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

Abstract

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.

Imaging ovarian cancer – from baseline characteristics to high-risk image factors

“…Of the 159 OC cases eligible for analysis, the distribution was as follows: 99 (60%) were classified as serous, 27 (16%) endometrioid, ten (6%) mucinous, seven (4%) clear-cell, and 12 (7%) undifferentiated/adenocarcinoma NOS, and four cases (2%) had missing information on histologic subtype in medical charts/pathology reports. As in a previously published paper on this OC cohort [ 5 ], due to the small number of cases and for purposes of clinical relevance, histological type and grade were combined into one variable with the following classification: high-grade serous tumors and endometroid tumors (all grades) were grouped, and all other histological types combined in one group (including serous type with low or unknown grade). Tumor grade was divided into low or high, with the previous intermediate grade classified as high grade.…”

“…A p -value < 0.05 was considered statistically significant. For sake of comparison, logistic and Cox regression analyses with CT-PCI in relation to the above stated outcomes were re-calculated and included in Table 2 together with CT short score, although previously published [ 5 ].…”

Prediction of Surgical Outcome in Advanced Ovarian Cancer by Imaging and Laparoscopy: A Narrative Review

“…The evaluation of the Peritoneal Cancer Index at the beginning of the surgery (laparotomy) was also investigated as a prognostic factor in ovarian cancer patients [ 68 , 69 , 77 , 98 , 99 ]. Several studies showed that a high CT-Peritoneal Cancer Index score is a predictor of surgical complications, lower disease-free survival and lower overall survival [ 84 , 99 , 100 , 101 ].…”

The role of computed tomography in the assessment of tumour extent and the risk of residual disease after upfront surgery in advanced ovarian cancer (AOC)

“…This matter suggests considering treatment options for the patient other than primary surgery [ 8 ]. Likewise, PCI estimation from a preoperative CT scan (CT-PCI) is not a component of standard guidelines for ovarian cancer diagnostics, but previous studies on CT-PCI in ovarian cancer have shown a significant relationship between CT-PCI and suboptimal surgery, postoperative complications and overall survival (OS) [ 9 , 10 ].…”