Factors and prediction model for catheter obstruction in hyperthermic intraperitoneal chemotherapy: Based on machine learning and logistic regression_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

DONG Zepeng , WANG Jiahao , HU Shibo , Zeshaan Yahaya Haji Mahmood , YU Junhui , SUN Xuejun ,  ZHENG Jianbao

Department of General Surgery, The First Affiliated Hospital of Xi’an Jiaotong University, Xi’an 710061, P. R. China;

Corresponding author：

ZHENG Jianbao, Email: bobzheng@mail.xjtu.edu.cn

Keywords：

hyperthermic intraperitoneal chemotherapy; catheter obstruction; risk factors; tumors

DOI：

10.7507/1007-9424.202502003

Video：

Export PDF Favorites Scan Get Citation

Abstract Full text Figures/Tables Video References Cited by

Objective To explore the risk factors affecting on catheter obstruction during hyperthermic intraperitoneal chemotherapy (HIPEC). Methods Based on the inclusion and exclusion criteria, the data of the patients who underwent HIPEC and related perfusion records at the First Affiliated Hospital of Xi’an Jiaotong University from February 2023 to December 2023 were retrospectively collected. The collected data were analyzed using Chi-square tests, machine learning, and non-parametric tests. The significance level was set at α=0.05. Results A total of 210 HIPEC patients meeting the criteria were included, of whom 51 (24.3%) experienced catheter obstruction. The univariate analysis revealed that the inflow-outflow temperature gradient of the perfusate (ΔT of the perfusate), perfusion flow rate, chemotherapy exposure, hypertension status, surgical approach, and HIPEC catheter length were associated with catheter obstruction (P<0.05). Subsequently, combining the results of the univariate analysis with feature values screened by machine learning, the following factors were selected, including HIPEC catheter length, ΔT of the perfusate, perfusion flow rate, age, gender, chemotherapy exposure, fibrinogen level, hypertension status, surgical approach, and blood transfusion. A predictive model for HIPEC catheter obstruction based on these features was established, achieving an area under the receiver operating characteristic curve (AUC) (95%CI) of 0.825 (0.757, 0.893). Conclusion This study preliminarily identifies key factors influencing the incidence of catheter obstruction during HIPEC treatment, such as ΔT of the perfusate, perfusion flow rate, chemotherapy exposure, surgical approach, HIPEC catheter length, and hypertension, continuously monitoring these factors, thereby reducing the risk of catheter obstruction.

1.	Sung H, Ferlay J, Siegel RL, et al. Global cancer statistics 2020: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 Countries. CA Cancer J Clin, 2021, 71(3): 209-249.
2.	张涛, 曲直, 王贇, 等. 腹腔热灌注化疗的研究进展. 现代肿瘤医学, 2022, 30(5): 30-935.
3.	Gamboa AC, Winer JH. Cytoreductive surgery and hyperthermic intraperitoneal chemotherapy for gastric cancer. Cancers (Basel), 2019, 11(11): 1662. doi: 10.3390/cancers11111662.
4.	李晶, 林仲秋. 妇科恶性肿瘤腹腔热灌注化疗临床应用专家共识(2019). 中国实用妇科与产科杂志, 2019, 35(2): 194-201.
5.	李源, 王点石, 林曜, 等. 腹腔热灌注化疗过程中发生堵管的原因分析、预防措施及处理方法. 腹部外科, 2023, 36(2): 139-141.
6.	邓吟咏, 贺育华, 蒋理立, 等. 腹腔热灌注化疗非机械堵管发生现状及影响因素分析. 中国普外基础与临床杂志, 2023, 30(4): 456-459.
7.	Hildebrandt B, Wust P, Ahlers O, et al. The cellular and molecular basis of hyperthermia. Crit Rev Oncol Hematol, 2002, 43(1): 33-56.
8.	Piché N, Leblond FA, Sidéris L, et al. Rationale for heating oxaliplatin for the intraperitoneal treatment of peritoneal carcinomatosis: a study of the effect of heat on intraperitoneal oxaliplatin using a murine model. Ann Surg, 2011, 254(1): 138-144.
9.	van Driel WJ, Koole SN, Sikorska K, et al. Hyperthermic intraperitoneal chemotherapy in ovarian cancer. N Engl J Med, 2018, 378(3): 230-240.
10.	Verwaal VJ, van Ruth S, de Bree E, et al. Randomized trial of cytoreduction and hyperthermic intraperitoneal chemotherapy versus systemic chemotherapy and palliative surgery in patients with peritoneal carcinomatosis of colorectal cancer. J Clin Oncol, 2003, 21(20): 3737-3743.
11.	Kobayashi D, Kodera Y. Intraperitoneal chemotherapy for gastric cancer with peritoneal metastasis. Gastric Cancer, 2017, 20(Suppl 1): 111-121.
12.	Ceelen W, Demuytere J, de Hingh I. Hyperthermic intraperitoneal chemotherapy: A critical review. Cancers (Basel), 2021, 13(13): 3114. doi: 10.3390/cancers13133114.
13.	Mehri R, Mavriplis C, Fenech M. Red blood cell aggregates and their effect on non-Newtonian blood viscosity at low hematocrit in a two-fluid low shear rate microfluidic system. PLoS One, 2018, 13(7): e0199911. doi: 10.1371/journal.pone.0199911.
14.	Hinghofer-Szalkay H, Moser M. Fluid and protein shifts after postural changes in humans. Am J Physiol, 1986, 250(1 Pt 2): H68-H75. doi: 10.1152/ajpheart.1986.250.1.H68.
15.	Khanafer KM, Bull JL, Upchurch GR, et al. Turbulence significantly increases pressure and fluid shear stress in an aortic aneurysm model under resting and exercise flow conditions. Ann Vasc Surg, 2007, 21(1): 67-74.
16.	Sudano I, Roas S, Noll G. Vascular abnormalities in essential hypertension. Curr Pharm Des, 2011, 17(28): 3039-3044.

