The Peritoneal Cancer Index is a Strong Predictor of Incomplete Cytoreductive Surgery in Ovarian Cancer

Jónsdóttir, Björg; Lomnytska, Marta; Poromaa, Inger Sundström; Silins, Ilvars; Stålberg, Karin

doi:10.1245/s10434-020-08649-6

Cited by 50 publications

(34 citation statements)

References 31 publications

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“…In their study 62% of patients with PCI above 24 had an unsatisfactory surgical outcome de ned as SCS. The authors conclude that neoadjuvant chemotherapy could be considered if the PCI is higher than 24 .Theis study just emphasizes the reasons underlying SCS but has no predictive value for SCS or open-close surgery [16].…”

Section: Discussionmentioning

confidence: 94%

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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Section: Discussionmentioning

confidence: 94%

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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“…However, a risk for disease upstaging as well as a documented risk of the abdominal wall metastasis and necessity for abdominal wall resection are arguments against laparoscopic evaluation of PCI [18,19]. We previously found that PCI evaluation is useful for assessment of operability and we identified a cut-off of !24 in relation with the risk for incomplete cytoreduction [13]. Additionally, pre-operative cancer antigen-125 > 600 U/mL, PCI >20 and intra-operative mapping of ovarian cancer score >6 are reported to be predictors of complete tumour resection, while the combination of all these three values predicted the incomplete resection of disease in up to 90% of patients [20].…”

Section: Discussionmentioning

confidence: 97%

“…PCI is widely used during the evaluation of the extent of colorectal carcinosis and prediction of surgical complexity [12]. Elevated PCI has been associated with higher FIGO stage, prolonged duration of surgery, an increased number of visceral resections, incomplete cytoreduction and postoperative complications [13,14]. PCI scoring is, however, to a lesser extent used by ovarian cancer surgeons and it is not fully known which baseline variables are the most important predictors for high-grade postoperative complications.…”

Section: Introductionmentioning

confidence: 99%

Peritoneal cancer index predicts severe complications after ovarian cancer surgery

Lomnytska

Karlsson

Jónsdóttir

et al. 2021

European Journal of Surgical Oncology

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Introduction: prediction and importance of severe postoperative complications after ovarian cancer surgery is a strong issue in patient selection and evaluation. Pre-and early peroperative predictors of severe 30-days postoperative complications (Clavien-Dindo class !3) after surgery for primary ovarian cancer are not fully established, neither their impact on patients' survival. Materials and methods: A prospective observational study included 256 patients with primary ovarian cancer FIGO stages IIB-IV, operated during 2009e2018 in a primary or interval debulking surgery setting. Patient variables were analysed in relation to severe postoperative complications (Clavien-Dindo class !3) and overall survival. Results: High-grade postoperative complications occurred in 24.2% patients. Class 3a complications were observed in 12.5% cases. High-grade complications class !3 were observed in 31.6% after primary debulking surgery compared to 12.2% after interval debulking surgery (p ¼ 0.0004). Peritoneal cancer index !21 and preoperative albumin concentration 33 g/L were independent predictors of high-grade complications. Peritoneal cancer index correlated with the surgical complexity score and completeness of cytoreduction. Increased peritoneal cancer index was a negative predictor of overall survival, but highgrade complications did not influence survival negatively. Conclusions: Peritoneal cancer index !21 was an independent predictor of high-grade complications after ovarian cancer surgery. Increased peritoneal cancer index also impacted overall survival negatively, but high-grade complications did not influence overall survival.

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“…The burden of peritoneal carcinomatosis determined by the PCI score [18] and the extent of cytoreduction achieved significantly influence the survival rates. Some studies have used PCI scores in identifying patients with limited peritoneal cancer indicating that those with a lesser PCI score could benefit more with the combined approach.…”

Section: Discussionmentioning

confidence: 99%

Phase 2 non-randomised trial of secondary cytoreduction and hyperthermic intraperitoneal chemotherapy in recurrent platinum-sensitive ovarian cancer

Raj¹,

Keerthi²,

Ramasamy³

et al. 2021

ecancer

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Background:The role of secondary cytoreduction with hyperthermic intraperitoneal chemotherapy (HIPEC) is not clearly defined in recurrent platinum-sensitive ovarian cancer (PSOC). There is a paucity of studies on secondary cytoreduction with HIPEC in PSOC from developing countries like India. This study was done to assess the feasibility and safety of secondary cytoreduction and HIPEC in recurrent PSOC.Methods: This was a prospective, non-randomised, open-label, phase 2 trial of secondary cytoreduction and HIPEC (Cisplatin 75 mg/m 2 43°C over 60 minutes) in patients with recurrent platinum-sensitive epithelial carcinoma of ovary/fallopian tube/peritoneum done in a tertiary cancer centre from February 2016 to August 2019. The primary outcome was to assess the overall survival (OS) and the secondary outcomes were to assess the progression-free survival (PFS) and toxicity.Results: Twenty-seven patients were screened and among them, 15 patients were included in this analysis with a median follow-up of 25 months. The mean cancer antigen (CA) 125 at the time of recurrence was 149 U/mL (range: 10-2,030 U/mL) and the median platinum-free interval was 21 months. The perioperative chemotherapy used was paclitaxel + carboplatin 53.3% (8/15), liposomal doxorubicin + carboplatin 40% (6/15) and none 6.5% (1/15). The median Peritoneal Carcinomatosis Index score was 8 (range: 3-25). The Clavien Dindo score was I, II and III in 6.7%, 26.7% and 13.3% patients, respectively. Recurrence was radiological and biochemical in 60% (9/15) and 7% (1/15), respectively. The most common site of recurrence was intra-abdominal (peritoneal). The median PFS and OS were 15 months (range: 0-34) and 26 months (range: 23-29), respectively. The grade 3 or 4 toxicity was 40%. Conclusion :Secondary cytoreduction with HIPEC is feasible and safe in recurrent PSOC. Conclusive evidence that secondary cytoreduction with HIPEC is essential awaits the results from ongoing randomised controlled trials.

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The Peritoneal Cancer Index is a Strong Predictor of Incomplete Cytoreductive Surgery in Ovarian Cancer

Cited by 50 publications

References 31 publications

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

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

Peritoneal cancer index predicts severe complications after ovarian cancer surgery

Phase 2 non-randomised trial of secondary cytoreduction and hyperthermic intraperitoneal chemotherapy in recurrent platinum-sensitive ovarian cancer

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