Prognostic scores for colorectal cancer with peritoneal metastases treated with cytoreductive surgery and hyperthermic intraperitoneal chemotherapy

Figures & data

Table 1. Demographics and variables collected.

n = 128	Mean values ± SD (Median: Range) or n (%)
Age (years)	57 ± 14 (60: 22–80)
Gender male / female (n)	61/67 (48%/52%)
Weight (kg)	77 ± 14 (78: 50–135)
Height (cm)	175 ± 49 (170: 152–205)
CEA µg/l	39 ± 120 (6: 0.2–1127)
CA 15-3 kU/l	20 ± 9 (18: 7–65)
CA 19-9 kU/l	208 ± 688 (16: 1–4431)
CA 72-4 kU/l	83 ± 172 (8: 1–600)
CA 125 kU/l	60 ± 99 (23: 3–533)
Hemoglobin g/l	129 ± 16 (131: 76–167)
C-reactive protein mg/l	21 ± 40 (5: 0.3–197)
WBC × 10^9/l	8 ± 5 (7: 3–42)
Platelet count × 10^9/l	300 ± 118 (274: 106–775)
Albumin g/l	37 ± 6 (38: 16–47)
Colon/Rectum/Appendix	101/15/12 (79%/12%/9%)
Synch/Metach	78/50 (61%/39%)
N stage 0/1/2/3/missing data	41/40/32/3/12 (32%/31%/25%/2%/9%)
Low/moderate/well diff./missing data	34/61/17/16 (27%/48%/13%/12%)
Vascular invasion	34/100 (34%)
Neural invasion	26/99 (26%)
Mucinous tumor	64/119 (54%)
Signet cell tumor	23/126 (18%)
KRAS mutated	17/37 (46%)
PCI	18 ± 11 (15: 2–39)
CC 0/1/open & close	90/10/28 (70%/8%/22%)
COREP	3 ± 3 (2: 0–15)
PSDS	9 ± 6 (8: 2–35)
COMPASS	92 ± 44 (84: 16–214)
CEA/PCI	2 ± 5 (0.4: 0–33)

Table 2. Univariate logistical analyses with odds ratios.

	Open/Close Endpoint	p Value	<12 m survival Endpoint	p Value
Evaluating preoperative prognostic indicators (n = 128)
CEA	1.004 (CI: 0.9994–1.008)	.09^∧	1.005 (CI: 1.0–1.01)	.06
CA 15-3	1.04 (CI: 0.998–1.09)	.06	1.05 (CI: 1.005–1.09)	.03
CA 19-9	1 (CI: 1.0–1.001)	.05*	1.002 (CI: 1.0–1.003)	.03*
CA 72-4	1.002 (CI: 1.0–1.004)	.05	1.004 (CI: 1.0–1.006)	.001
CA 125	1.004 (CI: 1.0–1.008)	.04	1.007 (CI: 1.003–1.01)	.003
Hemoglobin	0.99 (CI: 0.96–1.01)	.3	0.99 (CI: 0.97–1.01)	.4
C-reactive protein^a	1.009 (CI: 0.99–1.02)	.09^∧	1.02 (CI: 1.007–1.03)	.002
WBC	1.06 (CI: 0.98–1.14	.2	1.08 (CI: 0.99–1.2)	.09
Platelet count	1.004 (CI: 1.0–1.007)	.02	1.007 (CI: 1.003–1.01)	.0003
Albumin^a	0.9 (CI: 0.8–0.98)	.01	0.9 (CI: 0.8–0.95)	.001^∧
Signet cell	3.2 (CI: 1.2–8.7)	.02*	3.2 (CI: 1.2–8.3)	.02
Poor differentiation	1.4 (CI: 0.5–3.9)	.5	6.7 (CI: 0.78–57.2)	.08
Redefining the point system with dichotomized variables n = 104^a for mCOREP
CEA	1.8 (CI: 0.7–4.6)	.2	2.5 (CI: 1.01–6.2)	.05*
CA 19-9	2.8 (CI: 1.1–7.1)	.03	3.1 (CI: 1.3–7.6)	.01
CA 125	6.4 (CI: 2.6–15.7)	<.0001^∧	9.6 (CI: 3.8–24.3)	<.0001*
CRP	4.4 (CI: 1.7–11.0)	.002	6.1 (CI: 2.4–15.7)	.0002
Albumin	4.1 (CI: 1.6–10.8)	.004	4.5 (CI: 1.7–11.8)	.002
Platelet count	2.1 (CI: 0.7–5.8)	.2	4.1 (CI: 1.5–11.1)	.006
Signet cell	3.3 (CI: 1.2–8.7)	.02^∧	3.2 (CI: 1.2–8.3)	.02
Comparing modified-COREP with COREP n = 104^a
COREP	1.3 (CI: 1.1–1.5)	.0008	1.4 (CI: 1.2–1.6)	.00008
mCOREP	1.2 (CI: 1.1–1.2)	.0001*	1.2 (CI: 1.1–1.3)	.00002*
Comparing modified-COREP at referral vs. at the time of surgery n = 104^a
mCOREP referral	1.1 (CI: 1.03–1.3)	.01	1.2 (CI: 1.05–1.3)	.004
mCOREP op	1.2 (CI: 1.1–1.2)	.0001*	1.2 (CI: 1.1–1.3)	.00002*

