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PCI CRC HIPEC — SCE Medical Oncology MCQ

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ModerateGI CancersPCI CRC HIPECSCE Medical Oncology

A 58-year-old woman with CRC has peritoneal carcinomatosis confined to the pelvis (PCI score 8). She is otherwise fit with no extra-abdominal disease. The surgical team discusses CRS + HIPEC. What does the Peritoneal Cancer Index (PCI) predict?

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Correct answer: A — PCI (0-39) quantifies the extent and distribution of peritoneal disease — higher PCI predicts lower completeness of cytoreduction (CCR) and worse survival; PCI ≤20 for CRC generally allows meaningful cytoreduction; PCI >20 is associated with poor outcomes from CRS+HIPEC

The Peritoneal Cancer Index (Sugarbaker) divides the abdomen into 13 regions, scoring each 0-3 for tumour burden (total 0-39). In CRC peritoneal metastases, PCI is the strongest predictor of complete cytoreduction and survival after CRS+HIPEC. Generally: PCI ≤15-20 → reasonable outcomes from CRS+HIPEC; PCI >20 → diminishing returns. Completeness of Cytoreduction (CCR-0/1 = no visible disease or ≤2.5 mm residual) is the strongest predictor of OS. The PRODIGE 7 trial challenged the added value of HIPEC over CRS alone.

Reference: NICE; ESMO 2024 mCRC/Peritoneal Surface Malignancy; PRODIGE 7; Sugarbaker PCI