利用腹腔癌指数（PCI）通过影像评估输卵管-卵巢癌患者的非切除可能性——一项前瞻性多中心多模态研究（ISAAC研究）

Prediction of non-resectability in tubo-ovarian cancer patients using Peritoneal Cancer Index - A prospective multicentric study using imaging (ISAAC study)

GYNECOLOGIC ONCOLOGY

影响因子:4.1

分区:医学2区 Top / 妇产科学1区肿瘤学2区

发表日期:2024 Dec

作者: Patrícia Pinto, Francesca Moro, Juan Luis Alcázar, Sarah Alessi, Giacomo Avesani, Klára Benesova, Andrea Burgetova, Giuseppina Calareso, Valentina Chiappa, David Cibula, Anna Fagotti, Dorella Franchi, Filip Frühauf, Jiri Jarkovsky, Roman Kocian, Lukas Lambert, Martin Masek, Camilla Panico, Paola Pricolo, Giovanni Scambia, Jiri Slama, Antonia Carla Testa, Ailyn Mariela Vidal Urbinati, Julio Vara Garcia, Raffaella Vigorito, Daniela Fischerová

DOI: 10.1016/j.ygyno.2024.10.003

摘要

本研究旨在评估利用影像（超声、增强CT及全身弥散加权磁共振成像（WB-DWI/MRI））中的腹腔癌指数（PCI）在评估腹膜癌性腹腔转移及预测输卵管-卵巢癌患者非切除可能性中的表现。本研究为一项前瞻性多中心观察性研究。纳入所有疑似原发性卵巢/输卵管/腹膜癌症的患者，患者在术前接受超声、CT及WB-DWI/MRI（如有）。通过最优临界值（敏感性和特异性最接近）评估方法在预测非切除性方面的表现。预测非切除的金标准为手术后残留病灶>1厘米或手术不可行。利用组内相关系数（ICC）评估影像方法与手术探查在评估PCI评分部位的一致性。自2020年1月至2022年11月，共纳入242例患者。预测非切除的最佳PCI临界值为>12，此值的曲线下面积（AUC）最高，为0.87，其次为超声，临界值>10，AUC为0.81；WB-DWI/MRI，临界值>12，AUC为0.81；CT，临界值>11，AUC为0.74。ICC分析显示，超声与手术PCI具有极高的一致性（0.94），而CT和WB-DWI/MRI也具有较高的一致性（0.86和0.87）。由专家操作的超声在评估影像PCI时，与手术结果的符合度优于WB-DWI/MRI和CT。在预测非切除性方面，超声的表现不逊于CT，而其与WB-DWI/MRI的非劣性尚未得到证实。

Abstract

The aim was to evaluate the performance of the Peritoneal Cancer Index (PCI) using imaging (ultrasound, contrast-enhanced computed tomography (CT), and whole-body diffusion-weighted magnetic resonance imaging (WB-DWI/MRI) in assessing peritoneal carcinomatosis and predicting non-resectability in tubo-ovarian carcinoma patients.This was a prospective multicenter observational study. We considered all patients with suspected primary ovarian/tubal/peritoneal cancer who underwent preoperative ultrasound, CT, and WB-DWI/MRI (if available). The optimal cut off value for assessing the performance of the methods in predicting non-resectability was identified at the point at which the sensitivity and specificity were most similar. The reference standard to predict non-resectability was surgical outcome in terms of residual disease >1 cm or surgery not feasible. Agreement between imaging methods and surgical exploration in assessing sites included in the PCI score was evaluated using the Intraclass Correlation Coefficient (ICC).242 patients were included from January 2020 until November 2022. The optimal PCI cut-off for predicting non-resectability for surgical exploration was >12, which achieved the best AUC of 0.87, followed by ultrasound with a cut-off of >10 and AUC of 0.81, WB-DWI/MRI with a cut-off of >12 and AUC of 0.81, and CT with a cut-off of >11 and AUC of 0.74. Using ICC, ultrasound had very high agreement (0.94) with surgical PCI, while CT and WB-DWI/MRI had high agreement (0.86 and 0.87, respectively).Ultrasound performed by an expert operator had the best agreement with surgical findings compared to WB-DWI/MRI and CT in assessing radiological PCI. In predicting non-resectability, ultrasound was non-inferior to CT, while its non-inferiority to WB-DWI/MRI was not demonstrated.