Preoperative Immunonutritional Scores as Predictors of Mortality and Recurrence in Patients with Peritoneal Carcinomatosis Secondary to Serous Ovarian Cancer Undergoing Cytoreductive Surgery and HIPEC

Yıl 2025, Cilt: 47 Sayı: 6, 900 - 907, 26.09.2025

Yavuz Selim Angın , Orkhan Ulfanov , Elçin Telli , Elif Gündoğdu , Cengiz Ceylan , Akile Zengin , Mehmet Kılıç , Murat Ulaş

https://doi.org/10.20515/otd.1744552

Öz

Hyperthermic intraperitoneal chemotherapy (HIPEC) combined with cytoreductive surgery (CRS) has become an increasingly preferred treatment for women with ovarian cancer presenting with peritoneal involvement. However, due to the high morbidity of HIPEC, accurate preoperative patient selection is essential. This study aimed to evaluate the prognostic value of immunonutritional indices—CALLY (C-reactive protein, albumin, lymphocyte) and Prognostic Nutritional Index (PNI)—in predicting early mortality and recurrence in patients undergoing CRS and HIPEC. A retrospective analysis was conducted on 49 female patients. Low CALLY (<0.55) and PNI (<49) values were significantly associated with worse early mortality and disease-free survival (DFS). In receiver operating characteristic (ROC) analyses, CALLY and PNI showed strong predictive power with AUC values of 0.882 and 0.914, respectively. Kaplan-Meier survival curves demonstrated significantly reduced 3- and 6-month survival rates in patients with low scores.In conclusion, CALLY and PNI are easy-to-calculate, cost-effective, and clinically practical biomarkers that may improve patient selection for CRS and HIPEC and support the development of personalized perioperative care protocols.

Anahtar Kelimeler

Ovarian cancer , Cytoreduction , HIPEC , Peritoneal carcinomatosis , Immunonutritional scores , CALLY.

Sitoredüktif Cerrahi ve HİPEK Uygulanan Seröz Over Kanserine Sekonder Peritoneal Karsinomatozisli Hastalarda Preoperatif İmmünonütrisyonel Skorların Erken Mortalite ve Nüksü Öngörmedeki Rolü

Öz

Sıcak intraperitoneal kemoterapi (HIPEC) ve sitoredüktif cerrahi (CRS), peritoneal tutulumlu over kanserli kadınlarda giderek daha fazla kullanılan bir tedavi yöntemidir. Ancak HIPEC’in yüksek morbiditesi nedeniyle, doğru preoperatif hasta seçimi kritik önem taşımaktadır. Bu çalışma, immünonütrisyonel indeksler olan CALLY (C-reaktif protein, albümin, lenfosit) ve Prognostik Nutrisyonel İndeks (PNI)’in, HIPEC ve CRS uygulanan hastalarda erken mortalite ve nüks açısından prognostik değerini araştırmayı amaçlamaktadır. Retrospektif olarak değerlendirilen 49 kadın hastanın verileri incelenmiştir. Düşük CALLY (<0.55) ve PNI (<49) değerleri, erken mortalite ve hastalıksız sağkalımda (DFS) anlamlı kötüleşme ile ilişkilendirilmiştir. ROC analizlerinde CALLY için AUC 0.882, PNI için 0.914 olarak bulunmuş; her iki skor da çok değişkenli analizlerde bağımsız mortalite öngördürücüsü olarak saptanmıştır. Kaplan-Meier analizleri, düşük skorlu gruplarda 3 ve 6 aylık sağkalım oranlarının belirgin şekilde düşük olduğunu göstermiştir. Sonuç olarak, CALLY ve PNI gibi kolay hesaplanabilir ve maliyet etkin biyobelirteçler, CRS ve HIPEC uygulanacak hastaların seçiminde yardımcı olabilir ve kişiselleştirilmiş tedavi planlarının geliştirilmesine katkı sağlayabilir.

Anahtar Kelimeler

Over kanseri , Sitoredüksiyon , HİPEK , Peritoneal karsinmatoz , İmmünonutriyonel skorlar , CALLY.

