腹膜癌指数作为晚期卵巢癌初次及间隔性细胞减灭术中完全肿瘤减灭预测因素。

The peritoneal cancer index as a predictor of complete cytoreduction at primary and interval cytoreductive surgery in advanced ovarian cancer.

机构信息

Department of Gynaecological Oncology, The Royal Marsden NHS Foundation Trust, London, UK

Gynaecological Cancer Unit, St George's University Hospitals NHS Foundation Trust, London, UK.

出版信息

Int J Gynecol Cancer. 2023 Nov 6;33(11):1757-1763. doi: 10.1136/ijgc-2022-004093.

DOI:10.1136/ijgc-2022-004093

PMID:37890875

Abstract

OBJECTIVE

The peritoneal cancer index quantitatively assesses cancer distribution and tumor burden in the peritoneal cavity. The aim of this study is to evaluate the association between the peritoneal cancer index and completeness of surgical cytoreduction for ovarian cancer and to identify a cut-off above which complete cytoreduction is unlikely.

METHODS

This is a single-center prospective cohort observational study. A total of 100 consecutive patients who underwent ovarian cancer surgery were included. Peritoneal cancer index scores prior to and after surgery were calculated, and a cut-off value for incomplete cytoreduction was identified using a receiver operator characteristic (ROC) curve. Surgical complexity, blood loss, length of surgery, and complications were analyzed and associations with the peritoneal cancer index score were evaluated.

RESULTS

The overall median peritoneal cancer index score was 9.5 (range 0-36). The median age of the patients was 61 years (range 24-85). The most common stage was III (13% stage II, 53% stage III, 34% stage IV) and the most common histologic sub-type was high-grade serous (76% high-grade serous, 8% low-grade serous, 5% clear cell, 4% serous borderline, 2% endometrioid, 2% adult granulosa cell, 2% adenocarcinoma, 1% carcinosarcoma). Complete cytoreduction was achieved in 82% of patients, with a median score of 9 (range 0-30). The remaining 18% had a median score of 28.5 (range 0-36). The best predictor of incomplete cytoreduction was the peritoneal cancer index score, with an area under the curve (AUC) of 0.928 (95% CI 0.85 to 1.00). ROC curve analysis determined a peritoneal cancer index cut-off score of 20. Major complications occurred in 15% of patients with peritoneal cancer index scores >20 and in 2.5% of patients with scores ≤20, which was statistically significant (p=0.014).

CONCLUSIONS

In our study we found that a peritoneal cancer index score of ≤20 was associated with a high likelihood of complete cytoreduction. Incorporating the peritoneal cancer index into routine surgical practice and research may impact treatment plans.

摘要

目的

腹膜癌指数定量评估了腹腔内的癌症分布和肿瘤负担。本研究旨在评估腹膜癌指数与卵巢癌手术减瘤术的完全程度之间的关系，并确定一个不太可能实现完全减瘤术的临界值。

方法

这是一项单中心前瞻性队列观察研究。共纳入 100 例连续接受卵巢癌手术的患者。计算手术前后的腹膜癌指数评分，并使用受试者工作特征（ROC）曲线确定不完全减瘤的截断值。分析手术复杂性、出血量、手术时间和并发症，并评估其与腹膜癌指数评分的关系。

结果

患者的总体中位腹膜癌指数评分为 9.5（范围 0-36）。患者的中位年龄为 61 岁（范围 24-85）。最常见的分期为 III 期（13%为 II 期，53%为 III 期，34%为 IV 期），最常见的组织学亚型为高级别浆液性（76%为高级别浆液性，8%为低级别浆液性，5%为透明细胞性，4%为浆液性交界性，2%为子宫内膜样，2%为成人颗粒细胞瘤，2%为腺癌，1%为癌肉瘤）。82%的患者实现了完全减瘤，中位腹膜癌指数评分为 9（范围 0-30）。其余 18%的患者中位腹膜癌指数评分为 28.5（范围 0-36）。不完全减瘤的最佳预测指标是腹膜癌指数评分，曲线下面积（AUC）为 0.928（95%置信区间 0.85-1.00）。ROC 曲线分析确定腹膜癌指数临界值为 20。腹膜癌指数评分>20 的患者中有 15%发生主要并发症，而评分≤20 的患者中仅有 2.5%发生主要并发症，差异具有统计学意义（p=0.014）。