Ovarian cancer subtypes and survival in relation to three comprehensive imaging parameters

Hanna Sartor,Anna Kahn,Karin Jirström,Mihaela Asp,Päivi Kannisto,Jenny Brändstedt,Maria Bjurberg

doi:10.1186/s13048-020-00625-8

Hanna Sartor, Anna Kahn + Show 5 more

Open Access

https://doi.org/10.1186/s13048-020-00625-8

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Abstract

BackgroundOvarian cancer (OC) is usually detected in late clinical stages, and imaging at diagnosis is crucial. Peritoneal carcinomatosis (PC) and cardio phrenic lymph nodes (CPLN) are pathological findings of computed tomography (CT) and are relevant for surgical planning. Furthermore, mammographic breast density (BD) has shown an association with OC risk and might be prognostically relevant. However, it is not known if PC, CPLN, and BD are associated with aggressive OC subtypes and impaired OC survival. Herein, we investigated associations between three comprehensive image parameters and OC subtypes and survival.MethodsThe Malmö Diet and Cancer Study is a prospective study that included 17,035 women (1991–1996). Tumor information on 159 OC and information on OC specific survival (last follow-up, 2017-12-31) was registered. The CT and mammography closest to diagnosis were evaluated (Peritoneal Carcinomatosis Index PCI, CPLN, and BD). Associations between CT-PCI, CPLN, and BD vs. clinical stage [stage I vs. advanced stage (II-IV), histological type/grade (high grade serous and endometrioid vs. other subtypes], and OC-specific survival were analyzed by logistic and Cox regression.ResultsThere was a significant association between higher CT-PCI score and advanced clinical stage (adjusted OR 1.26 (1.07–1.49)), adjusted for age at diagnosis and histological type/grade. Increasing CT-PCI was significantly associated with impaired OC specific survival (adjusted HR 1.04 (1.01–1.07)), adjusted for age at diagnosis, histological type/grade, and clinical stage. There was no significant association between PCI and histological type/grade, nor between BD or CPLN vs. the studied outcomes.ConclusionsImage PCI score was significantly associated with advanced clinical stages and impaired OC survival. An objective approach (based on imaging) to scoring peritoneal carcinomatosis in ovarian cancer could help surgeons and oncologists to optimize surgical planning, treatment, and care.

Highlights

Ovarian cancer (OC) is usually detected in late clinical stages, and imaging at diagnosis is crucial
Radiological images illustrating peritoneal carcinomatosis, enlarged cardio phrenic lymph nodes (CPLN), and breast density is shown in Figs. 2 and 3
There was no association between computed tomography (CT)-peritoneal carcinomatosis index (PCI) and histologic type/grade (ORadj 1.02 (0.98–1.06), p = 0.434)

Summary

Introduction

Ovarian cancer (OC) is usually detected in late clinical stages, and imaging at diagnosis is crucial. Peritoneal carcinomatosis (PC) and cardio phrenic lymph nodes (CPLN) are pathological findings of computed tomography (CT) and are relevant for surgical planning. Mammographic breast density (BD) has shown an association with OC risk and might be prognostically relevant It is not known if PC, CPLN, and BD are associated with aggressive OC subtypes and impaired OC survival. Cardio phrenic lymph nodes (CPLN) are located above the abdominal cavity and diaphragm and are, by convention, considered radiologically positive if the short axis in the transaxial plane is ≥5 mm. How they should be handled in surgical care and their role in ovarian cancer prognosis have been debated [10, 11]. A recent paper (predominantly high grade serous OC) [10] indicated that there was a stronger correlation between CPLN positivity and peritoneal carcinomatosis of the upper abdomen (especially of the diaphragm) than between CPLN positivity and abdominal lymph node status, which makes the two parameters (CT-PCI and CPLN) interesting to study together

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