Inflammation-Based Prognostic Scores: Utility in Prognostication and Patient Selection for Cytoreduction and Perioperative Intraperitoneal Chemotherapy in Patients with Peritoneal Metastasis of Colonic Origin.

Abstract

Tumor-associated systemic inflammatory response has been correlated with prognosis. Our aim was to analyze the utility of inflammation-based prognostic scores for prognostication and patient selection for cytoreduction and perioperative intraperitoneal chemotherapy (POIC) in patients diagnosed with peritoneal metastasis of colonic origin. A retrospective analysis of a prospectively maintained database for all patients treated for peritoneal metastasis of colonic origin from February 2001 to April 2015. Inflammation-based prognostic scores including neutrophil-lymphocyte ratio, platelet-lymphocyte ratio (PLR) and Onodera's prognostic nutritional index (ONI) were calculated. Of 123 patients, 70 (56.9%) were men and 53 (43.1%) were women. Mean age at diagnosis was 49.9years. Significant prognosticators in univariate analysis included intraoperative peritoneal cancer index (p<0.000), tumor marker CA19-9 (p<0.000), PLR (p=0.020), POIC regimen (p<0.003), and completeness of cytoreduction (p<0.000). Multivariate Cox analysis identified CA19-9 (hazard ratio [HR] 1.0; 95% confidence interval [CI] 1.00-1.01, p=0.031), ONI (HR 0.86; 95% CI 0.79-0.94, p<0.000), PLR (HR 1.0; 95% CI 0.90-1.01, p=0.041), incompleteness of cytoreduction CC2 and CC3, and mucinous adenocarcinoma histology as significant independent prognosticators. The inflammation-based prognostic scores PLR and ONI and tumor marker CA19-9 are significant prognosticators of survival. They are useful in patient selection and prognostication for cytoreductive surgery and POIC in patients with peritoneal carcinomatosis of colonic origin.