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

  • Gastrointestinal Oncology
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

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.

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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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Authors and Affiliations

  1. Peritoneal Malignancy Institute, North Hampshire Hospital, Basingstoke, UK

    Brendan Moran MD & Chandrakumaran Kandiah MD, PhD

  2. Division of Surgical Oncology, Department of Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA

    David Bartlett MD, Choudry M. Haroon MD, James F. Pingpank MD & Lekshmi Ramalingam MD

  3. Division of Surgical Oncology, Department of General Surgery, Wake Forest Baptist Health, Winston-Salem, NC, USA

    Konstantinos Ioannis Votanopoulos MD, PhD, FACS, Konstantinos Chouliaras MD, Perry Shen MD & Edward A. Levine MD

  4. Department of Biostatistical Sciences, Wake Forest School of Medicine, Winston-Salem, NC, USA

    Greg Russell MS

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  1. Konstantinos Ioannis Votanopoulos MD, PhD, FACS
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  2. David Bartlett MD
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  3. Brendan Moran MD
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  4. Choudry M. Haroon MD
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  5. Greg Russell MS
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  6. James F. Pingpank MD
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  7. Lekshmi Ramalingam MD
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  8. Chandrakumaran Kandiah MD, PhD
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  9. Konstantinos Chouliaras MD
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  10. Perry Shen MD
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  11. Edward A. Levine MD
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Corresponding author

Correspondence to Konstantinos Ioannis Votanopoulos MD, PhD, FACS.

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Votanopoulos, K.I., Bartlett, D., Moran, B. et al. PCI is Not Predictive of Survival After Complete CRS/HIPEC in Peritoneal Dissemination from High-Grade Appendiceal Primaries. Ann Surg Oncol 25, 674–678 (2018). https://doi.org/10.1245/s10434-017-6315-3

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  • DOI: https://doi.org/10.1245/s10434-017-6315-3

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