1. Sung H, Ferlay J, Siegel RL, et al. Global cancer statistics 2020: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 Countries. CA Cancer J Clin, 2021, 71(3): 209-249.
2. 张涛, 曲直, 王贇, 等. 腹腔热灌注化疗的研究进展. 现代肿瘤医学, 2022, 30(5): 30-935.
3. Gamboa AC, Winer JH. Cytoreductive surgery and hyperthermic intraperitoneal chemotherapy for gastric cancer. Cancers (Basel), 2019, 11(11): 1662. doi: 10.3390/cancers11111662.
4. 李晶, 林仲秋. 妇科恶性肿瘤腹腔热灌注化疗临床应用专家共识(2019). 中国实用妇科与产科杂志, 2019, 35(2): 194-201.
5. 李源, 王点石, 林曜, 等. 腹腔热灌注化疗过程中发生堵管的原因分析、预防措施及处理方法. 腹部外科, 2023, 36(2): 139-141.
6. 邓吟咏, 贺育华, 蒋理立, 等. 腹腔热灌注化疗非机械堵管发生现状及影响因素分析. 中国普外基础与临床杂志, 2023, 30(4): 456-459.
7. Hildebrandt B, Wust P, Ahlers O, et al. The cellular and molecular basis of hyperthermia. Crit Rev Oncol Hematol, 2002, 43(1): 33-56.
8. Piché N, Leblond FA, Sidéris L, et al. Rationale for heating oxaliplatin for the intraperitoneal treatment of peritoneal carcinomatosis: a study of the effect of heat on intraperitoneal oxaliplatin using a murine model. Ann Surg, 2011, 254(1): 138-144.
9. van Driel WJ, Koole SN, Sikorska K, et al. Hyperthermic intraperitoneal chemotherapy in ovarian cancer. N Engl J Med, 2018, 378(3): 230-240.
10. Verwaal VJ, van Ruth S, de Bree E, et al. Randomized trial of cytoreduction and hyperthermic intraperitoneal chemotherapy versus systemic chemotherapy and palliative surgery in patients with peritoneal carcinomatosis of colorectal cancer. J Clin Oncol, 2003, 21(20): 3737-3743.
11. Kobayashi D, Kodera Y. Intraperitoneal chemotherapy for gastric cancer with peritoneal metastasis. Gastric Cancer, 2017, 20(Suppl 1): 111-121.
12. Ceelen W, Demuytere J, de Hingh I. Hyperthermic intraperitoneal chemotherapy: A critical review. Cancers (Basel), 2021, 13(13): 3114. doi: 10.3390/cancers13133114.
13. Mehri R, Mavriplis C, Fenech M. Red blood cell aggregates and their effect on non-Newtonian blood viscosity at low hematocrit in a two-fluid low shear rate microfluidic system. PLoS One, 2018, 13(7): e0199911. doi: 10.1371/journal.pone.0199911.
14. Hinghofer-Szalkay H, Moser M. Fluid and protein shifts after postural changes in humans. Am J Physiol, 1986, 250(1 Pt 2): H68-H75. doi: 10.1152/ajpheart.1986.250.1.H68.
15. Khanafer KM, Bull JL, Upchurch GR, et al. Turbulence significantly increases pressure and fluid shear stress in an aortic aneurysm model under resting and exercise flow conditions. Ann Vasc Surg, 2007, 21(1): 67-74.
16. Sudano I, Roas S, Noll G. Vascular abnormalities in essential hypertension. Curr Pharm Des, 2011, 17(28): 3039-3044.

CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Latest ArticlesFactors and prediction model for catheter obstruction in hyperthermic intraperitoneal chemotherapy: Based on machine learning and logistic regression

Abstract Full text Figures/Tables Video References Cited by

Format

Content