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Prognostic value of peritoneal cancer index in primary advanced ovarian cancer

Published:November 23, 2017DOI:https://doi.org/10.1016/j.ejso.2017.11.003

      Abstract

      Background

      Effective tumor debulking is a major factor associated with a favorable prognosis in patients with advanced ovarian cancer (AOC). However, FIGO staging fails to take full account of the extent of the disease in the peritoneum, making it difficult to plan appropriate surgical treatment. In contrast, the peritoneal cancer index (PCI) can provide more detailed information about peritoneal spread.

      Method

      We evaluated the prognostic value of PCI and its association with clinicopathological features in patients with AOC. Data for 80 patients with AOC who underwent primary debulking surgery were analyzed retrospectively. PCI scores of 0–39 were calculated based on the sizes of lesions in 13 abdominopelvic regions, and patients were classified into three categories with scores of 1–10, 11–20, and >20, respectively. Clinicopathological features, including the presence of residual tumor after surgery and the incidence of postoperative complications, were assessed in relation to PCI score.

      Results

      PCI was significantly associated with suboptimal surgery and postoperative complications, as well as with preoperative CA125, ascites, prolonged surgery, FIGO stage, positive aortic lymph nodes, prolonged hospitalization, and number of visceral resections. Overall and disease-free survival was also associated with PCI, with an optimal cut-off value of 15. Multivariate analysis identified age, residual tumor, and PCI as independent prognostic factors for survival. A PCI >10 is positively associated with a poor prognosis in patients with AOC.

      Conclusion

      Given the importance of effective tumor debulking, PCI may provide important information for surgical planning in patients with AOC.

