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The importance of the Peritoneal Cancer Index (PCI) to predict surgical outcome after neoadjuvant chemotherapy in advanced ovarian cancer
Purpose Achieving complete cytoreduction (CCR) is crucial for a patient’s prognosis with advanced epithelial ovarian cancer (EOC). So far, prognostic predictors have failed to predict surgical outcome after neoadjuvant chemotherapy (NACT). In clinical trials, scores were used to predict operability...
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| Published in: | Archives of gynecology and obstetrics 2022-11, Vol.306 (5), p.1665-1672 |
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| creator | Rawert, Friederike Luise Luengas-Würzinger, Veronica Claßen-Gräfin von Spee, Sabrina Baransi, Saher Schuler, Esther Carrizo, Katharina Dizdar, Anca Mallmann, Peter Lampe, Björn |
| description | Purpose
Achieving complete cytoreduction (CCR) is crucial for a patient’s prognosis with advanced epithelial ovarian cancer (EOC). So far, prognostic predictors have failed to predict surgical outcome after neoadjuvant chemotherapy (NACT). In clinical trials, scores were used to predict operability in recurrent ovarian cancer (Harter et al. in N Engl J Med 385(23):2123–2131, 2021) but there is no known prediction score for CCR after NACT. The Peritoneal Cancer Index (PCI) is an established tool to predict surgical outcome in primary setting (Lampe et al. in 25:135–144, 2015). We now examined the predictive power of the PCI to achieve CCR after NACT.
Methods
In this single-center study, the data of patients with advanced stage EOC (FIGO > IIIb) treated between 01/2015 and 12/2020 were analyzed retrospectively. Inclusion criteria were a mandatory staging laparoscopy, a PCI score > 25, and NACT. CT scans were analyzed in blinded fashion according to RECIST criteria (Borgani et al. in 237; 93–99, 2019) Reaction of PCI after NACT was compared with the analysis of radiologic imaging and CA-125 levels.
Results
Three hundred and sixteen patients were screened, 62 were treated with NACT, and 23 were included in our analysis. 87% of cases presented with an FIGO IIIc stadium. The reduction of PCI itself after NACT showed to be the most powerful predictor for achieving CCR. The reduction of the initial PCI score by minimum of 8.5 points was a better predictor for CCR than reaching a PCI |
| doi_str_mv | 10.1007/s00404-022-06527-y |
| format | article |
| fullrecord | <record><control><sourceid>proquest_pubme</sourceid><recordid>TN_cdi_pubmedcentral_primary_oai_pubmedcentral_nih_gov_9519707</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>2645858654</sourcerecordid><originalsourceid>FETCH-LOGICAL-c404t-8270a7e999233585082c68ba1b284fb017a250b7f3f610075daeb79843dab7d43</originalsourceid><addsrcrecordid>eNp9UU1v1DAUjBAVLYU_wAFZ4lIOKbYTx84FCa34WKlSeyhn68V2dr1K7GA7K_Yn8K9xuqW0HDjZfm_ezBtPUbwh-JJgzD9EjGtcl5jSEjeM8vLwrDgjdZWfnJDnj-6nxcsYdxgTKkTzojitWMU4E_Ss-HW7NciOkw8JnDLI9yjlyo0JNnlnYECrpR7Q2mnzE13crNbvUfJoCkZblVCcw8aqDPNzUn40CPqU0c540Lt5Dy4htTWjz6QBpgOyDoHeL5Qa-T0ECw6pO4VXxUkPQzSv78_z4vuXz7erb-XV9df16tNVqbLZVArKMXDTti2tKiYYFlQ1ogPSUVH3HSYcKMMd76u-WX6JaTAdb0Vdaei4rqvz4uORd5q70WhlXAowyCnYEcJBerDyacfZrdz4vWwZaTnmmeDiniD4H7OJSY42KjMMkF3PUdKmznuJhi1a7_6B7vwcXLYnKSeC15Q0JKPoEaWCjzGY_mEZguXiQR6TljlpeZe0POSht49tPIz8iTYDqiMg5pbbmPBX-z-0vwEyarYh</addsrcrecordid><sourcetype>Open Access Repository</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>2718742161</pqid></control><display><type>article</type><title>The importance of the Peritoneal Cancer Index (PCI) to predict surgical outcome after neoadjuvant chemotherapy in advanced ovarian cancer</title><source>Springer Nature</source><creator>Rawert, Friederike Luise ; Luengas-Würzinger, Veronica ; Claßen-Gräfin von Spee, Sabrina ; Baransi, Saher ; Schuler, Esther ; Carrizo, Katharina ; Dizdar, Anca ; Mallmann, Peter ; Lampe, Björn</creator><creatorcontrib>Rawert, Friederike Luise ; Luengas-Würzinger, Veronica ; Claßen-Gräfin von Spee, Sabrina ; Baransi, Saher ; Schuler, Esther ; Carrizo, Katharina ; Dizdar, Anca ; Mallmann, Peter ; Lampe, Björn</creatorcontrib><description>Purpose
Achieving complete cytoreduction (CCR) is crucial for a patient’s prognosis with advanced epithelial ovarian cancer (EOC). So far, prognostic predictors have failed to predict surgical outcome after neoadjuvant chemotherapy (NACT). In clinical trials, scores were used to predict operability in recurrent ovarian cancer (Harter et al. in N Engl J Med 385(23):2123–2131, 2021) but there is no known prediction score for CCR after NACT. The Peritoneal Cancer Index (PCI) is an established tool to predict surgical outcome in primary setting (Lampe et al. in 25:135–144, 2015). We now examined the predictive power of the PCI to achieve CCR after NACT.
