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Título

DEVELOPMENT OF A CLINICAL PROGNOSTIC SCORE FOR GASTRIC CANCER WITH PERITONEAL CARCINOMATOSIS

Resumo

BACKGROUND:
Gastric cancer (GC) who develops peritoneal carcinomatosis (PC) had a particularly unfavorable prognosis, with an estimated median survival of 6 months. The limited survival of these patients in general raises doubts about which factors confer an extremely worse outcomes, and those who could benefit from surgical procedures and may achieve an improvement in survival. Thus, this study aimed to create a prognostic score based on clinical and treatment variables for 6-months mortality in GC with PC.
METHODS:
We performed a retrospective analysis of stage IV GC with PC. Patients were randomized into two groups for the score construction: Development (DG) and validation (VG). Ten variables were selected to define the score categories: age, sex, ASA classification, Charlson Comorbidity index, neutrophil-lymphocyte ratio (NLR), Albumin, hemoglobin, Lauren type, cT and cN. The score performance metric was determined by the area under the receiver operating characteristic (ROC) curve (AUC) to define low and high-risk groups.
RESULTS:
Of the 393 stage IV CG, 227 (57.8%) had PC. Patients were predominantly male (59.5%) with a mean age of 60.6 years old. The binary logistic regression analysis was performed and points were assigned to the variables to build the score. ROC curve derived from these pooled parameters had an AUC of 0.65 (95%CI: 0.58–0.72, P<0.036) to define risk groups, with an optimal cutoff value of 64 points. According to the cutoff, 117 GCs were assigned as low-risk and 110 as high-risk group. Female, ASA III/IV, low hemoglobin and albumin levels, high NLR, and diffuse type were significantly high in high-risk group (p<0.001). The surgical procedures performed were similar between the groups (p=0.226). Patients in the lower risk group achieved greater adherence to palliative chemotherapy lines (p=0.002). Median OS was 11.2 and 1.2 months for low and high-risk patients in VG (p<0.001).
CONCLUSION:
The scoring system developed with 10 variables related to patient’s performance status and clinical data was able to distinguish GC with PC with high-risk of 6-months mortality. This may help to identify patients most likely to benefit from palliative procedures, including options for palliative surgery, chemotherapy or conversion.