Annals of Surgical Oncology

, Volume 23, Issue 1, pp 114–119 | Cite as

Linear Relationship of Peritoneal Cancer Index and Survival in Patients with Peritoneal Metastases from Colorectal Cancer

  • Matthieu Faron
  • Raluca Macovei
  • Diane Goéré
  • Charles Honoré
  • Léonor Benhaim
  • Dominique Elias
Colorectal Cancer



The peritoneal cancer index (PCI) is the main prognostic factor for establishing potentially resectable peritoneal metastases from colorectal cancer. Attempts have been made to set a PCI cutoff on which to base indications of complete cytoreductive surgery (CCRS) with hyperthermic intraperitoneal chemotherapy (HIPEC), but none have reached consensus. The aim of this study was to investigate the relation between the PCI and overall survival (OS).


We included all consecutive patients homogeneously treated with CCRS and HIPEC between 2003 and 2012. The PCI was calculated at the end of the surgical procedure. The correlation between the PCI and OS was studied using statistical modeling from the simplest to the most complex methods (including linear, quadratic, cubic, and spline cubic). These models were compared by Akaike’s information criteria (AIC).


For the 173 treated patients, 5-year OS reached 41 %. The mean PCI was 10.2 (±6.8). The linear model was the most appropriate to relate the PCI to OS as confirmed with the AIC scoring system. In multivariate analysis, the PCI was confirmed as being the most important prognostic factor (hazard ratio = 1.1 for each supplementary point, p < 0.0001).


There is a perfect linear correlation between the PCI and OS, which precludes setting a unique PCI cutoff for CCRS + HIPEC. Overall, CCRS + HIPEC is generally indicated for PCI < 12 and contraindicated for PCI > 17. Between 12 and 17, other parameters have to be taken into account, such as the presence of extraperitoneal metastases, general performance status, and chemosensitivity.


Overall Survival Peritoneal Metastasis Peritoneal Cancer Index Hyperthermic Intraperitoneal Chemotherapy Eastern Cooperative Oncology Group Score 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.



The authors declare no conflict of interest.