Methods
In this single-center study, the data of patients with advanced stage EOC (FIGO > IIIb) treated between 01/2015 and 12/2020 were analyzed retrospectively. Inclusion criteria were a mandatory staging laparoscopy, a PCI score > 25, and NACT. CT scans were analyzed in blinded fashion according to RECIST criteria (Borgani et al. in 237; 93–99, 2019) Reaction of PCI after NACT was compared with the analysis of radiologic imaging and CA-125 levels.
Results
Three hundred and sixteen patients were screened, 62 were treated with NACT, and 23 were included in our analysis. 87% of cases presented with an FIGO IIIc stadium. The reduction of PCI itself after NACT showed to be the most powerful predictor for achieving CCR. The reduction of the initial PCI score by minimum of 8.5 points was a better predictor for CCR than reaching a PCI < 25. In contrast to data deriving from patients undergoing primary debulking surgery (PDS), we found a PCI of 17, rather than 25, to be a more valuable cut-off for CCR in neoadjuvant-treated patients.
Conclusion
The extend of PCI reduction after NACT is a better predictor for achieving CCR compared with CA125 levels and radiologic imaging. The PCI must be assessed differently in neoadjuvant setting than in a primary situation. CCR was most likely for a post-NACT PCI < 17.</description><identifier>ISSN: 1432-0711</identifier><identifier>ISSN: 0932-0067</identifier><identifier>EISSN: 1432-0711</identifier><identifier>DOI: 10.1007/s00404-022-06527-y</identifier><identifier>PMID: 35357582</identifier><language>eng</language><publisher>Berlin/Heidelberg: Springer Berlin Heidelberg</publisher><subject>CA-125 Antigen ; Carcinoma, Ovarian Epithelial - drug therapy ; Carcinoma, Ovarian Epithelial - surgery ; Chemotherapy ; Chemotherapy, Adjuvant - methods ; Cytoreduction Surgical Procedures - methods ; Endocrinology ; Female ; Gastric cancer ; Gynecologic Oncology ; Gynecology ; Human Genetics ; Humans ; Medicine ; Medicine & Public Health ; Neoadjuvant Therapy - methods ; Neoplasm Recurrence, Local - drug therapy ; Neoplasm Staging ; Obstetrics/Perinatology/Midwifery ; Ovarian cancer ; Ovarian Neoplasms - diagnostic imaging ; Ovarian Neoplasms - drug therapy ; Ovarian Neoplasms - surgery ; Peritoneal cancer ; Retrospective Studies ; Surgical outcomes ; Treatment Outcome</subject><ispartof>Archives of gynecology and obstetrics, 2022-11, Vol.306 (5), p.1665-1672</ispartof><rights>The Author(s) 2022</rights><rights>2022. The Author(s).</rights><rights>The Author(s) 2022. This work is published under http://creativecommons.org/licenses/by/4.0/ (the “License”). Notwithstanding the ProQuest Terms and Conditions, you may use this content in accordance with the terms of the License.</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c404t-8270a7e999233585082c68ba1b284fb017a250b7f3f610075daeb79843dab7d43</citedby><cites>FETCH-LOGICAL-c404t-8270a7e999233585082c68ba1b284fb017a250b7f3f610075daeb79843dab7d43</cites><orcidid>0000-0002-7679-1190</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>230,314,776,780,881,27901,27902</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/35357582$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Rawert, Friederike Luise</creatorcontrib><creatorcontrib>Luengas-Würzinger, Veronica</creatorcontrib><creatorcontrib>Claßen-Gräfin von Spee, Sabrina</creatorcontrib><creatorcontrib>Baransi, Saher</creatorcontrib><creatorcontrib>Schuler, Esther</creatorcontrib><creatorcontrib>Carrizo, Katharina</creatorcontrib><creatorcontrib>Dizdar, Anca</creatorcontrib><creatorcontrib>Mallmann, Peter</creatorcontrib><creatorcontrib>Lampe, Björn</creatorcontrib><title>The importance of the Peritoneal Cancer Index (PCI) to predict surgical outcome after neoadjuvant chemotherapy in advanced ovarian cancer</title><title>Archives of gynecology and obstetrics</title><addtitle>Arch Gynecol Obstet</addtitle><addtitle>Arch Gynecol Obstet</addtitle><description>Purpose
