Prediction of suboptimal cytoreductive surgery in patients with advanced ovarian cancer based on preoperative and intraoperative determination of the peritoneal carcinomatosis index

Llueca, Antoni; Serra, Anna; Rivadulla, Isabel; Gómez, Luís Héctor Hernández; Escrig-Sos, Javier

doi:10.1186/s12957-018-1339-0

Cited by 55 publications

(49 citation statements)

References 25 publications

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“…Furthermore, we believe that patient outcome is particularly interesting to highlight and is likely more relevant than surgical findings as a standard of reference for imaging studies. Interestingly, CT-PCI can be used to preoperatively estimate the surgical challenges and postoperative complications in women with OC [8]. Also, Diaz et al have shown that peritoneal disease quantified by CT-PCI in advanced-stage ovarian cancer patients correlated with presurgical CA-125 levels and 5-year survival [9].…”

Section: Discussionmentioning

confidence: 99%

“…This is in line with our results, showing increasing CT-PCI to be significantly related to impaired OC-survival, even after adjustment for histological subtype and clinical stage. Previous studies [8,9] have addressed stage III and IV OC. However, we believe that it is important to include all OC stages since, in daily clinical practice, at the time of imaging, the clinical stage is unknown.…”

Section: Discussionmentioning

confidence: 99%

“…One of the most common findings is peritoneal metastases that can be evaluated with CT with an overall sensitivity of more than 90% (depending on anatomical site, lesion size, and radiologist experience) and with high specificity (around 80%) as compared to findings at surgery [4,5]. The Sugarbaker peritoneal carcinomatosis index (PCI) [6] allows a quantification of peritoneal metastases both surgically [7] and with imaging [5], and previous studies have reported that CT-PCI has the potential to help evaluate surgical outcome [8] and the 5-year survival probability in women with advanced ovarian cancer [9].…”

Section: Introductionmentioning

confidence: 99%

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Ovarian cancer subtypes and survival in relation to three comprehensive imaging parameters

et al. 2020

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Background: Ovarian cancer (OC) is usually detected in late clinical stages, and imaging at diagnosis is crucial. Peritoneal carcinomatosis (PC) and cardio phrenic lymph nodes (CPLN) are pathological findings of computed tomography (CT) and are relevant for surgical planning. Furthermore, mammographic breast density (BD) has shown an association with OC risk and might be prognostically relevant. However, it is not known if PC, CPLN, and BD are associated with aggressive OC subtypes and impaired OC survival. Herein, we investigated associations between three comprehensive image parameters and OC subtypes and survival. Methods: The Malmö Diet and Cancer Study is a prospective study that included 17,035 women (1991-1996). Tumor information on 159 OC and information on OC specific survival (last follow-up, 2017-12-31) was registered. The CT and mammography closest to diagnosis were evaluated (Peritoneal Carcinomatosis Index PCI, CPLN, and BD). Associations between CT-PCI, CPLN, and BD vs. clinical stage [stage I vs. advanced stage (II-IV), histological type/grade (high grade serous and endometrioid vs. other subtypes], and OC-specific survival were analyzed by logistic and Cox regression. Results: There was a significant association between higher CT-PCI score and advanced clinical stage (adjusted OR 1.26 (1.07-1.49)), adjusted for age at diagnosis and histological type/grade. Increasing CT-PCI was significantly associated with impaired OC specific survival (adjusted HR 1.04 (1.01-1.07)), adjusted for age at diagnosis, histological type/grade, and clinical stage. There was no significant association between PCI and histological type/ grade, nor between BD or CPLN vs. the studied outcomes. Conclusions: Image PCI score was significantly associated with advanced clinical stages and impaired OC survival. An objective approach (based on imaging) to scoring peritoneal carcinomatosis in ovarian cancer could help surgeons and oncologists to optimize surgical planning, treatment, and care.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Ovarian cancer subtypes and survival in relation to three comprehensive imaging parameters

et al. 2020

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“…Preoperative PCI restaging by both methods was performed by two radiologists independently including differences in statistical analysis to generate generalized values and compared with intraoperative evaluation. Patients were categorized by us according to the value of intraoperative PCI into three groups (PCI<10, 10<PCI<20, PCI>20), due to the complexity of achieving optimal cytoreduction in these cases of the prevalence of tumour process and the index of completeness of cytoreduction, which illustrated radicality intervention [8,9]. The research was carried out within the framework of the scientific work of the Department of Surgery No.…”

Section: Methodsmentioning

confidence: 99%

Magnetic Resonance Imaging With Diffuse Weighted Imaging and Computed Tomography With Intravenous Contrast in Staging of Disseminated Ovarian, Stomach, Colorectal Cancer

