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Review
. 2021 Jul 1:13:5239-5249.
doi: 10.2147/CMAR.S277912. eCollection 2021.

Effective Strategies to Predict Survival of Colorectal Peritoneal Metastases Patients Eligible for Cytoreductive Surgery and HIPEC

Geert A Simkens  1   2 , Anne G W E Wintjens  3 , Koen P Rovers  1 , Simon W Nienhuijs  1 , Ignace H de Hingh  1   4
Affiliations
Review

Effective Strategies to Predict Survival of Colorectal Peritoneal Metastases Patients Eligible for Cytoreductive Surgery and HIPEC

Geert A Simkens et al. Cancer Manag Res. .

Abstract

Cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC), often combined with systemic therapy, can be offered to selected colorectal peritoneal metastases (PM) patients. However, clinical heterogeneity and the lack of high-level evidence challenges determination of the correct treatment strategy. This review aims to provide an overview of current strategies to predict survival of colorectal PM patients treated with CRS and HIPEC, guiding clinicians to select a suitable treatment-strategy and to inform patients about their prognosis. First, the prognostic relevance of several clinicopathological prognostic factors, such as extent of PM, location of primary tumor, histology type, and the presence of lymph node or liver metastases will be discussed. Subsequently, special attention will be given to recent developments in several aspects of tumor biology such as RAF/RAS mutations, circulating tumor DNA, immunoprofiling, and consensus molecular subtypes. Finally, currently available prognostic models to predict survival will be evaluated, concluding these models perform moderate to good, but most of them partly rely on intra-operative data. New insights in tumor biology, as well as the reliable assessment of extent of peritoneal disease by diffusion weighted MRI pose promising opportunities to establish an adequate and clinically meaningful preoperative prognostic model in the near future.

Keywords: colorectal neoplasms; cytoreductive surgery; hyperthermic intraperitoneal chemotherapy; peritoneal metastases; prognosis; survival.

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Conflict of interest statement

Prof. Dr. Ignace H de Hingh reports grants from La Roche Hoffman, and RanD Biotech, outside the submitted work. The authors report no other conflicts of interest in this work.

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