Peritoneal cancer index as a predictor of survival in advanced stage serous epithelial ovarian cancer: a prospective study

Elzarkaa, Alaa A; Shaalan, Waleed; El-Emam, Doaa; Mansour, Hassan; Melis, Mahmoud; Malik, Eduard; Soliman, Amr A.

doi:10.3802/jgo.2018.29.e47

Cited by 49 publications

(28 citation statements)

References 29 publications

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“…The second objective of our study was to identify additional prognostic factors of long-term survival, especially biological parameters that might characterize subgroups of LTS. Our results in the univariate analysis were in accordance with the standard prognostic factors usually reported, i.e., age, absence of a macroscopic residual disease after primary or interval cytoreductive surgery, and the extent of peritoneal disease (PCI) [ 8 , 9 , 34 , 35 , 36 ]. In previous studies, many attempts to identify a PCI threshold as a prognostic factor have been performed.…”

Section: Discussionsupporting

confidence: 88%

Conditional Probability of Survival and Prognostic Factors in Long-Term Survivors of High-Grade Serous Ovarian Cancer

Fabbro

Colombo

Leaha

et al. 2020

Cancers

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Objective: High-grade serous ovarian cancers (HGSOC) are heterogeneous, often diagnosed at an advanced stage, and associated with poor overall survival (OS, 39% at five years). There are few data about the prognostic factors of late relapses in HGSOC patients who survived ≥five years, long-term survivors (LTS). The aim of our study is to assess the probability of survival according to the already survived time from diagnosis. Methods: Data from HGSOC patients treated between 1995 and 2016 were retrospectively collected to estimate the conditional probability of survival (CPS), probability of surviving Y years after diagnosis when the patient had already survived X years, and to determine the LTS prognostic factors. The primary endpoint was OS. Results: 404 patients were included; 120 of them were LTS. Patients were aged 61 years (range: 20–89), WHO performance status 0–1 in 86.9% and 2 in 13.1%, and Fédération Internationale de Gynécologie et d’Obstétrique (FIGO) staging III and IV in 82.7% and 17.3% patients. Breast cancer (BRCA) status was available in 116 patients (33% mutated), including 58 LTS (36% mutated). No macroscopic residual disease was observed in 58.4% patients. First-line platinum-based chemotherapy plus paclitaxel was administered in 80.4% of patients (median: six cycles (range: 1–14)). After a 9 point 3-year follow-up, median OS was four years (95% CI: 3.6–4.5). The CPS at five years after surviving one year was 42.8% (95% CI: 35.3–48.3); it increased to 81.7% (95% CI: 75.5–87.8) after four survived years. Progression-free interval>18 months was the only LTS prognostic factor in the multivariable analysis (hazard ratio (HR) = 0.23; 95% CI: 0.13–0.40; p < 0.001). Conclusion: The CPS provided relevant and encouraging clinical information on the life expectancy of HGSOC patients who already survived a period of time after diagnosis. LTS prognostic factors are useful for clinicians and patients.

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Section: Discussionsupporting

confidence: 88%

Conditional Probability of Survival and Prognostic Factors in Long-Term Survivors of High-Grade Serous Ovarian Cancer

Fabbro

Colombo

Leaha

et al. 2020

Cancers

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“…An accurate description of the disease extension should have been made in both groups. There is evidence that the measurement of the amount of disease by PCI is a main prognostic factor regarding the indication of cytoreductive surgery and OS [11]. We do not know the number of patients with or without limited disease, neither the extent nor the amount in this study.…”

Section: Dear Editormentioning

confidence: 84%

Secondary surgical cytoreduction needs to be assessed taking into account surgical technique, completeness of cytoreduction, and extent of disease

et al. 2020

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Recent evidence suggested that secondary surgical cytoreduction followed by chemotherapy does not result in longer overall survival in patients with platinum-sensitive recurrent ovarian cancer. This statement is based on a phase III multicenter, randomized clinical trial that lacks a description of the surgical protocol, the surgical technique, and the surgical variables. In a study that evaluates surgical cytoreduction, it is mandatory to assess the grade of cytoreductive surgery achieved (Sugarbaker PH, Langenbeck's Arch Surg 384:576-87, 1999), the extent of disease using PCI (Peritoneal Cancer Index), the technique itself, and the existence of a multidisciplinary approach with extensive upper abdominal procedures in experienced centers

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“…Elzarkaa et al recruited 96 patients with advanced epithelial ovarian cancer. A peritoneal cancer index score cut-off value of 13 was calculated using a receiver operating characteristic curve (sensitivity and specificity 80.6%, 45.0%, respectively; p=0.050) 19. A multivariate analysis determined that suboptimal surgical cytoreduction was the only independent predictive factor for recurrence (OR 7.5, 95% CI 1.47 to 38.67, p=0.015).…”

Section: Discussionmentioning

confidence: 99%

Pre-operative serum CA125, peritoneal cancer index and intra-operative mapping score as predictors of surgical results in primary epithelial ovarian cancer

Muallem

Sehouli

Richter

et al. 2020

International Journal of Gynecological Cancer

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ObjectivePrediction of post-operative residual disease after ovarian cancer cytoreductive surgery remains a topic of interest to gynecologic oncologists. The aim of this study was to explore the correlation between serum CA125, peritoneal cancer index, and intra-operative mapping of ovarian cancer and their predictive value for post-operative outcome.MethodsA total of 70 patients with primary epithelial ovarian cancer, who underwent primary cytoreductive surgery at Charité, Berlin between January 2013 and February 2014 were included. In all patients, pre-operative CA125 values, intra-operative peritoneal cancer index, and intra-operative mapping of ovarian cancer were determined.ResultsUsing a receiver operating characteristic analysis, cut-off values for CA125, peritoneal cancer index, and intra-operative mapping of ovarian cancer score could be defined. Patients with pre-operative serum CA125 >600 U/mL had a three times higher risk for residual tumor after primary cytoreductive surgery (p=0.037). A peritoneal cancer index score >20 indicated a nine times increased risk for residual tumor (p=0.003). More than six affected abdominopelvic fields on the intra-operative mapping of ovarian cancer was associated with a 25 times higher risk of residual tumor after primary cytoreductive surgery (p≤0.05). The combination of all three values predicted residual tumor in up to 90% of patients.ConclusionWe found that pre-operative CA125 >600 U/mL, peritoneal cancer index >20, and intra-operative mapping of ovarian cancer score >6 could be used as predictors of complete tumor resection. The combination of all these three values predicted the incomplete resection of disease in up to 90% of patients even in experienced centers.

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Peritoneal cancer index as a predictor of survival in advanced stage serous epithelial ovarian cancer: a prospective study

Cited by 49 publications

References 29 publications

Conditional Probability of Survival and Prognostic Factors in Long-Term Survivors of High-Grade Serous Ovarian Cancer

Conditional Probability of Survival and Prognostic Factors in Long-Term Survivors of High-Grade Serous Ovarian Cancer

Secondary surgical cytoreduction needs to be assessed taking into account surgical technique, completeness of cytoreduction, and extent of disease

Pre-operative serum CA125, peritoneal cancer index and intra-operative mapping score as predictors of surgical results in primary epithelial ovarian cancer

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