  1. 1.
    Chua T, Esquivel J, Pelz J, Morris D. Summary of current therapeutic options for peritoneal metastases from colorectal cancer. J Surg Oncol. 2013;107:566–73.PubMedCrossRefGoogle Scholar
  2. 2.
    Elias D, Lefevre JH, Chevalier J, et al. Complete cytoreductive surgery plus intraperitoneal chemohyperthermia with oxaliplatin for peritoneal carcinomatosis of colorectal origin. J Clin Oncol. 2009;27:681–5.PubMedCrossRefGoogle Scholar
  3. 3.
    Quenet F, Goéré D, Metha S, et al. Results of two bi-institutional prospective studies using intraperitoneal oxaliplatin with and without irinotecan during HIPEC following cytoreductive surgery for colorectal carcinomatosis. Ann Surg. 2011;254:294–301.PubMedCrossRefGoogle Scholar
  4. 4.
    Verwaal VJ, van Ruth S, Witkamp A, Boot H, van Slooten G, Zoetmulder FA. Long-term survival of peritoneal carcinomatosis of colorectal origin. Ann Surg Oncol. 2005;12:65–71.PubMedCrossRefGoogle Scholar
  5. 5.
    Sugarbaker P, Ryan D. Cytoreductive surgery plus HIPEC to treat peritoneal metastases from colorectal cancer: standard of care or an experimental approach? Lancet Oncol. 2012;13:362–9.CrossRefGoogle Scholar
  6. 6.
    Elias D, Gilly F, Boutitie F, et al. Peritoneal colorectal carcinomatosis treated with surgery and perioperative intraperitoneal chemotherapy: retrospective analysis of 523 patients from a multicentric French study. J Clin Oncol. 2010;28:63–8.PubMedCrossRefGoogle Scholar
  7. 7.
    da Silva RG, Sugarbaker PH. Analysis of prognostic factors in seventy patients having a complete cytoreduction plus perioperative intraperitoneal chemotherapy for carcinomatosis from colorectal cancer. J Am Coll Surg. 2006;203:878–86.PubMedCrossRefGoogle Scholar
  8. 8.
    Cashin PH, Graf W, Nygren P, Mahetme H. Cytoreductive surgery and intraperitoneal chemotherapy for colorectal peritoneal carcinomatosis: prognosis and treatment of recurrences in a cohort series. Eur J Surg Oncol. 2012;38:509–15.PubMedCrossRefGoogle Scholar
  9. 9.
    Elias D, Faron M, Stan Iuga B, et al. Prognostic similarities and differences in optimally resected liver metastases and peritoneal metastases from colorectal cancers. Ann Surg. 2015;261:157–63.PubMedCrossRefGoogle Scholar
  10. 10.
    Sugarbaker PH. Intraperitoneal chemotherapy and cytoreductive surgery for the prevention and treatment of peritoneal carcinomatosis and sarcomatosis. Semin Surg Oncol. 1998;14:254–61.PubMedCrossRefGoogle Scholar
  11. 11.
    Elias D, Souadka A, Fayard F, Mauguen A, Dumont F, Honoré C, Goéré D. Variation in the peritoneal cancer index scores between surgeons and according to when they are determined (before or after cytoreductive surgery). Eur J Surg Oncol. 2012;38:503–8.PubMedCrossRefGoogle Scholar
  12. 12.
    Gomez Portilla A, Shigeki K, Baratti D, Deraco M. The intraoperative staging systems in the management of peritoneal surface malignancy. J Surg Oncol. 2008;98:228–31.PubMedCrossRefGoogle Scholar
  13. 13.
    Esquivel J, Sticca R, Sugarbaker PH, et al. Cytoreductive surgery and hyperthermic intraperitoneal chemotherapy in the management of peritoneal surface malignancies of colonic origin: a consensus statement. Ann Surg Oncol. 2007;14:128–33.PubMedCrossRefGoogle Scholar
  14. 14.
    Yan TD, Morris DL. Cytoreductive surgery and perioperative intraperitoneal chemotherapy for isolated colorectal peritoneal carcinomatosis: experimental or standard of care? Ann Surg. 2008;248:829–35.PubMedGoogle Scholar
  15. 15.
    Yonemura Y, Canbay E, Ishibashi H. Prognostic factors of peritoneal metastases from colorectal cancer following cytoreductive surgery and preoperative chemotherapy. Sci World J. 2013;2013:978394.CrossRefGoogle Scholar
  16. 16.
    Elias D, Delperro JR, Sideris L, et al. Treatment of peritoneal carcinomatosis from colorectal cancer: impact of the complete cytoreductive surgery and difficulties in conducting randomized trials. Ann Surg Oncol. 2004;11:518–21.PubMedCrossRefGoogle Scholar
  17. 17.
    Sugarbaker PH. Peritonectomy procedures. Ann Surg. 1995;221:29–42.PubMedPubMedCentralCrossRefGoogle Scholar
  18. 18.
    Elias D, Matsuhisa T, Sideris L, et al. Heated intra-operative intraperitoneal oxaliplatin plus irinotecan after complete resection of peritoneal carcinomatosis: pharmacokinetics, tissue distribution and tolerance. Ann Oncol. 2004;15:1558–65.PubMedCrossRefGoogle Scholar
  19. 19.
    Elias D, Antoun A, Goharin A, et al. Research on the best chemohyperthermia technique for treatment of peritoneal carcinomatosis after complete resection. Int J Surg Invest. 2000;1:431–9.Google Scholar
  20. 20.
    Goere D, Malka D, Tzanis D, et al. Is there a possibility of a cure in patients with colorectal peritoneal carcinomatosis amenable to complete cytoreductive surgery and intraperitoneal chemotherapy? Ann Surg. 2013;257:1065–71.PubMedCrossRefGoogle Scholar
  21. 21.
    Glehen O, Kwiatowski F, Sugarbaker PH, et al. Cytoreductive surgery combined with perioperative intraperitoneal chemotherapy for the management of peritoneal carcinomatosis from colorectal cancer: a multi-institutional study. J Clin Oncol. 2004;22:3284–92.PubMedCrossRefGoogle Scholar
  22. 22.
    Goéré D, Souadka A, Faron M Alexis S, et al. Extent of colorectal peritoneal carcinomatosis: attempt at defining a threshold over which HIPEC does not offer survival benefit. A comparative study. Ann Surg Oncol (in press).Google Scholar

Copyright information

© Society of Surgical Oncology 2015

Authors and Affiliations

  • Matthieu Faron
    • 1
  • Raluca Macovei
    • 1
  • Diane Goéré
    • 1
  • Charles Honoré
    • 1
  • Léonor Benhaim
    • 1
  • Dominique Elias
    • 1
  1. 1.Departments of Surgical Oncology and StatisticsGustave Roussy Cancer Campus Grand ParisVillejuifFrance

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