Achieving complete cytoreduction (CCR) is crucial for a patient’s prognosis with advanced epithelial ovarian cancer (EOC). So far, prognostic predictors have failed to predict surgical outcome after neoadjuvant chemotherapy (NACT). In clinical trials, scores were used to predict operability in recurrent ovarian cancer (Harter et al. in N Engl J Med 385(23):2123–2131, 2021) but there is no known prediction score for CCR after NACT. The Peritoneal Cancer Index (PCI) is an established tool to predict surgical outcome in primary setting (Lampe et al. in 25:135–144, 2015). We now examined the predictive power of the PCI to achieve CCR after NACT.
Methods
In this single-center study, the data of patients with advanced stage EOC (FIGO > IIIb) treated between 01/2015 and 12/2020 were analyzed retrospectively. Inclusion criteria were a mandatory staging laparoscopy, a PCI score > 25, and NACT. CT scans were analyzed in blinded fashion according to RECIST criteria (Borgani et al. in 237; 93–99, 2019) Reaction of PCI after NACT was compared with the analysis of radiologic imaging and CA-125 levels.
Results
Three hundred and sixteen patients were screened, 62 were treated with NACT, and 23 were included in our analysis. 87% of cases presented with an FIGO IIIc stadium. The reduction of PCI itself after NACT showed to be the most powerful predictor for achieving CCR. The reduction of the initial PCI score by minimum of 8.5 points was a better predictor for CCR than reaching a PCI < 25. In contrast to data deriving from patients undergoing primary debulking surgery (PDS), we found a PCI of 17, rather than 25, to be a more valuable cut-off for CCR in neoadjuvant-treated patients.
Conclusion
The extend of PCI reduction after NACT is a better predictor for achieving CCR compared with CA125 levels and radiologic imaging. The PCI must be assessed differently in neoadjuvant setting than in a primary situation. CCR was most likely for a post-NACT PCI < 17.</description><subject>CA-125 Antigen</subject><subject>Carcinoma, Ovarian Epithelial - drug therapy</subject><subject>Carcinoma, Ovarian Epithelial - surgery</subject><subject>Chemotherapy</subject><subject>Chemotherapy, Adjuvant - methods</subject><subject>Cytoreduction Surgical Procedures - methods</subject><subject>Endocrinology</subject><subject>Female</subject><subject>Gastric cancer</subject><subject>Gynecologic Oncology</subject><subject>Gynecology</subject><subject>Human Genetics</subject><subject>Humans</subject><subject>Medicine</subject><subject>Medicine & Public Health</subject><subject>Neoadjuvant Therapy - methods</subject><subject>Neoplasm Recurrence, Local - drug therapy</subject><subject>Neoplasm Staging</subject><subject>Obstetrics/Perinatology/Midwifery</subject><subject>Ovarian cancer</subject><subject>Ovarian Neoplasms - diagnostic imaging</subject><subject>Ovarian Neoplasms - drug therapy</subject><subject>Ovarian Neoplasms - surgery</subject><subject>Peritoneal cancer</subject><subject>Retrospective Studies</subject><subject>Surgical outcomes</subject><subject>Treatment Outcome</subject><issn>1432-0711</issn><issn>0932-0067</issn><issn>1432-0711</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2022</creationdate><recordtype>article</recordtype><recordid>eNp9UU1v1DAUjBAVLYU_wAFZ4lIOKbYTx84FCa34WKlSeyhn68V2dr1K7GA7K_Yn8K9xuqW0HDjZfm_ezBtPUbwh-JJgzD9EjGtcl5jSEjeM8vLwrDgjdZWfnJDnj-6nxcsYdxgTKkTzojitWMU4E_Ss-HW7NciOkw8JnDLI9yjlyo0JNnlnYECrpR7Q2mnzE13crNbvUfJoCkZblVCcw8aqDPNzUn40CPqU0c540Lt5Dy4htTWjz6QBpgOyDoHeL5Qa-T0ECw6pO4VXxUkPQzSv78_z4vuXz7erb-XV9df16tNVqbLZVArKMXDTti2tKiYYFlQ1ogPSUVH3HSYcKMMd76u-WX6JaTAdb0Vdaei4rqvz4uORd5q70WhlXAowyCnYEcJBerDyacfZrdz4vWwZaTnmmeDiniD4H7OJSY42KjMMkF3PUdKmznuJhi1a7_6B7vwcXLYnKSeC15Q0JKPoEaWCjzGY_mEZguXiQR6TljlpeZe0POSht49tPIz8iTYDqiMg5pbbmPBX-z-0vwEyarYh</recordid><startdate>20221101</startdate><enddate>20221101</enddate><creator>Rawert, Friederike