Prognostic Value of Systemic Inflammatory Biomarkers in Patients Undergoing Cytoreductive Surgery with Hyperthermic Intraperitoneal Chemotherapy

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Introduction: Cytoreductive surgery with hyperthermic intraperitoneal chemotherapy (CRS-HIPEC) is a popular, but morbid, treatment for patients with peritoneal carcinomatosis. Thus, patient selection and prognostication are important. This study aims to evaluate three laboratory values, blood neutrophil to lymphocyte ratio (NLR), platelet to lymphocyte ratio (PLR), and monocyte to lymphocyte ratio (MLR), as potential prognostic biomarkers. Methods: We performed a retrospective review of 145 patients who underwent CRS-HIPEC between 2011-2019. Biomarker ratios were calculated from preoperative serum lab values. Regression models were used to evaluate the biomarkers’ associations with postoperative outcomes as well as overall survival (OS) and recurrence-free survival (RFS). Results: Increased NLR was independently associated with increased Clavien-Dindo complication classification (OR 1.99, p <0.001), hospital readmissions (RR 1.37, p=0.02), and worse OS (HR 4.58, p<0.001), but not RFS (HR 0.72, p=0.19). Increased PLR was independently associated with increased hospital length of stay (HR 1.002, p=0.03) and was not associated with changes in oncologic outcomes. Higher MLR was associated with worse OS (HR 17.83, p=0.0012) but not RFS (HR 3.10, p=0.06) or other postoperative outcomes. Additionally, intermediate (HR 2.13, p=0.005), and high-grade disease (HR 1.87, p=0.003) were associated with increased hospital length of stay, while male gender (HR 0.56, p=0.003) was associated with decreased hospital length of stay. Conclusion: In this retrospective review, increased preoperative NLR was independently associated with worse postoperative outcomes and shortened overall survival. Thus, the utilization of preoperative systemic inflammatory biomarkers may aid in preoperative counseling and risk stratification before CRS-HIPEC to improve outcomes.

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