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,p< 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 (p< 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.
目的：本研究旨在评估晚期卵巢癌（AOC）手术患者腹膜癌指数（PCI）与肿瘤细胞减灭术（CRS）彻底性之间的关联。次要目标包括确定预测不完全肿瘤细胞减灭的PCI临界值、通过Aletti手术复杂性评分（SCS）评估PCI与手术复杂性的关系，并探索疾病分布以更好地理解卵巢癌的播散模式。方法：回顾性分析了2017年1月至2024年9月在德比和伯顿大学医院接受初次或间歇性肿瘤细胞减灭术的227例AOC患者。术中记录PCI，采用SCS对手术进行分类。通过ROC分析确定不完全CRS的PCI阈值，逻辑回归预测CRS结局，热力图可视化疾病分布。结果：90.75%的患者实现了肉眼可见病灶的完全切除（R0），9.25%为不完全切除。不完全CRS组的中位PCI值（28，IQR 21-32）显著高于完全CRS组（15，IQR 8-23，p<0.001）。ROC分析确定PCI阈值为25.5，预测不完全CRS的敏感度为71.4%，特异度为83.5%。PCI>25.5时不完全肿瘤细胞减灭的几率增加12.65倍（p<0.001）。较高的PCI评分与更高的手术复杂性、更长的手术时间和更多的失血量相关，但并发症发生率相近。热力图显示疾病从盆腔到上腹部的阶梯式分布。结论：PCI是预测AOC患者CRS彻底性的可靠指标，>25.5的阈值提示不完全肿瘤细胞减灭的高风险。本研究强调了PCI在手术规划中的价值，并呼吁开展多中心研究以验证这些发现并进一步探讨疾病分布规律。
肿瘤(癌症)患者之家