Luise</creator><creator>Luengas-Würzinger, Veronica</creator><creator>Claßen-Gräfin von Spee, Sabrina</creator><creator>Baransi, Saher</creator><creator>Schuler, Esther</creator><creator>Carrizo, Katharina</creator><creator>Dizdar, Anca</creator><creator>Mallmann, Peter</creator><creator>Lampe, Björn</creator><general>Springer Berlin Heidelberg</general><general>Springer Nature B.V</general><scope>C6C</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>7X7</scope><scope>7XB</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>BENPR</scope><scope>CCPQU</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>K9.</scope><scope>M0S</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>7X8</scope><scope>5PM</scope><orcidid>https://orcid.org/0000-0002-7679-1190</orcidid></search><sort><creationdate>20221101</creationdate><title>The importance of the Peritoneal Cancer Index (PCI) to predict surgical outcome after neoadjuvant chemotherapy in advanced ovarian cancer</title><author>Rawert, Friederike Luise ; Luengas-Würzinger, Veronica ; Claßen-Gräfin von Spee, Sabrina ; Baransi, Saher ; Schuler, Esther ; Carrizo, Katharina ; Dizdar, Anca ; Mallmann, Peter ; Lampe, Björn</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c404t-8270a7e999233585082c68ba1b284fb017a250b7f3f610075daeb79843dab7d43</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2022</creationdate><topic>CA-125 Antigen</topic><topic>Carcinoma, Ovarian Epithelial - drug therapy</topic><topic>Carcinoma, Ovarian Epithelial - surgery</topic><topic>Chemotherapy</topic><topic>Chemotherapy, Adjuvant - methods</topic><topic>Cytoreduction Surgical Procedures - methods</topic><topic>Endocrinology</topic><topic>Female</topic><topic>Gastric cancer</topic><topic>Gynecologic Oncology</topic><topic>Gynecology</topic><topic>Human Genetics</topic><topic>Humans</topic><topic>Medicine</topic><topic>Medicine & Public Health</topic><topic>Neoadjuvant Therapy - methods</topic><topic>Neoplasm Recurrence, Local - drug therapy</topic><topic>Neoplasm Staging</topic><topic>Obstetrics/Perinatology/Midwifery</topic><topic>Ovarian cancer</topic><topic>Ovarian Neoplasms - diagnostic imaging</topic><topic>Ovarian Neoplasms - drug therapy</topic><topic>Ovarian Neoplasms - surgery</topic><topic>Peritoneal cancer</topic><topic>Retrospective Studies</topic><topic>Surgical outcomes</topic><topic>Treatment Outcome</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Rawert, Friederike Luise</creatorcontrib><creatorcontrib>Luengas-Würzinger, Veronica</creatorcontrib><creatorcontrib>Claßen-Gräfin von Spee, Sabrina</creatorcontrib><creatorcontrib>Baransi, Saher</creatorcontrib><creatorcontrib>Schuler, Esther</creatorcontrib><creatorcontrib>Carrizo, Katharina</creatorcontrib><creatorcontrib>Dizdar, Anca</creatorcontrib><creatorcontrib>Mallmann, Peter</creatorcontrib><creatorcontrib>Lampe, Björn</creatorcontrib><collection>Springer Nature OA Free Journals</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Central (Corporate)</collection><collection>ProQuest Health & Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>ProQuest Central (Alumni)</collection><collection>ProQuest Central UK/Ireland</collection><collection>ProQuest Central</collection><collection>ProQuest One Community College</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Health & Medical Collection (Alumni Edition)</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>MEDLINE - Academic</collection><collection>PubMed Central (Full Participant titles)</collection><jtitle>Archives of gynecology and obstetrics</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Rawert, Friederike Luise</au><au>Luengas-Würzinger, Veronica</au><au>Claßen-Gräfin von