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Research ArticleClinical Studies

Prognostic Value of Peritoneal Cancer Index After Complete Cytoreductive Surgery in Advanced Ovarian Cancer

MIHAELA ASP, SUSANNE MALANDER, JOHAN BENGTSSON, HANNA SARTOR and PAIVI KANNISTO
Anticancer Research May 2022, 42 (5) 2541-2551; DOI: https://doi.org/10.21873/anticanres.15732
MIHAELA ASP
1Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, Department of Clinical Science Lund, Skåne University Hospital, Lund University, Lund, Sweden;
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  • For correspondence: mihaela.asp@med.lu.se
SUSANNE MALANDER
2Division of Oncology, Department of Clinical Science Lund, Skåne University Hospital, Lund University, Lund, Sweden;
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JOHAN BENGTSSON
3Division of Medical Imaging and Physiology, Department of Clinical Science Lund, Skåne University Hospital, Lund University, Lund, Sweden;
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HANNA SARTOR
4Diagnostic Radiology, Department of Translational Medicine, Skåne University Hospital, Lund University, Lund, Sweden
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PAIVI KANNISTO
1Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, Department of Clinical Science Lund, Skåne University Hospital, Lund University, Lund, Sweden;
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Abstract

Background/Aim: Residual disease (RD) after primary debulking surgery (PDS) is a prognostic factor for survival in advanced ovarian cancer (AOC). This study aimed to examine whether the tumor extent affects overall survival (OS) and progression-free survival (PFS) in AOC patients treated with PDS. Patients and Methods: A total of 118 patients treated with PDS were included. Age, ECOG score, AOC International Federation of Gynecology and Obstetrics (FIGO) stage, CA-125, RD, peritoneal cancer index (PCI), preoperative imaging (CT-PCI) and macroscopic visualization at the surgery start (S-PCI) were analyzed. Tumor extent was quantified using the PCI, and by CT-PCI and S-PCI. Cox regression, Kaplan-Meier and receiver operating curves (ROC) were performed for survival analyses. Results: S-PCI correlated with both OS (1.067, 95%CI=1.018-1.119, p<0.007) and PFS. Patients exhibiting S-PCI≥18.5, adjusted to age, performance status, and RD, had a two-fold risk of dying (HR=2.070, 95%CI=1.061-4.038, p=0.033) compared those with PCI<18.5. CT-PCI correlated with OS in crude data (1.037, 95%CI=1.005-1.071, p=0.025), but this was not sustained in multivariate analyses. RD of any size doubled the risk of dying (2.177, 95%CI=1.235-3.838, p=0.007). Conclusion: The tumor extent at the beginning of surgery seemed to affect OS in patients with AOC, regardless of the extent of RD at the end of the surgery. PCI above 18.5 doubled the risk of dying of the disease. No difference in major complications was noted in the two groups of patients. CT-PCI seemed to play a prognostic role for PFS; however, it is still to be investigated as a prognostic factor for OS.

Key Words:
  • Advanced ovarian cancer
  • PCI
  • CT
  • complete cytoreductive surgery
  • overall survival
  • Received March 18, 2022.
  • Revision received March 30, 2022.
  • Accepted April 1, 2022.
  • Copyright © 2022 International Institute of Anticancer Research (Dr. George J. Delinasios), All rights reserved.
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Anticancer Research: 42 (5)
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May 2022
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Prognostic Value of Peritoneal Cancer Index After Complete Cytoreductive Surgery in Advanced Ovarian Cancer
MIHAELA ASP, SUSANNE MALANDER, JOHAN BENGTSSON, HANNA SARTOR, PAIVI KANNISTO
Anticancer Research May 2022, 42 (5) 2541-2551; DOI: 10.21873/anticanres.15732

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Prognostic Value of Peritoneal Cancer Index After Complete Cytoreductive Surgery in Advanced Ovarian Cancer
MIHAELA ASP, SUSANNE MALANDER, JOHAN BENGTSSON, HANNA SARTOR, PAIVI KANNISTO
Anticancer Research May 2022, 42 (5) 2541-2551; DOI: 10.21873/anticanres.15732
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Keywords

  • Advanced ovarian cancer
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  • complete cytoreductive surgery
  • overall survival
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