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Int J Hyperthermia. 2018 Aug;34(5):512-517. doi: 10.1080/02656736.2017.1351627. Epub 2017 Jul 26.

Predictive value of peritoneal cancer index for survival in patients with mucinous peritoneal malignancies treated with cytoreductive surgery and hyperthermic intraperitoneal chemotherapy: a single centre experience.

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a Department of General, Visceral, and Transplantation Surgery and Department of General, Visceral, Vascular, and Thoracic Surgery, Campus Virchow and Mitte, Charité , Universitätsmedizin Berlin , Berlin , Germany.
b Institute of Pathology, Campus Mitte, Charité , Universitätsmedizin Berlin , Berlin , Germany.
c Biostatistics Unit , Berlin Institute of Health and Charité Universitätsmedizin Berlin , Berlin , Germany.



This study investigated the correlation between the peritoneal carcinomatosis index (PCI) and patient outcome depending on the tumour type.


Peritoneal surface malignancy (PSM) treatment depends on tumour type. Mucinous PSM (m-PSM) is associated with a better prognosis than non-mucinous PSM (nm-PSM). The PCI's predictive ability has not yet been evaluated.


We analysed 123 patients with PSM treated with cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) between 2008 and 2015. The m-PSM group (n = 75) included patients with appendiceal cancer (n = 15), colorectal cancer (n = 21), or low-grade appendiceal mucinous neoplasm (n = 39); the nm-PSM group (n = 48) included patients with gastric (n = 18) or colorectal (n = 30) cancer. The PCI's predictive ability was evaluated by multiple Cox-proportional hazard regression analysis and Kaplan-Meier curves.


The 5-year survival and PCI were higher in m-PSM patients (67.0%; 20.5 ± 12.1) than in nm-PSM patients (32.6%; p = 0.013; 8.9 ± 6.0; p < 0.001). Colorectal nm-PSM patients with PCI ≥16 had a worse 2-year survival (25.0%) vs. patients with PCI <16 (79.1%; log rank = 0.009), but no significant effect was observed in patients with m-PSM (66.7% vs. 68.1%; p = 0.935). Underlying disease (HR 5.666-16.240), BMI (HR 1.109), and PCI (HR 1.068) significantly influenced overall survival in all patients.


PCI is prognostic in nm-PSM, but not in m-PSM. CRS and HIPEC may benefit not only patients with low PCI, but also those with high PCI and m-PSM.


Cytoreductive surgery; HIPEC; mucinous adenocarcinoma; peritoneal cancer index

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