Journal article
RAS Mutation Decreases Overall Survival After Optimal Cytoreductive Surgery and Hyperthermic Intraperitoneal Chemotherapy of Colorectal Peritoneal Metastasis: A Modification Proposal of the Peritoneal Surface Disease Severity Score.
- Arjona-Sanchez A Oncologic and Pancreatic Surgery Unit, University Hospital Reina Sofıa, Córdoba, Spain. alvaroarjona@hotmail.com.
- Rodriguez-Ortiz L Oncologic and Pancreatic Surgery Unit, University Hospital Reina Sofıa, Córdoba, Spain.
- Baratti D Peritoneal Surface Malignancy Program, Department of Surgery, Fondazione IRCCS Instituto Nazionale Tumori, Milan, Italy.
- Schneider MA Department of Surgery and Transplantation, University Hospital of Zurich, Zurich, Switzerland.
- Gutiérrez-Calvo A Surgery Department, Unit of Peritoneal Oncologic Surgery, Hospital Príncipe de Asturias, Alcalá de Henares, Madrid, Spain.
- García-Fadrique A Department of Surgery, Instituto Valenciano de Oncología, Valencia, Spain.
- Tuynman JB Department of Medical Oncology, VU University Medical Center, Amsterdam, The Netherlands.
- Cascales-Campos PA Departamento De Cirugía General, Unidad De Cirugía De La Carcinomatosis Peritoneal, Virgen De La Arrixaca University Hospital, Murcia, Spain.
- Martín VC Unit of Peritoneal Oncologic Surgery and Colorectal Surgery, Hospital University Nuestra Señora de la Candelaria, Tenerife, Spain.
- Morales R Unit of Oncologic and Pancreatic Surgery, Hospital Son Spaces, Palma de Mallorca, Spain.
- Salti GI Division of Surgical Oncology, The University of Illinois at Chicago Hospital and Health Sciences System, Chicago, IL, USA.
- Arteaga X Department of Surgery, Donostia Hospital, San Sebastián, Spain.
- Pacheco D Gastroenterology Service, Liver Transplantation Unit, Rio Hortega Hospital, Valladolid, Spain.
- Alonso-Gomez J Department of Surgery, H.U. Gran Canaria Dr. Negrín, Canarias, Spain.
- Yalkin O Department of Surgical Oncology, Ankara University Faculty of Medicine, Ankara, Turkey.
- Villarejo-Campos P Department of Surgical Oncology, University Hospital Ciudad Real, Ciudad Real, Spain.
- Sanchez-Hidalgo JM Oncologic and Pancreatic Surgery Unit, University Hospital Reina Sofıa, Córdoba, Spain.
- Casado-Adam A Oncologic and Pancreatic Surgery Unit, University Hospital Reina Sofıa, Córdoba, Spain.
- Cosano-Alvarez A Oncologic and Pancreatic Surgery Unit, University Hospital Reina Sofıa, Córdoba, Spain.
- Rufian-Peña S Oncologic and Pancreatic Surgery Unit, University Hospital Reina Sofıa, Córdoba, Spain.
- Briceño J Oncologic and Pancreatic Surgery Unit, University Hospital Reina Sofıa, Córdoba, Spain.
- 2019-05-22
Published in:
- Annals of surgical oncology. - 2019
Antineoplastic Combined Chemotherapy Protocols
Chemotherapy, Cancer, Regional Perfusion
Colorectal Neoplasms
Combined Modality Therapy
Cytoreduction Surgical Procedures
Female
Follow-Up Studies
Humans
Hyperthermia, Induced
Male
Middle Aged
Mutation
Peritoneal Neoplasms
Prognosis
Retrospective Studies
Survival Rate
ras Proteins
English
BACKGROUND
Cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) are currently the most accepted treatment for peritoneal metastases from colorectal cancer. Restrictive selection criteria are essential to obtain the best survival benefits for this complex procedure. The most widespread score for patient selection, the peritoneal surface disease severity score (PSDSS), does not include current biological factors that are known to influence on prognosis. We investigated the impact of including RAS mutational status in the selection criteria for these patients.
METHODS
We studied the risk factors for survival by multivariate analysis using a prospective database of consecutive patients with carcinomatosis from colorectal origin treated by CRS and HIPEC in our unit from 2009 to 2017. The risk factors obtained were validated in a multicentre, international cohort, including a total of 520 patients from 15 different reference units.
RESULTS
A total of 77 patients were selected for local análisis. Only RAS mutational status (HR: 2.024; p = 0.045) and PSDSS stage (HR: 2.90; p = 0.009) were shown to be independent factors for overall survival. Early PSDSS stages I and II associated to RAS mutations impaired their overall survival with no significant differences with PSDSS stage III overall survival (p > 0.05). These results were supported by the international multicentre validation.
CONCLUSIONS
By including RAS mutational status, we propose an updated RAS-PSDSS score that outperforms PSDSS alone providing a quick and feasible preoperative assessment of the expected overall survival for patients with carcinomatosis from colorectal origin undergone to CRS + HIPEC.
Cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) are currently the most accepted treatment for peritoneal metastases from colorectal cancer. Restrictive selection criteria are essential to obtain the best survival benefits for this complex procedure. The most widespread score for patient selection, the peritoneal surface disease severity score (PSDSS), does not include current biological factors that are known to influence on prognosis. We investigated the impact of including RAS mutational status in the selection criteria for these patients.
METHODS
We studied the risk factors for survival by multivariate analysis using a prospective database of consecutive patients with carcinomatosis from colorectal origin treated by CRS and HIPEC in our unit from 2009 to 2017. The risk factors obtained were validated in a multicentre, international cohort, including a total of 520 patients from 15 different reference units.
RESULTS
A total of 77 patients were selected for local análisis. Only RAS mutational status (HR: 2.024; p = 0.045) and PSDSS stage (HR: 2.90; p = 0.009) were shown to be independent factors for overall survival. Early PSDSS stages I and II associated to RAS mutations impaired their overall survival with no significant differences with PSDSS stage III overall survival (p > 0.05). These results were supported by the international multicentre validation.
CONCLUSIONS
By including RAS mutational status, we propose an updated RAS-PSDSS score that outperforms PSDSS alone providing a quick and feasible preoperative assessment of the expected overall survival for patients with carcinomatosis from colorectal origin undergone to CRS + HIPEC.
- Language
-
- English
- Open access status
- closed
- Identifiers
-
- DOI 10.1245/s10434-019-07378-9
- PMID 31111351
- Persistent URL
- https://sonar.ch/global/documents/47548
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