Faculty Collaboration Database

Neighborhood-Level Socioeconomic Disadvantage Predicts Outcomes in Cytoreductive Surgery and Hyperthermic Intraperitoneal Chemotherapy for Peritoneal Malignancy. Ann Surg Oncol 2023 Nov;30(12):7840-7847

Date

08/25/2023

Pubmed ID

37620532

Pubmed Central ID

PMC10592201

DOI

10.1245/s10434-023-14074-2

Scopus ID

2-s2.0-85168622027 (requires institutional sign-in at Scopus site)   5 Citations

Abstract

BACKGROUND: Cytoreductive surgery and hyperthermic intraperitoneal chemotherapy (CRS/HIPEC) improves survival in select patients with peritoneal metastases (PM), but the impact of social determinants of health on CRS/HIPEC outcomes remains unclear.

PATIENTS AND METHODS: A retrospective review was conducted of a multi-institutional database of patients with PM who underwent CRS/HIPEC in the USA between 2000 and 2017. The area deprivation index (ADI) was linked to the patient's residential address. Patients were categorized as living in low (1-49) or high (50-100) ADI residences, with increasing scores indicating higher socioeconomic disadvantage. The primary outcome was overall survival (OS). Secondary outcomes included perioperative complications, hospital/intensive care unit (ICU) length of stay (LOS), and disease-free survival (DFS).

RESULTS: Among 1675 patients 1061 (63.3%) resided in low ADI areas and 614 (36.7%) high ADI areas. Appendiceal tumors (n = 1102, 65.8%) and colon cancer (n = 322, 19.2%) were the most common histologies. On multivariate analysis, high ADI was not associated with increased perioperative complications, hospital/ICU LOS, or DFS. High ADI was associated with worse OS (median not reached versus 49 months; 5 year OS 61.0% versus 28.2%, P < 0.0001). On multivariate Cox-regression analysis, high ADI (HR, 2.26; 95% CI 1.13-4.50; P < 0.001), cancer recurrence (HR, 2.26; 95% CI 1.61-3.20; P < 0.0001), increases in peritoneal carcinomatosis index (HR, 1.03; 95% CI 1.01-1.05; P < 0.001), and incomplete cytoreduction (HR, 4.48; 95% CI 3.01-6.53; P < 0.0001) were associated with worse OS.

CONCLUSIONS: Even after controlling for cancer-specific variables, adverse outcomes persisted in association with neighborhood-level socioeconomic disadvantage. The individual and structural-level factors leading to these cancer disparities warrant further investigation to improve outcomes for all patients with peritoneal malignancies.

Author List

Winicki NM, Radomski SN, Florissi IS, Cloyd JM, Gutta G, Grotz TE, Scally CP, Fournier KF, Dineen SP, Powers BD, Veerapong J, Baumgartner JM, Clarke CN, Kothari AN, Maduekwe UN, Patel SH, Wilson GC, Schwartz P, Varley PR, Raoof M, Lee B, Malik I, Johnston FM, Greer JB

Authors

Callisia N. Clarke MD Chief, Associate Professor in the Surgery department at Medical College of Wisconsin
Anai N. Kothari MD Assistant Professor in the Surgery department at Medical College of Wisconsin
Ugwuji N. Maduekwe MD Associate Dean, Associate Professor in the Surgery department at Medical College of Wisconsin

MESH terms used to index this publication - Major topics in bold

Antineoplastic Combined Chemotherapy Protocols
Colorectal Neoplasms
Combined Modality Therapy
Cytoreduction Surgical Procedures
Humans
Hyperthermia, Induced
Neoplasm Recurrence, Local
Peritoneal Neoplasms
Retrospective Studies
Survival Rate