From the Guidelines
The life expectancy for patients with peritoneal carcinomatosis can range from 6 to 24 months without treatment, but with cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC), survival can be extended to 3-5 years or more in favorable cases, as seen in the PRODIGE 7 study 1. The primary cancer origin is a crucial prognostic factor, with appendiceal and colorectal origins generally having better outcomes than gastric or pancreatic origins.
- Treatment approaches, such as CRS combined with HIPEC, can substantially impact survival, with some studies showing improved outcomes for selected patients, as reported in the ESMO clinical practice guideline for diagnosis, treatment, and follow-up of metastatic colorectal cancer 1.
- The extent of peritoneal disease, measured by the Peritoneal Cancer Index, completeness of cytoreduction, patient's performance status, and response to systemic chemotherapy all influence prognosis, as noted in the ASCO guideline for treatment of metastatic colorectal cancer 1.
- Modern systemic chemotherapy regimens like FOLFOX, FOLFIRI, or gemcitabine-based combinations can provide modest survival benefits even when surgery isn't possible, as discussed in the ESMO consensus guidelines for management of patients with colon and rectal cancer 1.
- Age and comorbidities also play important roles in determining both treatment options and overall prognosis, highlighting the need for personalized treatment approaches.
- The most recent and highest quality study, the PRODIGE 7 study 1, found no difference in overall survival (OS) or relapse-free survival between patients treated with CRS plus HIPEC and those treated with CRS alone, but noted that 15% of patients with isolated colorectal peritoneal metastases experienced no disease progression in the 5 years following surgery, indicating that CRS may be a curative option for an appropriately selected subgroup of patients.
From the Research
Life Expectancy with Peritoneal Carcinomatosis
- The life expectancy for patients with peritoneal carcinomatosis varies depending on the primary cancer site and treatment approach.
- According to a study published in 2006 2, the mean and median overall survival times for patients with colorectal peritoneal carcinomatosis were 6.9 and 5.2 months, respectively.
- However, with cytoreductive surgery and hyperthermic intraperitoneal chemotherapy (HIPEC), the median survival time can be improved to 34 months 2.
- A 2019 study on gastric cancer with peritoneal carcinomatosis reported a median overall survival of 21.2 months, with 1-year and 3-year overall survival rates of 79.9% and 30.9%, respectively 3.
- Another study published in 2005 reported a median survival of 12 to 40 months for patients with peritoneal colorectal carcinomatosis treated with HIPEC 4.
- A 2014 study on cytoreductive surgery and HIPEC for peritoneal carcinomatosis reported 1-year and 3-year overall survival rates of 74.0% and 32.5% for colorectal carcinomatosis, and 89.4% and 29.3% for appendiceal carcinomatosis, respectively 5.
- A 2014 study on cytoreductive surgery and HIPEC for peritoneal carcinomatosis of colorectal and appendiceal origin reported a median overall survival of 20.2 months and a median progression-free survival of 16.4 months 6.
Factors Affecting Life Expectancy
- The extent of peritoneal disease, as measured by the Peritoneal Cancer Index (PCI), is a significant factor affecting overall survival, with higher PCI scores associated with poorer survival 3, 5.
- Complete cytoreduction and HIPEC can improve survival outcomes for patients with peritoneal carcinomatosis 2, 3, 4, 5, 6.
- Intraoperative blood transfusion and high estimated blood loss are associated with increased morbidity and poor survival 5.