Prognostic and Predictive Value of the Peritoneal Cancer Index in Primary Advanced Epithelial Ovarian Cancer Patients After Complete Cytoreductive Surgery: Study of Tumor Bank Ovarian Cancer

Ann Surg Oncol. 2015 Aug;22(8):2729-37. doi: 10.1245/s10434-014-4329-7. Epub 2015 Feb 12.


Purpose: The peritoneal cancer index (PCI) is used to refer gastrointestinal malignancy patients to either palliative or curative management of their peritoneal carcinomatosis. The aim of this retrospective study was to evaluate the prognostic value of the PCI in patients with primary advanced epithelial ovarian cancer (EOC) after complete cytoreductive surgery.

Methods: PCI quantitatively assesses cancer distribution on the peritoneum by calculating tumor sizes in each of 13 abdominopelvic regions. Correlation between PCI score and clinical factors were analyzed using Kendall's tau b. Univariate and multivariate survival analyses were performed with the Kaplan-Meier method and Cox regression model, respectively.

Results: We retrospectively enrolled 80 consecutive patients with primary EOC treated in our gynecology department. All patients underwent complete cytoreductive surgery. Patients whose history included interval tumor debulking and completion cytoreductive surgery were excluded. Most tumors were of a serous histological subtype (96.3 %). Median age at diagnosis was 58.0 years. Their median PCI score was 12.0 (range 3-32). We found statistical correlations between PCI and ascites (p = 0.001), surgery duration (p < 0.001), T status of TNM staging (p = 0.036), and preoperative CA 125 (p = 0.025). In the univariate analysis, higher PCI scores were related to poor overall (OS) and progression-free (PFS) survival rates (p = 0.036 and p < 0.001, respectively). Multivariate analysis showed that the association remained significant only for PFS (p = 0.005), not for OS (p = 0.162).

Conclusions: PCI did not portend OS in patients with primary ovarian cancer. Further prospective and multicenter studies are needed to validate these results.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Aged
  • Aged, 80 and over
  • Ascites / etiology
  • CA-125 Antigen / blood
  • Cytoreduction Surgical Procedures
  • Disease-Free Survival
  • Female
  • Humans
  • Kaplan-Meier Estimate
  • Middle Aged
  • Neoplasm Staging
  • Neoplasms, Glandular and Epithelial / secondary*
  • Operative Time
  • Ovarian Neoplasms / pathology*
  • Peritoneal Neoplasms / pathology*
  • Peritoneal Neoplasms / secondary
  • Peritoneal Neoplasms / surgery*
  • Predictive Value of Tests
  • Proportional Hazards Models
  • Retrospective Studies
  • Survival Rate
  • Tumor Burden


  • CA-125 Antigen