• Jesus Esquivel, Andrew M Lowy, Maurie Markman, Terence Chua, Joerg Pelz, Dario Baratti, Joel M Baumgartner, Richard Berri, Pedro Bretcha-Boix, Marcello Deraco, Guillermo Flores-Ayala, Olivier Glehen, Alberto Gomez-Portilla, Santiago González-Moreno, Martin Goodman, Evgenia Halkia, Shigeki Kusamura, Mecker Moller, Guillaume Passot, Marc Pocard, George Salti, Armando Sardi, Maheswari Senthil, John Spilioitis, Juan Torres-Melero, Kiran Turaga, and Richard Trout.
• Department of Surgical Oncology, Cancer Treatment Centers of America, Philadelphia, PA, USA, jesusesquivel@yahoo.com.
• Ann. Surg. Oncol. 2014 Dec 1; 21 (13): 4195-201.

BackgroundExtensive clinical experience suggests that hyperthermic intraperitoneal chemotherapy (HIPEC) may play an important role in the management of colorectal cancer patients with peritoneal carcinomatosis (CRCPC). However, there remains no established nonsurgical process to rationally select patients for this management, either for inclusion/stratification in clinical trials or as a component of standard of care. The Peritoneal Surface Disease Severity Score (PSDSS) was introduced as a basis to improve patient selection.MethodsThe American Society of Peritoneal Surface Malignancies conducted a retrospective review of 1,013 CRCPC patients. The PSDSS was evaluated on 3 specific criteria obtained before surgery (symptoms, extent of peritoneal dissemination, and primary tumor histology). Overall survival was analyzed according to four tiers of disease severity, and a comparison was made between patients who underwent cytoreductive surgery + HIPEC and those who did not.ResultsThe PSDSS was calculated on 884 patients (87 %). The median survival of 275 patients not undergoing CRS/HIPEC based on their PSDSS-I (n = 8), II (n = 80), III (n = 55), and IV (n = 132)-was 45, 19, 8, and 6 months, respectively. The median survival of 609 patients who underwent CRS/HIPEC based on their PSDSS-I (n = 75), II (n = 317), III (n = 82), and IV (n = 135)-was 86, 43, 29, and 28 months, respectively.ConclusionsThese data support that the PSDSS, undertaken before surgery, is capable of defining CRCPC populations who have a statistically defined high or considerably lower likelihood of long-term survival after CRS/HIPEC. The PSDSS can be quite useful in the decision to enter CRCPC patients into, and their stratification within, clinical trials.

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