Introduction: The maximum residual tumour size after surgery is the most important prognostic factor related to survival in advanced ovarian cancer. This parameter can be subjectively determined by the surgeon at the end of the operation and by a radiologist with a postoperative CT scan. CT scans after optimal cytoreduction can reveal residual/progressive disease in a significant percentage of patients, ranging from 21% to 49%. The aim of this study was to validate the PCI scale for the systematic reading of postoperative CT scans in patients with advanced ovarian cancer and to establish it as a new prognostic marker. Material and Methods: Patients with advanced ovarian cancer (FIGO II-IV), diagnosed between 2007 and 2019 in Hospital La Fe Valencia, in whom cytoreductive surgery was performed (achieving R0 or R1), and in whom a postoperative CT scan was performed between the third and eighth week post-surgery and prior to the start of chemotherapy, were included. Two different radiologists who specialised in gynaecological malignancy performed a blind analysis of the CT scans. They then read the images using the Peritoneal Carcinomatosis Index (PCI) scale, which divides the abdominopelvic cavity into 12 quadrants. Using the Qualitative Assessment (QA) scale, they established the presence or lack of tumour disease in each of these regions, with QA 1–2 being definitely/probably normal, QA 3 indeterminate and QA 4–5 probably/definitely metastatic. Results: This study included a cohort of 117 patients. The radiological study found measurable tumour disease in up to 49% of patients after optimal primary cytoreduction (R0 or R1). There was “substantial agreement” between the results of the two radiologists according to the Kappa analysis (0.624). Both radiologists’ (A and B) findings were related to a significant reduction in both disease-free survival (DFS) and overall survival (OS) in patients with residual disease in the CT scan (QA 4–5) versus those without macroscopic disease (QA 1–3) (p< 0.05). Conclusions: The finding of radiological tumour disease on a standardised and systematised postsurgical CT scan prior to the initiation of adjuvant chemotherapy is associated with the prognosis of patients with advanced ovarian cancer.
引言：手术后的最大残余肿瘤大小是影响晚期卵巢癌患者生存的最重要预后因素。该参数可由外科医生在手术结束时主观判断，也可由放射科医生通过术后CT扫描确定。在达到理想肿瘤细胞减灭术后，CT扫描可在相当比例（21%至49%）的患者中发现残留或进展性疾病。本研究旨在验证腹膜癌指数评分系统在晚期卵巢癌患者术后CT系统化阅片中的应用价值，并将其确立为新的预后标志物。材料与方法：研究纳入2007年至2019年间在瓦伦西亚拉菲医院确诊的晚期卵巢癌患者（FIGO分期II-IV期），所有患者均接受肿瘤细胞减灭术（达到R0或R1切除），并在术后第3至8周且开始化疗前接受CT检查。由两位妇科恶性肿瘤专科放射科医师对CT影像进行盲法分析，采用将腹盆腔划分为12个区域的腹膜癌指数评分系统，结合定性评估量表对各区域是否存在肿瘤病变进行判定：QA 1-2级为明确/可能正常，QA 3级为不确定，QA 4-5级为可能/明确转移。结果：本研究共纳入117例患者。放射学检查发现，在达到理想初次肿瘤细胞减灭术（R0或R1）后，高达49%的患者存在可测量肿瘤病灶。根据Kappa分析显示，两位放射科医师的评估结果具有"高度一致性"（0.624）。两位医师（A和B）的评估结果均表明：与CT扫描未见肉眼病变（QA 1-3级）的患者相比，存在残留病灶（QA 4-5级）患者的无病生存期和总生存期均显著缩短（p<0.05）。结论：在开始辅助化疗前，通过标准化、系统化的术后CT扫描发现放射学肿瘤病变，与晚期卵巢癌患者的预后密切相关。
肿瘤(癌症)患者之家