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Prediction of Early Recurrence Following CRS/HIPEC in Patients With Disseminated Appendiceal Cancer. J Surg Res 2023 Dec;292:275-288



Pubmed ID




Scopus ID

2-s2.0-85170090934 (requires institutional sign-in at Scopus site)   1 Citation


INTRODUCTION: In patients with disseminated appendiceal cancer (dAC) who underwent cytoreductive surgery (CRS) with hyperthermic intraperitoneal chemotherapy (HIPEC), characterizing and predicting those who will develop early recurrence could provide a framework for personalizing follow-up. This study aims to: (1) characterize patients with dAC that are at risk for recurrence within 2 y following of CRS ± HIPEC (early recurrence; ER), (2) utilize automated machine learning (AutoML) to predict at-risk patients, and (3) identifying factors that are influential for prediction.

METHODS: A 12-institution cohort of patients with dAC treated with CRS ± HIPEC between 2000 and 2017 was used to train predictive models using's AutoML. Patients with early recurrence (ER) were compared to those who did not have recurrence or presented with recurrence after 2 y (control; C). However, 75% of the data was used for training and 25% for validation, and models were 5-fold cross-validated.

RESULTS: A total of 949 patients were included, with 337 ER patients (35.5%). Patients with ER had higher markers of inflammation, worse disease burden with poor response, and received greater intraoperative fluids/blood products. The highest performing AutoML model was a Stacked Ensemble (area under the curve = 0.78, area under the curve precision recall = 0.66, positive predictive value = 85%, and negative predictive value = 63%). Prediction was influenced by blood markers, operative course, and factors associated with worse disease burden.

CONCLUSIONS: In this multi-institutional cohort of dAC patients that underwent CRS ± HIPEC, AutoML performed well in predicting patients with ER. Variables suggestive of poor tumor biology were the most influential for prediction. Our work provides a framework for identifying patients with ER that might benefit from shorter interval surveillance early after surgery.

Author List

SenthilKumar G, Merrill J, Maduekwe UN, Cloyd JM, Fournier K, Abbott DE, Zafar N, Patel S, Johnston F, Dineen S, Baumgartner J, Grotz TE, Maithel SK, Raoof M, Lambert L, Hendrix R, Kothari AN


Anai N. Kothari MD Assistant Professor in the Surgery department at Medical College of Wisconsin