高腹膜癌指数是否会导致晚期卵巢癌患者预后更差？：基于最新证据的系统评价和荟萃分析

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.

作者信息

Wang Siyu, Liu Shaoxuan, Liu Fangyuan, Guo Ying, Han Fengjuan

机构信息

Department of Obstetrics and Gynecology, Heilongjiang University of Chinese Medicine, Harbin, Heilongjiang, China.

Department of Obstetrics and Gynecology, First Affiliated Hospital, Heilongjiang University of Chinese Medicine, Harbin, Heilongjiang, China.

出版信息

Front Oncol. 2024 Jul 2;14:1421828. doi: 10.3389/fonc.2024.1421828. eCollection 2024.

DOI:10.3389/fonc.2024.1421828

PMID:39015504

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC11249540/

Abstract

BACKGROUND

The newest clinical evidence that the relationship between the peritoneal cancer index (PCI) and the postoperative prognosis of advanced ovarian cancer patients remains controversial, and there are no large-sample and multicenter studies to clarify this matter. Therefore, in this paper, we used meta-analysis to systematically assess the postoperative prognostic value of PCI in subjects with advanced ovarian cancer to provide individualized treatment plans and thus improve the prognosis of patients.

METHODS

Literature on the correlation between PCI and the postoperative prognosis in subjects with advanced OC undergoing cytoreductive surgery (CRS) was searched in the Cochrane Library, Pubmed, Embase, and Web of Science from the database inception to April 20, 2023. The search was updated on February 28, 2024. We only included late-stage (FIGO stage: III-IV) patients who did not undergo neoadjuvant chemotherapy (NACT) or hyperthermic intraperitoneal chemotherapy (HIPEC). Afterwards, literature screening and data extraction were conducted using Endnote20 software. The literature quality was assessed using the Newcastle-Ottawa Scale (NOS). Lastly, statistical analysis was performed with STATA 15.0 software.

RESULTS

Five studies with 774 patients were included. The result indicated that patients with high PCI had a worse prognosis than those with low PCI. The combined hazard ratio was 2.79 [95%CI: (2.04, 3.82), p<0.001] for overall survival (OS) in patients with high PCI. Further subgroup analysis by the FIGO staging revealed that in stage III [HR: 2.61, 95%CI: (2.00, 3.40), p<0.001] and stage III-IV patients [HR: 2.69, 95%CI: (1.66, 4.36), p<0.001], a high PCI score was significantly associated with a worse prognosis. The PCI score had a greater impact on the OS of patients with higher stages. The combined hazard ratio was 1.89 [95%CI: (1.51, 2.36), p<0.001] for progression-free survival (PFS) in patients with high PCI.

CONCLUSION

PCI may be used as a postoperative prognosis indicator in patients with advanced OC on primary debulking surgery. High PCI indicates a worse prognosis. However, further research is warranted to confirm these findings.

SYSTEMATIC REVIEW REGISTRATION

https://www.crd.york.ac.uk/prospero/, identifier CRD42023424010.

摘要

背景

关于腹膜癌指数（PCI）与晚期卵巢癌患者术后预后之间的关系，最新临床证据仍存在争议，且尚无大样本多中心研究对此进行阐明。因此，本文采用荟萃分析系统评估PCI对晚期卵巢癌患者术后的预后价值，以提供个体化治疗方案，从而改善患者预后。

方法

在Cochrane图书馆、Pubmed、Embase和Web of Science数据库中检索自建库至2023年4月20日有关PCI与接受减瘤手术（CRS）的晚期卵巢癌患者术后预后相关性的文献。检索于2024年2月28日更新。我们仅纳入未接受新辅助化疗（NACT）或腹腔内热灌注化疗（HIPEC）的晚期（国际妇产科联盟（FIGO）分期：III - IV期）患者。之后，使用Endnote20软件进行文献筛选和数据提取。采用纽卡斯尔 - 渥太华量表（NOS）评估文献质量。最后，使用STATA 15.0软件进行统计分析。

结果

纳入5项研究，共774例患者。结果表明，PCI高的患者预后比PCI低的患者差。PCI高的患者总生存（OS）的合并风险比为2.79 [95%置信区间：（2.04，3.82），p < 0.001]。按FIGO分期进行的进一步亚组分析显示，在III期[风险比：2.61，95%置信区间：（2.00，3.40），p < 0.001]和III - IV期患者[风险比：2.69，95%置信区间：（1.66，4.36），p < 0.001]中，高PCI评分与较差的预后显著相关。PCI评分对更高分期患者的OS影响更大。PCI高的患者无进展生存（PFS）的合并风险比为1.89 [95%置信区间：（1.51，2.36），p < 0.001]。