In Reply We thank Bhatt and colleagues for their interesting comments on our article. First, they consider the median baseline peritoneal cancer index (PCI) of 5 to be low. Importantly, the surgical baseline PCI was determined by laparoscopy in 74% of patients. Compared with laparotomy, laparoscopy may underestimate the PCI. This potential underestimation is reflected by the higher median PCI of 9 during cytoreductive surgery (CRS), which is similar to the PCI during CRS in recent Dutch multicenter cohort studies and other randomized clinical trials (eg, PRODIGE7) studying colorectal peritoneal metastases (CPM). Although this comparison suggests representative disease extent of our trial population, we agree that it could be valuable to compare the PCI between enrolled patients and patients not approached for trial participation. Because we did not analyze these data during phase 2, we aim to collect these during phase 3 to increase insight in the trial’s external validity.

中文翻译：

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CAIRO6试验对结直肠腹膜转移瘤治疗的新见解—回复

作为回复，我们感谢 Bhatt 及其同事对我们文章的有趣评论。首先，他们认为中位基线腹膜癌指数 (PCI) 为 5 较低。重要的是，74% 的患者通过腹腔镜检查确定了手术基线 PCI。与开腹手术相比，腹腔镜可能会低估 PCI。这种潜在的低估反映在细胞减灭术 (CRS) 期间较高的 PCI 中位数为 9，这与最近荷兰多中心队列研究和其他研究结直肠腹膜转移 (CPM) 的随机临床试验 (例如 PRODIGE7) 中的 CRS 期间的 PCI 相似. 虽然这种比较表明我们的试验人群具有代表性的疾病程度，但我们同意比较登记患者和未参加试验的患者之间的 PCI 可能是有价值的。