A Cohort Study to Decode the Application of Peritoneal Carcinomatosis Index in Predicting the Prognosis of Advanced Ovarian Malignancies

Abstract

Introduction: Peritoneal Carcinomatosis Index (PCI) is used to assess the extent of peritoneal cancer by dividing the peritoneal cavity into 13 well-defined regions and assessing the size of the largest tumour nodule in each region. Aim: To evaluate the imaging features of peritoneal carcinomatosis using Computed Tomography (CT) and Magnetic Resonance Imaging (MRI) and correlate it with diagnostic laparotomy. Also to To determine the prognostic significance of peritoneal carcinomatosis index calculated radiologically in predicting the outcome of advanced ovarian malignancies. Materials and Methods: This was a prospective cohort study conducted in Kilpauk Medical College, Chennai, Tamil Nadu, India, from July 2019 to December 2020. Total of 50 females between 18-80 years of age with advanced ovarian malignancies with peritoneal deposits underwent CT and MRI to calculate initial PCI. Then these patients underwent cytoreductive debulking after which final response was assessed. Followedup for a period of 1 year to assess the treatment response and to look for any complications. IBM Statistical Package for the Social Sciences (SPSS) version 22.0 software was used for statistical analysis. Descriptive analysis was carried out using mean and standard deviation for quantitative variables. Results: Fifty women were included with a mean age of 53.4 years. PCI calculated using CT and MRI showed strong correlation with laparoscopic PCI with correlation coefficient (r) of 0.984 and 0.988 respectively with a statistically significant p-value <0.001. Initial radiological PCI and cytoreduction showed strong correlation when analysed using ROC curve (Receiver Operating Characteristic curve) with an AUC (Area under the ROC Curve) of 0.933. With Youden index a cut-off value of 11 was derived under which patients had optimal cytoreduction and a better outcome. Radiological PCI showed good sensitivity (82.35%) and specificity (88.78) for predicting complications and it was found that patients with PCI >15 were at a higher risk for developing various complications. Conclusion: Radiological PCI strongly correlate with laparoscopic PCI and is a very strong predictor of disease outcome in advanced ovarian malignancies. It was found that patients with high PCI values had poor response to cytoreductive surgery and chemotherapy. So, high initial PCI values above 11 was indicative of poor patient prognosis.

Does a high peritoneal cancer index lead to a worse prognosis of patients with advanced ovarian cancer?: a systematic review and meta-analysis based on the latest evidence

“…After these steps, 16 studies remained for further analysis and their references were investigated. However, among these studies, 5 ( 7 , 17 – 20 ) did not provide acceptable outcome indicators, 3 ( 11 , 21 , 22 ) did not include HR values, 1 ( 23 ) was a conference abstract, and 2 ( 24 , 25 ) included patients who had undergone intermittent CRS. Consequently, these 11 papers were excluded as they did not meet the inclusion criteria.…”

“…Our study’s findings, along with a cohort study, emphasize the importance of PCI in predicting survival prognosis. High PCI values have been linked to adverse responses to CRS and chemotherapy, with a PCI score above 11 indicating a poorer prognosis ( 7 ) and significantly lower postoperative survival rates in advanced OC patients (P < 0.0253) ( 21 ). This suggests that a high PCI score is detrimental to OC patient survival, aligning with the consensus from numerous studies.…”

“…By utilizing the PCI score, it may be possible to evaluate the condition of OC patients and thus guide treatment options. In fact, the PCI has proven to be beneficial in assessing postoperative survival rates in individuals with advanced OC ( 7 – 10 ). Zhou et al ( 9 ).…”