title: Survival prognostic factors in patients with colorectal peritoneal carcinomatosis treated with cytoreductive surgery and intraoperative hyperthermic intraperitoneal chemotherapy: a single institution experience.
abstract: OBJECTIVE
  The aim of this research was to examine overall (OS) and disease-free survival (DFS) in patients with colorectal peritoneal carcinomatosis (CRC-PC), treated with cytoreductive surgery (CRS) and intraoperative hyperthermic intraperitoneal chemotherapy (HIPEC), as well as to analyse factors of prognostic significance.
  
  
  METHODS
  We included 61 patients with pathological/and computerized tomography (CT) confirmation of CRC-PC, treated with CRS+HIPEC from 2005 to 2012. Peritoneal Cancer Index (PCI) score was used for quantitative assessment of the CRC-PC extent. We performed CRS following the Sugarbaker's principles in all patients with PCI ≤20 and only in 3/61 (4.92%) patients with PCI >20. HIPEC (oxaliplatin 410 mg/m(2) in 2000mL isotonic solution and 41?C) was performed using RanD Performer® HT perfusion system during 30-60 min. Cox proportional hazard regression was used to determine significant factors for OS and DFS.
  
  
  RESULTS
  The follow-up ranged from 1 to 83 months (median 22). Median OS was 51 months (95% confidence interval/ CI 22+). Median DFS for patients without residual disease (57/61, 93.44%) was 23 months (95% CI 16+). One-, 2- and 6-year OS (DFS) were 78.6% (68.3%), 58.7% (46.7%) and 50.5% (38.1%), respectively. By the end of the study, 55.74% of the patients were still alive. Cox multivariate analysis indicated PCI score as a parameter of highly prognostic significance for patients treated with CRS+HIPEC (p<0.001). Patients with PCI (13 (vs PCI ≥13) had significantly longer OS and DFS (p<0.001), also confirmed for PCI subcategories (PCI <7 vs 7≤ PCI <13 vs PCI ≥13). All patients with PCI <7 are still alive.
  
  
  CONCLUSIONS
  Our study indicates that CRS+HIPEC significantly improves the survival of CRC-PC patients. This treatment modality should be considered as the most suitable in well-selected patients with this disease.
authors.affiliation: Surgical Oncology Clinic, Institute for Oncology and Radiology of Serbia, Belgrade; 2School of Medicine, University of Belgrade, Belgrade, Serbia.
authors.forename: Srdjan
authors.initials: S
authors.lastname: Nikolic
authors.forename: Radan
authors.initials: R
authors.lastname: Dzodic
authors.forename: Milan
authors.initials: M
authors.lastname: Zegarac
authors.forename: Igor
authors.initials: I
authors.lastname: Djurisic
authors.forename: Dusica
authors.initials: D
authors.lastname: Gavrilovic
authors.forename: Vera
authors.initials: V
authors.lastname: Vojinovic
authors.forename: Milan
authors.initials: M
authors.lastname: Kocic
authors.forename: Nada
authors.initials: N
authors.lastname: Santrac
authors.forename: Petar
authors.initials: P
authors.lastname: Radlovic
authors.forename: Davorin
authors.initials: D
authors.lastname: Radosavljevic
authors.forename: Gordana
authors.initials: G
authors.lastname: Pupic
authors.forename: Aleksandar
authors.initials: A
authors.lastname: Martinovic
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000971:Antineoplastic Combined Chemotherapy Protocols; D002277:Carcinoma / Q000188:drug therapy / Q000473:pathology / Q000601:surgery*; D015179:Colorectal Neoplasms / Q000188:drug therapy / Q000473:pathology / Q000601:surgery*; D003131:Combined Modality Therapy; D018572:Disease-Free Survival; D006801:Humans; D006979:Hyperthermia, Induced; D007263:Infusions, Parenteral; D007430:Intraoperative Care; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000188:drug therapy / Q000601:surgery; D009944:Organoplatinum Compounds / Q000008:administration & dosage*; D000077150:Oxaliplatin; D010534:Peritoneal Neoplasms / Q000188:drug therapy / Q000473:pathology / Q000601:surgery*; D011379:Prognosis
chemical_list: D009944:Organoplatinum Compounds; D000077150:Oxaliplatin