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Abstract
Introduction/Background Residual disease (RD) after primary debulking surgery (IDS) is a prognostic factor for survival in AOC. This study aims to examine if the tumor extent, affects overall survival (OS) and progression free survival (PFS) in AOC patients treated with PDS. Tumor extent was quantified by peritoneal cancer index (PCI), for preoperative imaging (CT-PCI) and for macroscopic visualisation at the surgery start (S-PCI).
Methodology 118 patients treated with PDS 2016–2018, were included in the cohort. Age, ECOG score, FIGO stage, CA-125, RD, CT-PCI, and S-PCI were analyzed. Cox-regression, Kaplan-Meier and Receiver Operating Curves (ROC) were performed for survival analyses.
A: unadjusted analysis evaluated each variable at a time. B: adjusted for age and ECOG, PCI-variable
Kaplan-Meier S-PCI <18.5 S-PCI ≥ 18.5 regarding OS
Results S-PCI correlated with both OS (1.067, (1.018–1.119); p<0.007) and PFS. Patients exhibiting S-PCI of 18.5 or higher, adjusted to age, performance status and RD, had a two-fold risk of dying (HR 2.070, 95%CI 1.061–4.038; p=0.033). CT-PCI correlated significantly with OS in crude data (1.037, (1.005–1.071); p=0.025), but this was not sustained in multivariate analyses. Patients with RD at any size had more than two times higher risk of dying compared to those without RD (2.177, (1.235–3.838); p=0.007).
Conclusion The tumor extent at the beginning of surgery seemed to affect OS in patients with AOC, regardless RD at the end of the surgery. PCI above 18.5 doubled the risk of dying of the disease. No difference in major complications were noted in the two groups of patients. CT-PCI seemed to play a prognostic role for PFS, however as a prognostic factor for OS, it is still to be investigated.