The independent multivariable prognostically significant factors are indicated with *(Multivariable p values < .05) and ^∧(Multivariable p values >.05 ≤ .1).

^an = 104 – CRP and albumin were not consecutively available on all patients during 2009.

Table 3. COREP and modified COREP scoring systems.

		COREP		Modified COREP*
CEA	3.1–70 µg/l	1	>30 µg/l	2
	>70 µg/l	2.5
CA 15-3	30–50 kU/l	0.5	N/A
	>50 kU/l	4.5
CA 19-9	37–70 kU/l	1	>60 kU/l	3
	>70 kU/l	2.5
CA 125	40–350 kU/l	2	>40 kU/l	6
	>350 kU/l	3.5
CRP	N/A		CRP > 10	4
Albumin	N/A		<34 g/l	4
Platelet count	N/A		>400 × 10^9/l	2
Signet cell	Yes	1.5	Yes	3
Hemoglobin	<125 g/l	1	N/A
WBC		>9 × 10^9/l		N/A
STM preop changes	Normal or regressing	−5	N/A
	Stable/mixed response	0
	Progression	1.5
Total range		0–17		0–25

* Rounded odds ratio from the open/close univariate analyses of Table 2 were used to give scoring values to the modified COREP score.

Table 4. Comparison of four prognostic scoring systems with univariate and multivariable logistical analyses and cox-proportional hazards analyses (n = 104).

	Risk of open/close laparotomy				Recurrence-free survival
	Univariate OR	Uni p	Harrell’s c	Multi p	Univariate HR	Uni p	Multi p
mCOREP	1.2 (CI: 1.1–1.2)	<.001	0.7716	.9	1.1 (CI: 1.1–1.2)	<.001	.009
PSDS	1.1 (CI: 1.1–1.2)	.002	0.7302	.09	1.1 (CI: 1.1–1.1)	<.001	.9
COMPASS	1.04 (CI: 1.0–1.1)	<.001	0.8345	<.001	1.01 (CI: 1.01–1.02)	<.001	.08
CEA/PCI	1.1 (CI: 1.0–1.2)	.1	0.4567	.3	1.06 (CI: 1.02–1.1)	.004	.3
	Risk of short survival <12 months				Overall survival
mCOREP	1.2 (CI: 1.1–1.3)	<.001	0.8247	.04	1.1 (CI: 1.07–1.2)	<.001	.1
PSDS	1.2 (CI: 1.1–1.3)	<.001	0.7537	.9	1.1 (CI: 1.08–1.2	<.001	.08
COMPASS	1.03 (CI: 1.0–1.04)	<.001	0.8157	.03	1.02 (CI: 1.01–1.02)	<.001	.01
CEA/PCI	1.05 (CI: 1.0–1.1)	.3	0.5294	.5	1.04 (CI: 0.99–1.09)	.1	.5

Figure 1. Overall survival of 3 prognostic groups according to the mCOREP score (n = 104).

Figure 2. Recurrence free survival of 3 prognostic groups according to the mCOREP score (n = 104).

Figure 3. Overall survival of 4 prognostic groups according to the PSDS score (n = 128).

Figure 4. Overall survival of 4 prognostic groups according to the COMPASS score (n = 128).