Incidence, risk factors, and impact of severe neutropenia after hyperthermic intraperitoneal mitomycin C

Laura A. Lambert; Terri S. Armstrong; J. Jack Lee; Suyu Liu; Matthew H.G. Katz; Cathy Eng; Robert A. Wolff; Melissa L. Tortorice; Pier Tansey; Santiago Gonzalez-Moreno; Donald H. Lambert; Paul F. Mansfield

doi:10.1245/s10434-009-0523-4

Incidence, risk factors, and impact of severe neutropenia after hyperthermic intraperitoneal mitomycin C

Laura A. Lambert, Terri S. Armstrong, J. Jack Lee, Suyu Liu, Matthew H.G. Katz, Cathy Eng, Robert A. Wolff, Melissa L. Tortorice, Pier Tansey, Santiago Gonzalez-Moreno, Donald H. Lambert, Paul F. Mansfield

Research output: Contribution to journal › Article › peer-review

54 Scopus citations

Abstract

Background: Cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) are considered the standard of care for patients with peritoneal dissemination of appendiceal cancer and are increasingly being evaluated for use in patients with carcinomatosis from colon cancer. Mitomycin C (MMC) is one of the most frequently used HIPEC agents in the management of peritoneal-based gastrointestinal malignancies. This study analyzes the incidence and risk factors for developing neutropenia following MMC-HIPEC combined with CRS. Methods: All patients undergoing CRS and MMC-HIPEC for appendiceal cancer between January 1993 and October 2006 were retrospectively reviewed. Logistic regression was used to identify risk factors for the development of neutropenia, defined as an absolute neutrophil count (ANC) <1,000/mm³. Results: One hundred and twenty MMC-HIPEC were performed in 117 patients with appendiceal cancer. The incidence of neutropenia was 39%. Neutropenia occurred in 57.6% of female and 21.3% of male patients (p < 0.0001). Female gender and MMC dose per body surface area (BSA) were independent risk factors for neutropenia on multivariable logistic regression [odds ratio (OR) of neutropenia in females = 3.58 (95% confidence interval, CI: 1.52, 8.43); OR for 5 unit (mg/m²) increase in MMC dose per BSA = 3.37 (95% CI: 1.72, 6.63)]. Neutropenia did not increase the risk of mortality, postoperative infection or length of hospital stay. Conclusion: Neutropenia is a frequent complication associated with MMC-HIPEC. Female sex and MMC dose per BSA are independent risk factors for neutropenia. These differences must be considered in the management of patients undergoing MMC-HIPEC to minimize the toxicity of the procedure.

Original language	English (US)
Pages (from-to)	2181-2187
Number of pages	7
Journal	Annals of surgical oncology
Volume	16
Issue number	8
DOIs	https://doi.org/10.1245/s10434-009-0523-4
State	Published - Aug 2009

ASJC Scopus subject areas

Surgery
Oncology

Access to Document

10.1245/s10434-009-0523-4

Cite this

Lambert, L. A., Armstrong, T. S., Lee, J. J., Liu, S., Katz, M. H. G., Eng, C., Wolff, R. A., Tortorice, M. L., Tansey, P., Gonzalez-Moreno, S., Lambert, D. H., & Mansfield, P. F. (2009). Incidence, risk factors, and impact of severe neutropenia after hyperthermic intraperitoneal mitomycin C. Annals of surgical oncology, 16(8), 2181-2187. https://doi.org/10.1245/s10434-009-0523-4

@article{b630925010a4466b894bbbb3810dc2d8,

title = "Incidence, risk factors, and impact of severe neutropenia after hyperthermic intraperitoneal mitomycin C",

abstract = "Background: Cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) are considered the standard of care for patients with peritoneal dissemination of appendiceal cancer and are increasingly being evaluated for use in patients with carcinomatosis from colon cancer. Mitomycin C (MMC) is one of the most frequently used HIPEC agents in the management of peritoneal-based gastrointestinal malignancies. This study analyzes the incidence and risk factors for developing neutropenia following MMC-HIPEC combined with CRS. Methods: All patients undergoing CRS and MMC-HIPEC for appendiceal cancer between January 1993 and October 2006 were retrospectively reviewed. Logistic regression was used to identify risk factors for the development of neutropenia, defined as an absolute neutrophil count (ANC) <1,000/mm3. Results: One hundred and twenty MMC-HIPEC were performed in 117 patients with appendiceal cancer. The incidence of neutropenia was 39%. Neutropenia occurred in 57.6% of female and 21.3% of male patients (p < 0.0001). Female gender and MMC dose per body surface area (BSA) were independent risk factors for neutropenia on multivariable logistic regression [odds ratio (OR) of neutropenia in females = 3.58 (95% confidence interval, CI: 1.52, 8.43); OR for 5 unit (mg/m2) increase in MMC dose per BSA = 3.37 (95% CI: 1.72, 6.63)]. Neutropenia did not increase the risk of mortality, postoperative infection or length of hospital stay. Conclusion: Neutropenia is a frequent complication associated with MMC-HIPEC. Female sex and MMC dose per BSA are independent risk factors for neutropenia. These differences must be considered in the management of patients undergoing MMC-HIPEC to minimize the toxicity of the procedure.",

author = "Lambert, {Laura A.} and Armstrong, {Terri S.} and Lee, {J. Jack} and Suyu Liu and Katz, {Matthew H.G.} and Cathy Eng and Wolff, {Robert A.} and Tortorice, {Melissa L.} and Pier Tansey and Santiago Gonzalez-Moreno and Lambert, {Donald H.} and Mansfield, {Paul F.}",

