The volume-time index (VTI) is prognostic in patients with colorectal cancer peritoneal metastases undergoing cytoreductive surgery and intraperitoneal chemotherapy |
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| Affiliation: | 1. Hepatobiliary and Surgical Oncology Unit, Department of Surgery, St George Hospital, Kogarah, NSW, Australia;2. Cancer Care Centre, St George Hospital, Kogarah, NSW, Australia;3. St George Hospital Clinical School, University of New South Wales, Sydney, NSW, Australia;4. School of Medicine, University of Notre Dame, Sydney, NSW, Australia;5. College of Medicine, Al-Imam Mohammad Ibn Saud Ismalic University (IMSIU), Riyadh, Saudi Arabia;1. University of California San Francisco, Department of Surgery, 513 Parnassus Avenue, S-321, San Francisco, CA, 94143-0470, USA;2. University of California, San Francisco, Department of Medicine, 505 Parnassus Avenue, Room M994, San Francisco, CA, 94122, USA;3. The Ohio State University Wexner Medical Center, Department of Surgery, Division of Colon and Rectal Surgery, N725 Doan Hall, 410 West 10th Avenue, Columbus, OH, 43210, USA;1. Division of GI, Trauma, and Endocrine Surgery, Department of Surgery, University of Colorado School of Medicine, 12636 East 17th Ave, Room 5401, Aurora, CO, 80045, USA;2. Trauma Services, University of Colorado Hospital, Mail Stop-F756, 12401 E 17th Ave Aurora, CO, 80045, USA;3. Department of Surgery, UC Health Memorial Hospital, 1400 E. Boulder Street, Suite 600, Colorado Springs, CO, 80909, USA;4. Department of Surgery, UC Health Medical Center of the Rockies, 2500 Rocky Mountain Avenue, Suite 2200 Loveland, CO, 80538, USA;5. Department of Surgery, Denver Health Medical Center, 700 Delaware St., Davis Pavilion, Pavilion D & E Denver, CO, 80204, USA;1. Department of Surgery, School of Medicine, Emory University, Atlanta, GA, USA;2. Winship Cancer Institute, Emory University, Atlanta, GA, USA;1. Endocrine Surgery Unit, General Surgery Department, Hospital Ramón y Cajal, Madrid, Spain;2. Endocrine Surgery Unit, General Surgery Department, Hospital Fundación Jiménez Díaz, Madrid, Spain;1. Center for Neural Engineering, Department of Engineering, Science and Mechanics, The Pennsylvania State University, University Park, PA, 16802, USA;2. Department of Surgery, Penn State Hershey College of Medicine and Milton S. Hershey Medical Center, Hershey, PA, 17033, USA;3. Department of Public Health Sciences, Penn State Hershey College of Medicine and Milton S. Hershey Medical Center, Hershey, PA, 17033, USA |
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| Abstract: | BackgroundPeritoneal cancer index (PCI) is an important prognostic factor in colorectal cancer peritoneal metastases (CRPM), however it fails to consider the time period over which disease burden develops. The volume-time index (VTI) is the ratio between PCI and time from primary tumour resection.MethodsA retrospective cohort study of 182 patients managed from 1996 to 2017 was performed.ResultsAs stratified by high vs low VTI groups, median overall survival (OS) was 23 months (95% 17–46) vs 44 months (95% 35–72) with a difference in 5-year OS of 20.3% (95%CI 10.2–40.4) vs 40.1% (95%CI 29.7–54.1), p = 0.002. No difference in 5-year recurrence free survival (RFS) exists. On multivariable analysis, an elevated VTI was independently associated with poorer OS (adjusted HR 3.20, 95%CI 1.64–6.23, p < 0.001) and RFS (adjusted HR 1.90, 95%CI 1.10–3.29, p = 0.02).ConclusionVTI is an independent prognostic factor for OS and RFs in patients with CRPM undergoing CRS/IPC, behaving as a surrogate of tumour aggressiveness. |
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| Keywords: | Colorectal neoplasm Peritoneal metastases Cytoreductive surgery Intraperitoneal chemotherapy |
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