Aditi Bhatt1, Yutaka Yonemura2, Sanket Mehta3, Nazim Benzerdjeb4, Praveen Kammar3, Loma Parikh5, Aruna Prabhu6, Suniti Mishra7, Mita Shah8, Sakina Shaikh1, Vahan Kepenekian9, Isabelle Bonnefoy9, Mahesh D Patel1, Sylvie Isaac4, Olivier Glehen10,11. 1. Department of Surgical Oncology, Zydus Hospital, Ahmedabad, India. 2. Peritoneal Metastases Center, Kishiwada Tokushukai Hospital, Osaka, Japan. 3. Department of Surgical Oncology, Saifee Hospital, Mumbai, India. 4. Department of Pathology, Centre Hospitalier Lyon-sud, Lyon, France. 5. Department of Pathology, Zydus Hospital, Ahmedabad, India. 6. Department of Surgical Oncology, Thangam Cancer Centre, Nammakkal, India. 7. Department of Pathology, Fortis Hospital, Bangalore, India. 8. Department of Pathology, Saifee Hospital, Mumbai, India. 9. Department of Surgical Oncology, Centre Hospitalier Lyon-sud, Lyon, France. 10. Department of Surgical Oncology, Centre Hospitalier Lyon-sud, Lyon, France. olivier.glehen@chu-lyon.fr. 11. Hospices Civils de Lyon, Centre Hospitalier Lyon-sud, Lyon, Pierre Bénite, France. olivier.glehen@chu-lyon.fr.
Abstract
BACKGROUND: The surgical peritoneal cancer index (sPCI) is calculated based on a subjective evaluation of the extent of peritoneal disease during surgery. The pathologic PCI (pPCI) may be a more accurate and objective method for determining the PCI. This study aimed to compare the sPCI and pPCI and to study the potential pitfalls and clinical implications of using the pPCI. METHODS: This prospective study (July to December 2018) included all patients undergoing cytoreductive surgery (CRS). The pPCI was calculated for each patient and compared with the sPCI. The impact of potential confounding factors on the difference between pPCI and sPCI was evaluated. RESULTS: Among 191 patients undergoing CRS at four centers, the pPCI and sPCI were concordant for 37 patients (19.3%). The pPCI was lower than the sPCI for 125 patients (65.4%) and higher for 29 patients (15.1%). The concordance between the two groups was maximum for gastric cancer (38.8%) and colorectal cancer (27.6%) and least for mesothelioma (6.7%) and rare primary tumors (5.6%) (p = 0.04). The difference was 0 to 3 points for 119 patients (62.3%), 4 to 5 points for 27 patients (14.1%), and more than 5 points for 45 patients (23.5%). The rate of concordance was not influenced by the use of neoadjuvant chemotherapy (NACT) (p = 0.4), but the difference was greater when NACT was used (p = 0.03). CONCLUSIONS: The pPCI strongly differs from the sPCI for patients undergoing CRS for peritoneal disease and may provide a more accurate evaluation of the peritoneal disease extent. Further studies are needed to determine its prognostic value compared with sPCI, and consensus guidelines are needed for calculating it.
BACKGROUND: The surgical peritoneal cancer index (sPCI) is calculated based on a subjective evaluation of the extent of peritoneal disease during surgery. The pathologic PCI (pPCI) may be a more accurate and objective method for determining the PCI. This study aimed to compare the sPCI and pPCI and to study the potential pitfalls and clinical implications of using the pPCI. METHODS: This prospective study (July to December 2018) included all patients undergoing cytoreductive surgery (CRS). The pPCI was calculated for each patient and compared with the sPCI. The impact of potential confounding factors on the difference between pPCI and sPCI was evaluated. RESULTS: Among 191 patients undergoing CRS at four centers, the pPCI and sPCI were concordant for 37 patients (19.3%). The pPCI was lower than the sPCI for 125 patients (65.4%) and higher for 29 patients (15.1%). The concordance between the two groups was maximum for gastric cancer (38.8%) and colorectal cancer (27.6%) and least for mesothelioma (6.7%) and rare primary tumors (5.6%) (p = 0.04). The difference was 0 to 3 points for 119 patients (62.3%), 4 to 5 points for 27 patients (14.1%), and more than 5 points for 45 patients (23.5%). The rate of concordance was not influenced by the use of neoadjuvant chemotherapy (NACT) (p = 0.4), but the difference was greater when NACT was used (p = 0.03). CONCLUSIONS: The pPCI strongly differs from the sPCI for patients undergoing CRS for peritoneal disease and may provide a more accurate evaluation of the peritoneal disease extent. Further studies are needed to determine its prognostic value compared with sPCI, and consensus guidelines are needed for calculating it.
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