      Keywords

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      References

        • Llueca J.A.
        • Martinez-Ramos D.
        • Escrig-Sos J.
        • Torrella-Ramos A.
        • Herraiz J.L.
        • Serra A.
        • et al.
        Current status of ovarian cancer in the Spanish Province of Castellon. Prognostic factors in observed and relative survival. A population cancer registry-based study between 2004 and 2008.
        Prog Obstet Ginecol. 2014; 57: 405-412
        • Bristow R.E.
        • Tomacruz R.S.
        • Armstrong D.K.
        • Trimble E.L.
        • Montz F.J.
        Survival effect of maximal cytoreductive surgery for advanced ovarian carcinoma during the platinum era: a meta-analysis.
        J Clin Oncol. 2002; 20: 1248-1259
        • Chi D.S.
        • Eisenhauer E.L.
        • Zivanovic O.
        • Sonoda Y.
        • Abu-Rustum N.R.
        • Levine D.A.
        • et al.
        Improved progression-free and overall survival in advanced ovarian cancer as a result of a change in surgical paradigm.
        Gynecol Oncol. 2009; 114: 26-31
        • Goff Barbara A.
        • Matthews Barbara J.
        • Wynn Michelle
        • Muntz Howard G.
        • Lishner Denise M.
        • Baldwin Laura-Mae
        Ovarian cancer: patterns of surgical care across the United States.
        Gynecol Oncol. 2006; 103: 383-390
        • Jacquet P.
        • Sugarbaker P.H.
        Clinical research methodologies in diagnosis and staging of patients with peritoneal carcinomatosis. Peritoneal carcinomatosis: principles of management.
        Cancer Treat Res. 1996; 82: 359-374
        • Sugarbaker P.H.
        • Jablonski K.A.
        Prognostic features of 51 colorectal and 130 appendiceal cancer patients with peritoneal carcinomatosis treated by cytoreductive surgery and intraperitoneal chemotherapy.
        Ann Surg. 1995; 221: 124-132
        • Esquivel J.
        • Sticca R.
        • Sugarbaker P.
        • Levine E.
        • Yan T.D.
        • Alexander R.
        • et al.
        Cytoreductive surgery and hyperthermic intraperitoneal chemotherapy in the management of peritoneal surface malignancies of colonic origin: a consensus statement.
        Ann Surg Oncol. 2007; 14: 128-133
        • Petrillo M.
        • Vizzielli G.
        • Fanfani F.
        • Gallotta V.
        • Cosentino F.
        • Chiantera V.
        • et al.
        Definition of a dynamic laparoscopic model for the prediction of incomplete cytoreduction in advanced epithelial ovarian cancer: Proof of a concept.
        Gynecol Oncol. 2015; 139: 5-9
        • Clavien P.A.
        • Sanabria J.R.
        • Strasberg S.M.
        Proposed classification of complications of surgery with examples of utility in cholecystecomy.
        Surgery. 1992; 111: 518-526
        • Eisenhauer E.A.
        • Therasse P.
        • Bogaerts J.
        • Schwartz L.H.
        • Sargent D.
        • Ford R.
        • et al.
        New response evaluation criteria in solid tumours: revised RECIST guideline (version 1.1).
        Eur J Cancer. 2009; 45: 228-247
        • Neijt J.
        Ovarian cancer: rethinking prognostic factors and chemotherapy.
        ASCO Educational Book, 1994: 214-220
        • Sebbag G.
        • Sugarbaker P.
        Peritoneal mesothelioma proposing for a staging system.
        EJSO. 2001; 27: 223-224
        • Sugarbaker P.
        • Chang D.
        • Koslowe P.
        Prognostic features for peritoneal carcinomatosis in colorectal and appendiceal cancer patients when treated by cytoreductive surgery and intraperitoneal chemotherapy.
        in: Sugarbaker P.H. Peritoneal carcinomatosis: drugs and diseases. Kluwer Academic Publishers, Boston1996: 8-104
        • Villeneuve L.
        • Thivolet A.
        • Bakrin N.
        • Mohamed F.
        • Isaac S.
        • Valette P.J.
        • et al.
        A new internet tool to report peritoneal malignancy extent. Peritoneal malignancy stage evaluation (PROMISE) application.
        Eur J Surg Oncol. 2016; 42: 877-882
        • Glehen O.
        • Gilly F.N.
        • Boutitie F.
        • Bereder J.M.
        • Quenet F.
        • Sideris L.
        • et al.
        Toward curative treatment of peritoneal carcinomatosis from nonovarian origin by cytoreductive surgery combined with perioperative intraperitoneal chemotherapy: a multi-institutional study of 1,290 patients.
        Cancer. 2010; 116: 5608-5618
        • Tentes A.G.
        • Tripsiannis G.
        • Markakidis S.
        • Karanikiotis C.
        • Tzegas G.
        • Georgiadis G.
        • et al.
        Peritoneal cancer index: a prognostic indicator of survival in advanced ovarian cancer.
        EJSO. 2003; 29: 69-73
        • Makar A.P.
        • Baekelandt M.
        • Trope C.G.
        • Kristensen G.B.
        The prognostic significance of residual disease, FIGO substage, tumor histology, and grade in patients with FIGO stage III ovarian cancer.
        Gynecol Oncol. 1995; 56: 175-180
        • Wimberger P.
        • Lehmann N.
        • Kimmig R.
        • Burges A.
        • Meier W.
        • Du Bois A.
        • et al.
        Prognostic factors for complete debulking in advanced ovarian cancer and its impact on survival: an exploratory analysis of a prospectively randomized phase III study of the Arbeitsgemeinschaft Gynaekologische Onkologie Ovarian Cancer Study Group (AGO-OVAR).
        Gynecol Oncol. 2007; 106: 69-74
        • Cascales Campos P.
        • Gil J.
        • Parrilla P.
        Morbidity and mortality outcomes of cytoreductive surgery and hyperthermicintraperitoneal chemotherapy in patients with primary and recurrent advanced ovarian cancer.
        EJSO. 2014; 40: 970-975
        • Eisenkop S.M.
        • Spirtos N.M.
        • Friedman R.L.
        • Lin W.C.
        • Pisani A.L.
        • Perticucci S.
        Relative influences of tumor volume before surgery and the cytoreductive outcome on survival for patients with advanced ovarian cancer: a prospective study.
        Gynecol Oncol. 2003; 90: 390-396
        • Konigsrainer I.
        • Zieker D.
        • Glatzle J.
        • Lauk O.
        • Klimek J.
        • Symons S.
        • et al.
        Experience after 100 patients treated with cytoreductive surgery and hyperthermicintraperitoneal chemotherapy.
        World J Gastroenterol. 2012; 18: 2061-2066
        • Llueca J.A.
        • Herraiz J.L.
        • Catala C.
        • Serra A.
        • Rivadulla I.
        • Escrig J.
        • MUAPOS Working Group
        Effectiveness and safety of cytoreduction surgery in advanced ovarian cancer: initial experience at a university general hospital.
        J Clin Gynecol Obstet. 2015; 4: 251-257
        • Suidan R.
        • Leitao M.
        • Zivanovic O.
        • Gardner G.
        • Kara C.
        • Roche L.
        • et al.
        Predictive value of the Age-Adjusted Charlson Comorbidity Index on perioperative complications and survival in patients undergoing primary debulking surgery for advanced epithelial ovarian cancer.
        Gynecol Oncol. 2015; 138: 246-251
        • Suidan R.
        • Ramirez P.
        • Sarasohn D.
        • Teitcher J.
        • Iyer R.
        • Zhou O.
        • et al.
        A multicenter assessment of the ability of preoperative computed tomography scan and CA-125 to predict gross residual disease at primary debulking for advanced epithelial ovarian cancer.
        Gynecol Oncol. 2017; 145: 27-31
        • Bachmann C.
        • Bachmann R.
        • Fend F.
        • Wallwiener D.
        Incidence and impact of lymph node metastases in advanced ovarian cancer: implications for surgical treatment.
        J Cancer. 2016; 7: 2241-2246
        • Kyung J.
        • Jung-Yun L.
        • Jung Won Y.
        • Eun Ji N.
        • Sunghoon K.
        • Sang-Wun K.
        • et al.
        Role of systematic lymphadenectomy as part of primary debulking surgery for optimally cytoreduced advanced ovarian cancer: reappraisal in the era of radical surgery.
        Oncotarget. 2017; 8: 37807-37816