMPASS achieved 61% accuracy with 27% sensitivity and 100% specificity. Conclusions PROPS is more effective in predicting unresectability as compared to PSDSS, PS and COMPASS, and has the added advantage of using solely pre-operative factors.

Cytoreductive Surgery and HIPEC in Elderly Patient with Colorectal Cancer and Peritoneal Metastasis

“…Some of the scores that focus only on clinical data: Peritoneal Surface Disease Severity Score [19]; clinical data plus histology is incorporated in COREP and modified COREP scores [20] Other evaluation systems include radiological examination: CT predicted PCI [11] and Preoperative Predictive Score [19] which combines clinical data and CT results. However, CT has a low sensitivity and specificity for the detection of PM [21].…”

“…However, CT has a low sensitivity and specificity for the detection of PM [21]. Additionally, some scoring systems base their decision on intra-operative findings: Gilly peritoneal carcinomatosis staging [11], Verwaal Prognostic Score, Colorectal Peritoneal Metastases Prognostic Surgical Score (COMPASS) [19], and PCI [11].…”

Manejo De La Carcinomatosis Peritoneal De Origen Colorrectal Y Realidad en Panamá

“…World J Surg Onc. (27) Estas herramientas presentan la desventaja de incluir factores que necesitan ser evaluados dentro del quirófano limitando su uso en el entorno preoperatorio. Yong y colaboradores, realizaron un estudio retrospectivo con 56 pacientes con CPCCR, donde el objetivo era desarrollar una nueva Puntuación Pre-Operativa Predictiva (del inglés PROPS) que permitiera identificar aquellos pacientes que no fueran candidatos para el tratamiento.…”

“…El estudio demostró que PROPS tenía mayor capacidad de detectar casos irresecables (especificidad del 68%) con una menor tasa de falsos positivos comparado con PSDSS. (27) Además, se ha introducido la puntuación "Colorectal Peritoneal Score" del inglés (COREP) para la evaluación del pronóstico para la CRS/HIPEC, que consiste en una variable histopatológica, niveles de hemoglobina, recuento de glóbulos blancos, cuatro marcadores tumorales séricos (CEA, CA125, CA19-9, y CA15-3) y sus cambios entre la derivación y la cirugía. Esta refleja la biología del tumor y puede apoyar a la radiología para mejorar el proceso de selección de pacientes.…”