Spee, Sabrina</au><au>Baransi, Saher</au><au>Schuler, Esther</au><au>Carrizo, Katharina</au><au>Dizdar, Anca</au><au>Mallmann, Peter</au><au>Lampe, Björn</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>The importance of the Peritoneal Cancer Index (PCI) to predict surgical outcome after neoadjuvant chemotherapy in advanced ovarian cancer</atitle><jtitle>Archives of gynecology and obstetrics</jtitle><stitle>Arch Gynecol Obstet</stitle><addtitle>Arch Gynecol Obstet</addtitle><date>2022-11-01</date><risdate>2022</risdate><volume>306</volume><issue>5</issue><spage>1665</spage><epage>1672</epage><pages>1665-1672</pages><issn>1432-0711</issn><issn>0932-0067</issn><eissn>1432-0711</eissn><abstract>Purpose
Achieving complete cytoreduction (CCR) is crucial for a patient’s prognosis with advanced epithelial ovarian cancer (EOC). So far, prognostic predictors have failed to predict surgical outcome after neoadjuvant chemotherapy (NACT). In clinical trials, scores were used to predict operability in recurrent ovarian cancer (Harter et al. in N Engl J Med 385(23):2123–2131, 2021) but there is no known prediction score for CCR after NACT. The Peritoneal Cancer Index (PCI) is an established tool to predict surgical outcome in primary setting (Lampe et al. in 25:135–144, 2015). We now examined the predictive power of the PCI to achieve CCR after NACT.
Methods
In this single-center study, the data of patients with advanced stage EOC (FIGO > IIIb) treated between 01/2015 and 12/2020 were analyzed retrospectively. Inclusion criteria were a mandatory staging laparoscopy, a PCI score > 25, and NACT. CT scans were analyzed in blinded fashion according to RECIST criteria (Borgani et al. in 237; 93–99, 2019) Reaction of PCI after NACT was compared with the analysis of radiologic imaging and CA-125 levels.
Results
Three hundred and sixteen patients were screened, 62 were treated with NACT, and 23 were included in our analysis. 87% of cases presented with an FIGO IIIc stadium. The reduction of PCI itself after NACT showed to be the most powerful predictor for achieving CCR. The reduction of the initial PCI score by minimum of 8.5 points was a better predictor for CCR than reaching a PCI < 25. In contrast to data deriving from patients undergoing primary debulking surgery (PDS), we found a PCI of 17, rather than 25, to be a more valuable cut-off for CCR in neoadjuvant-treated patients.
Conclusion
The extend of PCI reduction after NACT is a better predictor for achieving CCR compared with CA125 levels and radiologic imaging. The PCI must be assessed differently in neoadjuvant setting than in a primary situation. CCR was most likely for a post-NACT PCI < 17.</abstract><cop>Berlin/Heidelberg</cop><pub>Springer Berlin Heidelberg</pub><pmid>35357582</pmid><doi>10.1007/s00404-022-06527-y</doi><tpages>8</tpages><orcidid>https://orcid.org/0000-0002-7679-1190</orcidid><oa>free_for_read</oa></addata></record> |
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| source | Springer Nature |
| subjects | CA-125 Antigen Carcinoma, Ovarian Epithelial - drug therapy Carcinoma, Ovarian Epithelial - surgery Chemotherapy Chemotherapy, Adjuvant - methods Cytoreduction Surgical Procedures - methods Endocrinology Female Gastric cancer Gynecologic Oncology Gynecology Human Genetics Humans Medicine Medicine & Public Health Neoadjuvant Therapy - methods Neoplasm Recurrence, Local - drug therapy Neoplasm Staging Obstetrics/Perinatology/Midwifery Ovarian cancer Ovarian Neoplasms - diagnostic imaging Ovarian Neoplasms - drug therapy Ovarian Neoplasms - surgery Peritoneal cancer Retrospective Studies Surgical outcomes Treatment Outcome |
| title | The importance of the Peritoneal Cancer Index (PCI) to predict surgical outcome after neoadjuvant chemotherapy in advanced ovarian cancer |
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