腹膜癌指数作为细胞减灭术结果的预测指标及卵巢癌分布的热图分析：一项回顾性分析

The Peritoneal Cancer Index as a Predictor of Cytoreductive Surgery Outcomes and Heatmapping of Ovarian Cancer Distribution: A Retrospective Analysis.

作者信息

Ashmore Ayisha A, Al-Majali Joud, Chui Samantha Kimi, Addley Susan, Abdul Summi, Asher Viren, Bali Anish, Phillips Andrew

机构信息

Derby Gynaecological Cancer Centre, Department of Gynaecology, University Hospitals of Derby and Burton NHS Foundation Trust (UHDB), Royal Derby Hospital, Uttoxeter Road, Derby DE22 3NE, UK.

Royal Derby Hospital, School of Medicine, University of Nottingham, Nottingham NG7 2RD, UK.

出版信息

Cancers (Basel). 2025 Aug 27;17(17):2790. doi: 10.3390/cancers17172790.

DOI:10.3390/cancers17172790

PMID:40940887

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC12427369/

Abstract

OBJECTIVE

This study aimed to evaluate the association between the Peritoneal Cancer Index (PCI) and the completeness of cytoreductive surgery (CRS) in patients undergoing surgery for advanced ovarian cancer (AOC). Secondary objectives included identifying a PCI cut-off predictive of incomplete cytoreduction, assessing the relationship between PCI and surgical complexity via the Aletti Surgical Complexity Score (SCS), and exploring disease distribution to better understand ovarian cancer distribution.

METHODS

A retrospective review of 227 patients undergoing primary or interval debulking surgery for AOC from January 2017 to September 2024 at University Hospitals of Derby and Burton was conducted. PCI was recorded intra-operatively, and procedures were classified using the SCS. ROC analysis identified PCI thresholds for incomplete CRS, logistic regression predicted CRS outcomes, and heat mapping visualised disease distribution.

RESULTS

Complete CRS of visible disease (R0) was achieved in 90.75% of patients, while 9.25% had incomplete CRS. Median PCI was significantly higher in incomplete CRS cases (28, IQR 21-32) compared to complete CRS (15, IQR 8-23, < 0.001). ROC analysis identified a PCI threshold of 25.5 with 71.4% sensitivity and 83.5% specificity for predicting incomplete CRS. PCI > 25.5 increased the odds of incomplete cytoreduction by 12.65 times ( < 0.001). Higher PCI scores correlated with increased surgical complexity, operative time, and blood loss, though complication rates were similar. Heat maps showed stepwise disease distribution from pelvis to upper abdomen.

CONCLUSIONS

PCI is a reliable predictor of CRS completeness in AOC, with a threshold of >25.5 indicating a high risk of incomplete cytoreduction. The study underscores PCI's role in surgical planning and calls for multi-centre studies to validate these findings and further examine disease distribution.

摘要

目的

本研究旨在评估晚期卵巢癌（AOC）手术患者的腹膜癌指数（PCI）与肿瘤细胞减灭术（CRS）的彻底性之间的关联。次要目标包括确定预测肿瘤细胞减灭不彻底的PCI临界值，通过阿莱蒂手术复杂性评分（SCS）评估PCI与手术复杂性之间的关系，以及探究疾病分布情况以更好地了解卵巢癌的分布。

方法

对2017年1月至2024年9月在德比和伯顿大学医院接受AOC初次或间歇性肿瘤细胞减灭术的227例患者进行回顾性研究。术中记录PCI，并使用SCS对手术进行分类。ROC分析确定肿瘤细胞减灭不彻底的PCI阈值，逻辑回归预测CRS结果，热图显示疾病分布。

结果

90.75%的患者实现了可见病灶的完全CRS（R0），而9.25%的患者CRS不彻底。与完全CRS（15，IQR 8 - 23，<0.001）相比，CRS不彻底病例的PCI中位数显著更高（28，IQR 21 - 32）。ROC分析确定预测肿瘤细胞减灭不彻底的PCI阈值为25.5，敏感性为71.4%，特异性为83.5%。PCI>25.5使肿瘤细胞减灭不彻底的几率增加12.65倍（<0.001）。较高的PCI评分与手术复杂性增加、手术时间延长和失血量增加相关，尽管并发症发生率相似。热图显示疾病从盆腔到上腹部呈逐步分布。