Четвериков

Zavoloka

Onyshchenko

et al. 2019

EUREKA: Health Sciences

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The aim of the research. Development and implementation of new methods for pre-operative staging of advanced ovarian, gastric and colorectal cancer to improve patient selection for cytoreductive surgery and increase its radicality. Materials and methods. Data from 120 patients with advanced ovarian cancer, 28 with advanced gastric cancer and 119 with advanced colorectal cancer were analyzed. Preoperative detection of the incidence of peritoneal carcinoma and the possibility of surgery in radical or cytoreductive volume performed by CT with intravenous contrast (72 patients with ovarian cancer, 17 patients with gastric cancer, and 69 patients with colorectal cancer), and MR T1 and T2, contrast-enhanced T1, and diffuse-weighted sequences (48 patients with ovarian cancer, 11 patients with gastric cancer, and 50 patients with colorectal cancer). Subsequently, preoperative and intraoperative assessment of the prevalence of the tumour process with peritoneal carcinoma index (PCI) by Sugarbaker was performed. Results. A statistically significant increase in the informativeness of the preoperative assessment of the incidence of tumour process in peritoneum and the presence of distant metastases using DWI / MRI compared with CT with intravenous contrast was determined. Patients from all groups were categorized according to the completeness index of cytoreduction achieved by preoperative staging and patient selection using DWI / MRI and CT. The use of DWI / MRI allowed to significantly reduce the number of suboptimal and non-optimal cytoreductive interventions. Conclusions. DWI / MRI has made it possible to significantly improve the preoperative incidence of advanced ovarian, gastric, and colorectal cancer compared to CT, predict the radicality of future surgery, and detect inoperable cases.

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“…Another way to characterize the tumor burden is through visual quanti cation of the tumor in the peritoneal cavity (PCI), rst described by Sugarbaker in 1998 for colorectal cancer [15,38,44]. A high peritoneal cancer index (PCI) indicates a worse surgical outcome and suggests considering other treatment options for the patient than primary surgery [10,22]. PCI in AOC has not been used outside clinical of studies.…”

Section: Introductionmentioning

confidence: 99%

The role of computed tomography in predicting peritoneal carcinomatosis and upfront surgery outcome in advanced ovarian cancer

M¹,

Malander²,

Wallengren³

et al. 2020

Preprint

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Background Epithelial ovarian cancer is usually diagnosed at advanced stages. To choose the best therapeutic approach, an accurate assessment of the tumor spread is crucial. This study aimed to determine whether numeric scoring, the amount of ascites, and the presence of cardiophrenic nodes (CPLNs) visualized by computed tomography (CT), can predict the tumor extent and improve the outcome of AOC upfront surgery. Methods This single center retrospective analysis of 194 patients diagnosed with AOC included 119 patients treated with upfront surgery at the Skåne University Hospital, Lund, Sweden, from January 2016 to December 2018. CT based peritoneal cancer index (PCI) scores, enlarged cardiophrenic lymph nodes (CPLNs), and the amount of ascites were correlated to the surgical PCI (S-PCI) and the completeness of the cytoreductive surgery.The patients were grouped according to the residual disease (RD) and the overall survival (OS) rates for the three groups were determined using Kaplan-Meier curves. Linear regression and the interclass correlation (ICC) analyses were used to determine the relationship between CT-PCI and S-PCI. Results The survival rate was significantly higher in patients with no macroscopic residual disease compared those with residual disease <10 mm (p<0.03) or residual disease ≥10 mm (p<0.005). S-PCI and large ascites volumes were correlated with the risk of suboptimal residual disease (for ascites > 1000 ml, OR 5.5626 (1.665-19.007) p<0.019; for S-PCI, OR 1.24 (1.141-1.348), p<0.001). CT-PCI, CA-125 level and CPLN were not predictive of the cytoreductive surgery results in the adjusted data to days from CT to operation and for ascites. CT-PCI correlated well to S-PCI ((95%) CI: 0.397 (0.252-0.541) p<0.001). Conclusions CT is a reliable tool for assessing the extent of the disease in AOC, but it has limitations in predicting surgical outcome. This study was unable to show an association between the CT-PCI and surgical outcome when the data were adjusted and ascites, CA-125 level, days between the CT examination to surgery and CPLN. Ascites volumes exceeding 1000 ml increased the risk of residual disease and thereby worse outcome. That certain areas (e.g., small bowel region) are particularly critical when evaluating surgical outcome using preoperative CT-PCI warrants further investigation.

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Prediction of suboptimal cytoreductive surgery in patients with advanced ovarian cancer based on preoperative and intraoperative determination of the peritoneal carcinomatosis index

Cited by 55 publications

References 25 publications

Ovarian cancer subtypes and survival in relation to three comprehensive imaging parameters

Ovarian cancer subtypes and survival in relation to three comprehensive imaging parameters

Magnetic Resonance Imaging With Diffuse Weighted Imaging and Computed Tomography With Intravenous Contrast in Staging of Disseminated Ovarian, Stomach, Colorectal Cancer

The role of computed tomography in predicting peritoneal carcinomatosis and upfront surgery outcome in advanced ovarian cancer

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