Charif Khaled

Impact of the completeness of cytoreductive surgery on the prognostic role of the KELIM score in patients treated for ovarian peritoneal metastasis

The two major treatment related prognostic factors for peritoneal metastasis of ovarian cancer (PMOC) are chemosensitivity and completeness of cytoreduction (CC). Chemosensitivity can be assessed by the CA-125 elimination rate constant K (KELIM) score, based on CA-125 kinetics. CC is evaluated by residual macroscopic disease. The aim of this study was to evaluate the prognostic impact of KELIM score versus CC, in a population who underwent complete (CC-0) and near-complete (CC-1) debulking. Monocentric retrospective study including patients with primary PMOC treated with curative intent between January 2010 and December 2021. The Biomarker Kinetics website (CA-125 KELIM Calculator) was used to calculate the KELIM score. Univariate and multivariate analysis were performed to assess the impact of CC and KELIM score on PFS and OS. A total of 111 patients were included in the study. Kaplan-Meier analysis showed that PFS and OS were significantly influenced by KELIM, CC, PCI, and BRCA mutation (p < 0.05). Multivariate Cox analysis showed that PFS was significantly influenced by CC (HR = 0.481, p = 0.0027), while OS was influenced by KELIM (HR 0.561, p = 0.0408). These results suggest that PFS is more impacted by the completeness of the surgery than the KELIM score and the KELIM score influences OS more than the completeness of surgery.

Assessment of the American College of Surgeons Surgical Risk Calculator (ACS-SRC) for Prediction of Early Postoperative Complications in Patients Undergoing Cytoreductive Surgery for Ovarian Peritoneal Carcinomatosis

Ovarian cancer (OC) is diagnosed at a locally advanced stage in two-thirds of cases. The first line of treatment consists of cytoreductive surgery (CRS) combined with neoadjuvant and/or adjuvant chemotherapy. However, CRS can be associated with high rates of postoperative complications (POCs), and detection of fragile patients at high risk of POCs is important. The American College of Surgeons Surgical Risk Calculator (ACS-SRC) provides a predictive model for early POCs (30 days) for any given surgical procedure. This study aimed to evaluate the performance of the ACS-SRC in predicting the occurrence of early POCs for patients undergoing CRS for OC. This was a retrospective study that included patients undergoing CRS for advanced OC between January 2010 and December 2022. Early POCs were reviewed, and the rate of POCs was compared with those predicted by the ACS-SRC to evaluate its accuracy (i.e., discrimination and calibration). A total of 218 patients were included, 112 of whom underwent extensive surgery/resection. A total of 94 complications were recorded. This cohort demonstrated correct calibration of the ACS-SRC for the prediction of surgical site infection, readmission, and the need for nursing care post-discharge (NCPD; transfer to revalidation center or need for nursing care at home). Using both the discrimination and calibration methods, the score only predicted NCPD. In this study, the ACS-SRC was shown to be of little value for patients undergoing cytoreductive surgery for ovarian peritoneal carcinomatosis, as it only accurately predicted NCPD.