Author: Falla-Zuniga, Luis Felipe ; Iugai, Sergei ; King, Mary Caitlin ; Nieroda, Carol ; Sardi, Armando ; Gushchin, Vadim ; Lopez-Ramirez, Felipe ; Nikiforchin, Andrei ; Baron, Ekaterina ; Barakat, Philipp ; Kovalik, Vladislav

BACKGROUNDThe role of systemic inflammation, a significant prognostic factor in various malignancies, is underexplored in mucinous appendix cancer (MAC). We assessed how inflammation, expressed by preoperative serum C-reactive protein (CRP), correlates with survival across MAC histopathologies managed with cytoreductive surgery and hyperthermic intraperitoneal chemotherapy (CRS/HIPEC).METHODSThis retrospective cohort study included MAC patients with peritoneal dissemination, who had complete CRS/HIPEC (CC-0/1) (1998-2023). Preoperative serum CRP cut-off was defined with the minimum p-value approach and time-dependent receiver operating characteristic analysis. Survival was analyzed using the Kaplan-Meier method and Cox regression.RESULTSOf 273 patients, 163 had low-grade and 110 had high-grade MAC. CRP cut-off was 2.00 mg/dL. Among low-grade, 132 patients had CRP<2 and 31 had CRP≥2. In high-grade, 87 patients had CRP<2 and 23 had CRP≥2. Median follow-up was 86 (95%CI: 48-124) months. In low-grade MAC, 5-year progression-free survival (PFS) was 88.5 % in CRP<2 and 53.9 % in CRP≥2 (p < 0.001), while 5-year overall survival (OS) was 89.2 % and 85.4 %, respectively (p = 0.018). In high-grade tumors, 5-year PFS was 46.5 % in CRP<2 and 19.3 % in CRP≥2 (p = 0.011), while 5-year OS was 56.5 % and 45.3 %, respectively (p = 0.291). Multivariate Cox regression showed a strong association of CRP≥2 with worse PFS (HR 5.10; 95%CI: 2.46-10.58) and OS (HR 3.18; 95%CI: 1.22-8.28) in low-grade MAC only.CONCLUSIONSElevated pre-CRS/HIPEC serum CRP was associated with worse PFS and OS in low-grade, but not in high-grade MAC. These findings highlight CRP's utility in prognosis assessment and can be useful in identifying target MAC subgroups for studying anti-inflammatory agents.

01 Apr 2025·Gynecologic Oncology Reports

Association between time to adjuvant chemotherapy and survival in ovarian cancer patients treated with cytoreductive surgery and hyperthermic intraperitoneal chemotherapy

Article

Author: Nieroda, Carol ; Iugai, Sergei ; Gushchin, Vadim ; King, Mary Caitlin ; Diaz-Montes, Teresa ; Sardi, Armando ; Kovalik, Vladislav ; Uzhegova, Kseniia ; Ledakis, Panayotis ; Falla-Zuniga, Luis Felipe

IntroductionDelayed adjuvant chemotherapy (AC) worsens survival in advanced ovarian cancer (OC), but data on its impact after cytoreductive surgery and hyperthermic intraperitoneal chemotherapy (CRS/HIPEC) is limited. We aimed to assess if delayed AC negatively affects survival in OC patients treated with CRS/HIPEC.MethodsWe conducted a retrospective analysis of a single-center prospective database including FIGO stage III-IV epithelial OC patients who underwent initial CRS/HIPEC (upfront or interval) followed by AC. Patients were grouped into delayed AC (≥60 days) and no delay (<60 days). Patient characteristics were compared. Logistic regression identified risk factors for delay. Kaplan-Meier method and stratified Wilcoxon test were used for survival analysis.ResultsOf 95 patients identified, 43 (45.3 %) were delayed, while 52 (54.7 %) had no delay. Delayed patients were significantly older (p = 0.013), had higher stage (p = 0.038) and peritoneal cancer index (PCI) (p = 0.020), more Clavien-Dindo grade III-IV complications (p = 0.002), and longer hospital stay (p = 0.003). Age ≥ 65 years (odds ratio [OR]: 5.25, p = 0.001), PCI ≥ 24 (OR: 3.89, p = 0.006), and stage IV (OR: 3.28, p = 0.017) were associated with a higher likelihood of delay. After adjusting for stage, comorbidities, complete cytoreduction (CC)-score, and CRS type, there were no significant differences in progression-free or overall (OS) survival between groups. Subgroup analysis found early chemotherapy worsened OS in CC-0 patients (p = 0.017), while CC-1 patients demonstrated a non-significant trend towards improved OS.ConclusionOlder OC patients with high tumor burden are more likely to have AC delay after CRS/HIPEC. Without clear survival benefits from early AC initiation, time to chemotherapy may be based on individual patient characteristics.

01 Jan 2025·Annals of Surgical Oncology

ASO Visual Abstract: Quality of Life After Cytoreductive Surgery and Hyperthermic Intraperitoneal Chemotherapy (CRS/HIPEC): Cancer Survivors’ Perspective Through in-Depth Interviews

Article

Author: Pawlikowski, Kathleen ; Falla-Zuniga, Luis Felipe ; Sardi, Armando ; Nikiforchin, Andrei ; Nieroda, Carol ; Gushchin, Vadim ; King, Mary Caitlin ; Barakat, Philipp ; Iugai, Sergei ; Lopez-Ramirez, Felipe

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