Kaynakça

• 1.Kurman, R. J., & Shih, I. M. (2016). The Dualistic Model of Ovarian Carcinogenesis: Revisited, Revised, and Expanded. The American Journal of Pathology, 186(4), 733–747.
• 2. van Driel, W. J., Koole, S. N., Sikorska, K., Schagen van Leeuwen, J. H., Schreuder, H. W., Hermans, R. H., ... & Verwaal, V. J. (2018). Hyperthermic intraperitoneal chemotherapy in ovarian cancer. New England Journal of Medicine, 378(3), 230-240.
• 3. Iida, Hiroya, et al. "Superiority of CRP-albumin-lymphocyte index (CALLY index) as a non-invasive prognostic biomarker after hepatectomy for hepatocellular carcinoma." Hpb 24.1 (2022): 101-115.
• 4. Yang, Ming, et al. "Association between C-reactive protein-albumin-lymphocyte (CALLY) index and overall survival in patients with colorectal cancer: From the investigation on nutrition status and clinical outcome of common cancers study." Frontiers in Immunology 14 (2023): 1131496.
• 5. Angın, Yavuz Selim, et al. "Pancreatic Cancer and the Prognostic Value of the CALLY Index: A Comparative Analysis." Indian Journal of Surgery (2025): 1-7.
• 6. Sugarbaker, Paul H. "Peritonectomy procedures." Peritoneal carcinomatosis: a multidisciplinary approach (2007): 247-264.
• 7. Yu-chong Yang et al. "The prognostic nutritional index is a predictive indicator of prognosis and postoperative complications in gastric cancer: A meta-analysis.." European journal of surgical oncology : the journal of the European Society of Surgical Oncology and the British Association of Surgical Oncology, 42 8 (2016): 1176-82 .
• 8. Zhongtao Wang et al. "Pretreatment prognostic nutritional index as a prognostic factor in lung cancer: Review and meta-analysis.." Clinica chimica acta; international journal of clinical chemistry, 486 (2018): 303-310 .
• 9. Y. Geng et al. "Prognostic nutritional index predicts survival and correlates with systemic inflammatory response in advanced pancreatic cancer.." European journal of surgical oncology : the journal of the European Society of Surgical Oncology and the British Association of Surgical Oncology, 41 11 (2015): 1508-14 .
• 10. Y. Mohri et al. "Prognostic Nutritional Index Predicts Postoperative Outcome in Colorectal Cancer." World Journal of Surgery, 37 (2013): 2688-2692.
• 11. Feng, Z., Wen, H., Ju, X., Bi, R., Chen, X., Yang, W., & Wu, X. The preoperative prognostic nutritional index is a predictive and prognostic factor of high-grade serous ovarian cancer. BMC Cancer. 2018; 18.
• 12. Reece, Lauren, et al. "Preoperative nutrition status and postoperative outcomes in patients undergoing cytoreductive surgery and hyperthermic intraperitoneal chemotherapy." Annals of surgical oncology 26 (2019): 2622-2630.
• 13. Jónsdóttir, Björg, et al. "The peritoneal cancer index is a strong predictor of incomplete cytoreductive surgery in ovarian cancer." Annals of surgical oncology 28 (2021): 244-251.
• 14. Gremese, E., Bruno, D., Varriano, V., Perniola, S., Petricca, L., & Ferraccioli, G. Serum Albumin Levels: A Biomarker to Be Repurposed in Different Disease Settings in Clinical Practice. Journal of Clinical Medicine. 2023; 12.
• 15. Xie, Qin, Jian Ding, and Yi Chen. "Role of CD8+ T lymphocyte cells: Interplay with stromal cells in tumor microenvironment." Acta Pharmaceutica Sinica B 11.6 (2021): 1365-1378.
• 16. McSorley, S., Watt, D., Horgan, P., & McMillan, D. Postoperative Systemic Inflammatory Response, Complication Severity, and Survival Following Surgery for Colorectal Cancer. Annals of Surgical Oncology. 2016; 23.
• 17. Riedl, J., Barth, D., Brueckl, W., Zeitler, G., Foris, V., Mollnar, S., Stotz, M., Rossmann, C., Terbuch, A., Balić, M., Niedrist, T., Bertsch, T., Stoeger, H., Pichler, M., Olschewski, H., Absenger, G., Ficker, J., Gerger, A., & Posch, F. C-Reactive Protein (CRP) Levels in Immune Checkpoint Inhibitor Response and Progression in Advanced Non-Small Cell Lung Cancer: A Bi-Center Study. Cancers. 2020; 12.
• 18. Gearing, P., Hawke, J., Mohan, H., Heriot, A., Khan, A., Beaumont, A., Laing, E., & Waters, P. Perioperative nutritional assessment and interventions in patients undergoing cytoreductive surgery and hyperthermic intraperitoneal chemotherapy (HIPEC): A systematic review.. European journal of surgical oncology : the journal of the European Society of Surgical Oncology and the British Association of Surgical Oncology. 2023.
• 19. Florescu, D., Boldeanu, M., Șerban, R., Florescu, L., Serbanescu, M., Ionescu, M., Streba, L., Constantin, C., & Vere, C. Correlation of the Pro-Inflammatory Cytokines IL-1β, IL-6, and TNF-α, Inflammatory Markers, and Tumor Markers with the Diagnosis and Prognosis of Colorectal Cancer. Life. 2023; 13.