note = "Funding Information: ACKNOWLEDGMENT The authors wish to acknowledge The Morton Foundation, the Carlos H. Cantu Family Foundation and an anonymous patient donor for supporting this project. The project is also supported in part by grant CA16672 from the National Cancer Institute.",

year = "2009",

month = aug,

doi = "10.1245/s10434-009-0523-4",

language = "English (US)",

volume = "16",

pages = "2181--2187",

journal = "Annals of surgical oncology",

issn = "1068-9265",

publisher = "Springer New York",

number = "8",

}

TY - JOUR

T1 - Incidence, risk factors, and impact of severe neutropenia after hyperthermic intraperitoneal mitomycin C

AU - Lambert, Laura A.

AU - Armstrong, Terri S.

AU - Lee, J. Jack

AU - Liu, Suyu

AU - Katz, Matthew H.G.

AU - Eng, Cathy

AU - Wolff, Robert A.

AU - Tortorice, Melissa L.

AU - Tansey, Pier

AU - Gonzalez-Moreno, Santiago

AU - Lambert, Donald H.

AU - Mansfield, Paul F.

N1 - Funding Information: ACKNOWLEDGMENT The authors wish to acknowledge The Morton Foundation, the Carlos H. Cantu Family Foundation and an anonymous patient donor for supporting this project. The project is also supported in part by grant CA16672 from the National Cancer Institute.

PY - 2009/8

Y1 - 2009/8

N2 - Background: Cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) are considered the standard of care for patients with peritoneal dissemination of appendiceal cancer and are increasingly being evaluated for use in patients with carcinomatosis from colon cancer. Mitomycin C (MMC) is one of the most frequently used HIPEC agents in the management of peritoneal-based gastrointestinal malignancies. This study analyzes the incidence and risk factors for developing neutropenia following MMC-HIPEC combined with CRS. Methods: All patients undergoing CRS and MMC-HIPEC for appendiceal cancer between January 1993 and October 2006 were retrospectively reviewed. Logistic regression was used to identify risk factors for the development of neutropenia, defined as an absolute neutrophil count (ANC) <1,000/mm3. Results: One hundred and twenty MMC-HIPEC were performed in 117 patients with appendiceal cancer. The incidence of neutropenia was 39%. Neutropenia occurred in 57.6% of female and 21.3% of male patients (p < 0.0001). Female gender and MMC dose per body surface area (BSA) were independent risk factors for neutropenia on multivariable logistic regression [odds ratio (OR) of neutropenia in females = 3.58 (95% confidence interval, CI: 1.52, 8.43); OR for 5 unit (mg/m2) increase in MMC dose per BSA = 3.37 (95% CI: 1.72, 6.63)]. Neutropenia did not increase the risk of mortality, postoperative infection or length of hospital stay. Conclusion: Neutropenia is a frequent complication associated with MMC-HIPEC. Female sex and MMC dose per BSA are independent risk factors for neutropenia. These differences must be considered in the management of patients undergoing MMC-HIPEC to minimize the toxicity of the procedure.

AB - Background: Cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) are considered the standard of care for patients with peritoneal dissemination of appendiceal cancer and are increasingly being evaluated for use in patients with carcinomatosis from colon cancer. Mitomycin C (MMC) is one of the most frequently used HIPEC agents in the management of peritoneal-based gastrointestinal malignancies. This study analyzes the incidence and risk factors for developing neutropenia following MMC-HIPEC combined with CRS. Methods: All patients undergoing CRS and MMC-HIPEC for appendiceal cancer between January 1993 and October 2006 were retrospectively reviewed. Logistic regression was used to identify risk factors for the development of neutropenia, defined as an absolute neutrophil count (ANC) <1,000/mm3. Results: One hundred and twenty MMC-HIPEC were performed in 117 patients with appendiceal cancer. The incidence of neutropenia was 39%. Neutropenia occurred in 57.6% of female and 21.3% of male patients (p < 0.0001). Female gender and MMC dose per body surface area (BSA) were independent risk factors for neutropenia on multivariable logistic regression [odds ratio (OR) of neutropenia in females = 3.58 (95% confidence interval, CI: 1.52, 8.43); OR for 5 unit (mg/m2) increase in MMC dose per BSA = 3.37 (95% CI: 1.72, 6.63)]. Neutropenia did not increase the risk of mortality, postoperative infection or length of hospital stay. Conclusion: Neutropenia is a frequent complication associated with MMC-HIPEC. Female sex and MMC dose per BSA are independent risk factors for neutropenia. These differences must be considered in the management of patients undergoing MMC-HIPEC to minimize the toxicity of the procedure.

UR - http://www.scopus.com/inward/record.url?scp=67650986136&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=67650986136&partnerID=8YFLogxK

U2 - 10.1245/s10434-009-0523-4

DO - 10.1245/s10434-009-0523-4

M3 - Article

C2 - 19475451

AN - SCOPUS:67650986136

SN - 1068-9265

VL - 16

SP - 2181

EP - 2187

JO - Annals of surgical oncology

JF - Annals of surgical oncology

IS - 8

ER -

Incidence, risk factors, and impact of severe neutropenia after hyperthermic intraperitoneal mitomycin C

Abstract

ASJC Scopus subject areas

Access to Document

Other files and links

Fingerprint

Cite this