Peritoneal carcinomatosis index as a predictor of diaphragmatic involvement in stage III and IV ovarian cancer

Abstract

ObjectiveTo analyze the surgical outcomes and diaphragmatic involvement in stage III and IV ovarian cancer.Patients and methodsAll patients with stage III–IV ovarian cancer between January 2013 and January 2016 were included. The outcomes of interest reviewed were as follows: surgical (complications, mortality), peritoneal carcinomatosis index (PCI), rate of complete resection, and disease-free interval and survival.ResultsFifty-seven patients were included, 38 (67%) with diaphragmatic involvement; in 10 cases (18%), diaphragmatic resection was required. Optimal cytoreduction (OCR) was obtained in 49 cases (86%). The PCI was >10 in 31 cases (54%). Respiratory complications occurred in 10 cases (18%) and mortality in 3 (5%). Disease-free survival rate in 3 years was 53%, being 87% in cases without diaphragmatic involvement. The overall survival rate in 3 years is 46%, 83% in the cases without diaphragmatic involvement and 27% in cases with affectation (p<0.05). In cases of OCR, 3 year survival rate was 65%. In the multivariate analysis for the overall survival of cases with OCR, the only independent prognostic factor found was the operative PCI. A strong correlation was found between the total PCI and the diaphragmatic PCI (p<0.001). With a PCI >10, virtually all cases will present diaphragmatic involvement (p<0.05).ConclusionThe tumor burden is different in stages III and IV of advanced ovarian cancer and the PCI is an effective method to quantify it. The PCI constitutes an independent prognostic factor for the advanced stages of ovarian cancer. A PCI >10 constitutes a useful prognostic factor of the affectation and forces the surgeon to thoroughly review both diaphragms.

Validation of three predictive models for suboptimal cytoreductive surgery in advanced ovarian cancer

“…Surgical techniques of the upper abdomen have been used to achieve cytoreduction percentages greater than 47%, and their use is related to an increase in the cytoreduction rate but possibly also to an increase in morbidity 19 , 20 . Establishing a balance between optimal cytoreduction and the number of complications constitutes the key point in the current situation for surgical teams specializing in advanced ovarian cancer surgery.…”

<p>Chemokine Ligand 5 to Predict Optimal Cytoreduction in Ovarian Cancer</p>

“…One of the main objectives of surgical treatment is to predict whether the surgical team will be able to perform optimal cytoreduction. 8 Higher CCL5 levels are associated with lower histological differentiation, higher tumor invasion depth, more frequent lymph node involvement, and higher tumor stage. 10 CCL5 is highly expressed and secreted by tumor and tumor stromal cells.…”

“…Several authors have used radiological modalities, CA125 tumor markers, laparoscopy, MRI, CT-Scan and peritoneal carcinomatosis index (PCI) as methods for predicting optimal surgical results. [6][7][8][9] Unfortunately, these studies have produced mixed outcomes, and whether outcomes depend more on patientor hospital-specific factors remain unknown.…”

Comparison of Peritoneal Carcinomatosis Scoring Methods in Predicting Resectability and Prognosis in Gynecologic Malignancies

“…Ovarian cancer is a significant cause of death from gynaecologic cancer, with 70-80% of cases diagnosed in advanced stages [1,2]. Complete primary debulking surgery is an independent survival factor [1,2] because the tumour residue's size is inversely related to overall survival [3,4].…”

“…Among the diagnostic methods, laparotomy continues to be the most accurate one to determine the burden of disease in patients. It is an invasive method of diagnosis with associated complications [1].…”