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. 2018 May 15:11:2771-2777.
doi: 10.2147/OTT.S147559. eCollection 2018.

Peritoneal carcinomatosis index as a predictor of diaphragmatic involvement in stage III and IV ovarian cancer

Antoni Llueca  1   2   3 , Anna Serra  1   2   3 , José Luis Herraiz  2 , Isabel Rivadulla  1   4 , Luis Gomez-Quiles  1   4 , Juan Gilabert-Estelles  5   6 , Javier Escrig  1   3   4
Affiliations

Peritoneal carcinomatosis index as a predictor of diaphragmatic involvement in stage III and IV ovarian cancer

Antoni Llueca et al. Onco Targets Ther. .

Abstract

Objective: To analyze the surgical outcomes and diaphragmatic involvement in stage III and IV ovarian cancer.

Patients and methods: All patients with stage III-IV ovarian cancer between January 2013 and January 2016 were included. The outcomes of interest reviewed were as follows: surgical (complications, mortality), peritoneal carcinomatosis index (PCI), rate of complete resection, and disease-free interval and survival.

Results: Fifty-seven patients were included, 38 (67%) with diaphragmatic involvement; in 10 cases (18%), diaphragmatic resection was required. Optimal cytoreduction (OCR) was obtained in 49 cases (86%). The PCI was >10 in 31 cases (54%). Respiratory complications occurred in 10 cases (18%) and mortality in 3 (5%). Disease-free survival rate in 3 years was 53%, being 87% in cases without diaphragmatic involvement. The overall survival rate in 3 years is 46%, 83% in the cases without diaphragmatic involvement and 27% in cases with affectation (p<0.05). In cases of OCR, 3 year survival rate was 65%. In the multivariate analysis for the overall survival of cases with OCR, the only independent prognostic factor found was the operative PCI. A strong correlation was found between the total PCI and the diaphragmatic PCI (p<0.001). With a PCI >10, virtually all cases will present diaphragmatic involvement (p<0.05).

Conclusion: The tumor burden is different in stages III and IV of advanced ovarian cancer and the PCI is an effective method to quantify it. The PCI constitutes an independent prognostic factor for the advanced stages of ovarian cancer. A PCI >10 constitutes a useful prognostic factor of the affectation and forces the surgeon to thoroughly review both diaphragms.

Keywords: advanced ovarian cancer; carcinomatosis; diaphragmatic involvement; peritoneal cancer index; upper abdominal surgery.

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Conflict of interest statement

Disclosure The authors report no conflicts of interest in this work.

Figures

Figure 1
Figure 1
Diaphragmatic peritonectomy.
Figure 2
Figure 2
Diaphragmatic reconstruction post-resection. Note: Diaphragm is reconstructed using interrupted sutures of long-lasting absorbable suture material. Before closing diaphragm (A) and after (B).
Figure 3
Figure 3
Diaphragmatic involvement: overall survival. Notes: Diaphragmatic involvement: 38 cases. Without diaphragmatic involvement: 19 cases.
Figure 4
Figure 4
Diaphragmatic involvement: 10 as the cut-off for the PCI. Notes: Prevalence of involvement: 67%. Sensitivity: 79% (95% CI: 63–90). Specificity: 95% (95% CI: 74–99). Positive predictive value: 97%. Negative predictive value: 69%. Discrimination (receiver operating characteristic area): 87%. Abbreviation: PCI, peritoneal cancer index.
Figure 5
Figure 5
Diaphragmatic resection: 10 as cut-off for PCI. Notes: Prevalence of resection: 18%. Sensitivity: 90% (95% CI: 56–99). Specificity: 53% (95% CI: 38–68). Positive predictive value: 29%. Negative predictive value: 96%. Discrimination (receiver operating characteristic area): 72%. Abbreviation: PCI, peritoneal cancer index.
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