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Annals of Surgical Oncology

, Volume 25, Issue 3, pp 674–678 | Cite as

PCI is Not Predictive of Survival After Complete CRS/HIPEC in Peritoneal Dissemination from High-Grade Appendiceal Primaries

  • Konstantinos Ioannis Votanopoulos
  • David Bartlett
  • Brendan Moran
  • Choudry M. Haroon
  • Greg Russell
  • James F. Pingpank
  • Lekshmi Ramalingam
  • Chandrakumaran Kandiah
  • Konstantinos Chouliaras
  • Perry Shen
  • Edward A. Levine
Gastrointestinal Oncology
  • 262 Downloads

Abstract

Background

Cytoreductive surgery and hyperthermic intraperitoneal chemotherapy (CRS/HIPEC) is a treatment option in patients with carcinomatosis from high-grade appendiceal (HGA) primaries. It is unknown if there is a Peritoneal Carcinomatosis Index (PCI) upper limit above which a complete CRS/HIPEC does not assure long-term survival.

Methods

Retrospective analysis from three centers was performed. The PCI was used to grade volume of of disease. Survival in relation to PCI was studied on patients with complete cytoreduction.

Results

Overall, 521 HGA patients underwent CRS/HIPEC from 1993 to 2015, with complete CRS being achieved in 50% (260/622). Mean PCI was 14.8 (standard deviation 8.7, range 0–36). Median survival for the complete CRS cohort was 6.1 years, while 5- and 10-year survival was 51.7% (standard error [SE] 4.6) and 36.1% (SE 6.3), respectively. Arbitrary cut-off PCI limits with 5-point splits (p = 0.63) were not predictive of a detrimental effect on survival as long as a complete CRS was achieved. A linear effect of the PCI on survival (p = 0.62) was not observed, and single-point PCI cohort splits within a PCI range of < 5 to > 10 were not predictive of survival for complete CRS patients. The PCI correlated with the ability to achieve a complete CRS, with a mean PCI of 14.7 (8.7) for completeness of cytoreduction (CC)0, 22.3 (7.8) for CC1 and 26.1 (9.5) for CC2/3 resections (p = 0.0001, hazard ratio 1.12, 95% confidence interval 1.09), with an HR of 1.15 for each 1-unit increase in the PCI score. Only 21% of the cohort achieved a complete CRS with a PCI ≥ 21.

Conclusions

The PCI correlates with the ability to achieve a complete CRS in carcinomatosis from HGA. PCI is not associated with survival as long as a complete CRS can be achieved.

Notes

Disclosures

Konstantinos Ioannis Votanopoulos, David Bartlett, Brendan Moran, Choudry M. Haroon, Greg Russell, James F. Pingpank, Lekshmi Ramalingam, Chandrakumaran Kandiah, Konstantinos Chouliaras, Perry Shen, and Edward A. Levine have no disclosures to declare.

Funding

This work was supported by Wake Forest University Biostatistics shared resource NCI CCSG P30CA012197.

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Copyright information

© Society of Surgical Oncology 2017

Authors and Affiliations

  • Konstantinos Ioannis Votanopoulos
    • 3
  • David Bartlett
    • 2
  • Brendan Moran
    • 1
  • Choudry M. Haroon
    • 2
  • Greg Russell
    • 4
  • James F. Pingpank
    • 2
  • Lekshmi Ramalingam
    • 2
  • Chandrakumaran Kandiah
    • 1
  • Konstantinos Chouliaras
    • 3
  • Perry Shen
    • 3
  • Edward A. Levine
    • 3
  1. 1.Peritoneal Malignancy InstituteNorth Hampshire HospitalBasingstokeUK
  2. 2.Division of Surgical Oncology, Department of SurgeryUniversity of Pittsburgh Medical CenterPittsburghUSA
  3. 3.Division of Surgical Oncology, Department of General SurgeryWake Forest Baptist HealthWinston-SalemUSA
  4. 4.Department of Biostatistical SciencesWake Forest School of MedicineWinston-SalemUSA

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