Prediction of Metachronous Peritoneal Metastases After Radical Surgery for Colon Cancer: A Scoring System Obtained from an International Multicenter Cohort.
Corrado Pedrazzani, Giulia Turri, Daniele Marrelli, Hye Jin Kim, Eun Jung Park, Gaya Spolverato, Caterina Foppa, Antonino Spinelli, Salvatore Pucciarelli, Seung Hyuk Baik, Gyu Seog Choi
Author Information
Corrado Pedrazzani: Division of General and Hepatobiliary Surgery, Department of Surgical Sciences, Dentistry, Gynecology and Pediatrics, Verona University Hospital, University of Verona, Verona, Italy. corrado.pedrazzani@univr.it.
Giulia Turri: Division of General and Hepatobiliary Surgery, Department of Surgical Sciences, Dentistry, Gynecology and Pediatrics, Verona University Hospital, University of Verona, Verona, Italy.
Daniele Marrelli: Department of Surgery, Policlinico le Scotte, University of Siena, Siena, Italy.
Hye Jin Kim: Colorectal Cancer Centre, Kyungpook National University Medical Centre, School of Medicine, Kyungpook National University, Daegu, Republic of Korea.
Eun Jung Park: Division of Colon and Rectal Surgery, Department of Surgery, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea.
Gaya Spolverato: General Surgery 3, Department of Surgery, Oncology, and Gastroenterology, University of Padova, Padova, Italy.
Caterina Foppa: Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy.
Antonino Spinelli: Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy.
Salvatore Pucciarelli: General Surgery 3, Department of Surgery, Oncology, and Gastroenterology, University of Padova, Padova, Italy.
Seung Hyuk Baik: Division of Colon and Rectal Surgery, Department of Surgery, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea.
Gyu Seog Choi: Colorectal Cancer Centre, Kyungpook National University Medical Centre, School of Medicine, Kyungpook National University, Daegu, Republic of Korea.
BACKGROUND: Since novel strategies for prevention and treatment of metachronous peritoneal metastases (mPM) are under study, it appears crucial to identify their risk factors. Our aim is to establish the incidence of mPM after surgery for colon cancer (CC) and to build a statistical model to predict the risk of recurrence. PATIENTS AND METHODS: Retrospective analysis of consecutive pT3-4 CC operated at five referral centers (2014-2018). Patients who developed mPM were compared with patients who were PM-free at follow-up. A scoring system was built on the basis of a logistic regression model. RESULTS: Of the 1423 included patients, 74 (5.2%) developed mPM. Patients in the PM group presented higher preoperative carcinoembryonic antigen (CEA) [median (IQR): 4.5 (2.5-13.0) vs. 2.7 (1.5-5.9), P = 0.001] and CA 19-9 [median (IQR): 17.7 (12.0-37.0) vs. 10.8 (5.0-21.0), P = 0.001], advanced disease (pT4a 42.6% vs. 13.5%; pT4b 16.2% vs. 3.2%; P < 0.001), and negative pathological characteristics. Multivariate logistic regression identified CA 19-9, pT stage, pN stage, extent of lymphadenectomy, and lymphovascular invasion as significant predictors, and individual risk scores were calculated for each patient. The risk of recurrence increased remarkably with score values, and the model demonstrated a high negative predictive value (98.8%) and accuracy (83.9%) for scores below five. CONCLUSIONS: Besides confirming incidence and risk factors for mPM, our study developed a useful clinical tool for prediction of mPM risk. After external validation, this scoring system may guide personalized decision-making for patients with locally advanced CC.
