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Peritoneal Cancer Index Dominates Prognosis After CRS–HIPEC for Colorectal Peritoneal Metastases: A Consecutive Single-Centre Cohort with 3-Year Follow-Up

M. Kazanowski,Paweł Lesiak,Jędrzej Wierzbicki,B. Kapturkiewicz,Paweł Maciejewski,Marcin Pawłowski,Tomasz Jastrzębski,Marek Bębenek

Published 2025 in Cancers

ABSTRACT

Simple Summary Peritoneal metastases from colorectal cancer represent a distinct and aggressive disease pattern with historically poor outcomes. Cytoreductive surgery combined with hyperthermic intraperitoneal chemotherapy (HIPEC) offers selected patients the potential for long-term survival, yet prognostic factors that guide treatment selection remain under investigation. This study evaluated 75 consecutive patients treated at a tertiary oncology centre to identify variables influencing three-year survival after surgery and HIPEC. We found that the Peritoneal Cancer Index, reflecting the extent of peritoneal disease, was the only independent predictor of outcome. Completeness of cytoreduction, operative extent, and choice of intraperitoneal drug showed no additional prognostic effect. These findings support the dominant role of tumour burden in patient selection and underscore the need to integrate molecular and biological markers into future prognostic models. Abstract Background: Cytoreductive surgery (CRS) with hyperthermic intraperitoneal chemotherapy (HIPEC) can cure selected patients with colorectal peritoneal metastases (CPM). Real-world prognostic data, especially for the Peritoneal Cancer Index (PCI) and completeness of cytoreduction (CCR), are limited. Methods: We retrospectively analysed 75 consecutive patients treated with CRS + HIPEC at a tertiary centre (2014–2022), giving ≥36 months potential follow-up. Overall survival (OS) was assessed by Kaplan–Meier and Cox models. PCI was grouped 0–10, 11–20, >20; CCR was dichotomised (CCR-0 vs. CCR 1/2). Multivariable analysis included PCI, CCR, and resection extent; HIPEC drug was examined univariately. Results: The median follow-up was 41 months. Crude 3-year OS was 50.7% (38/75). Survival decreased with higher PCI: 69% for 0–10 (n = 42), 38% for 11–20 (n = 21), and 0% for > 20 (n = 4). Versus PCI 0–10, the adjusted hazard ratios (HR) were 3.02 (95% CI 1.52–6.03) for PCI 11–20 and 7.29 (1.72–30.81) for > 20. CCR-0 improved OS univariately (HR 0.43) but was non-significant after adjustment (HR 0.89). Resection limited to the peritoneum (HR 0.99) and choice of intraperitoneal drug showed no independent effect. Conclusions: In this real-world cohort, PCI was the only independent predictor of 3-year survival after CRS + HIPEC for CPM; neither CCR status, surgical extent, nor HIPEC agent altered prognosis once PCI was considered. PCI should therefore remain the principal selection criterion while molecular and biological markers are integrated into future risk models.

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