DNA ploidy and S-phase fraction analysis in peritoneal carcinomatosis from ovarian cancer: correlation with clinical pathological factors and response to chemotherapy

Figures & data

Table 1 Tumor characteristics and surgical results for all patients

Characteristics	No of patients (%)
Ovarian cancer
Primary advanced	24 (45.3)
Recurrent	29 (54.7)
Histological typing
Serous	49 (92.5)
Mucinous	4 (7.5)
Results of cytoreduction
CC0	17 (32.1)
CC1	15 (28.3)
CC2	7 (13.2)
CC3	9 (17.0)
Unresectable	5 (9.4)
Peritoneal cancer index
Mean	20.8
Range	4–39
Type of treatment
Carboplatin+taxol	19 (35.8)
Cisplatin+adriamycin	7 (13.2)
Carboplatin+taxol+cisplatin+adriamycin±gemcitabine	20 (37.8)
Monochemotherapy	7 (13.2)

Notes: CC score: CC0, complete cytoreduction; CC1, residual tumor <2.5 mm in size; CC2, residual tumor 2.5 mm–2.5 cm; CC3, residual tumor >2.5 cm.

Abbreviation: CC, completeness of cytoreduction.

Figure 1 (A) DNA index distribution in the 53 patients with peritoneal carcinomatosis from ovarian cancer. The DNA index of all the cell populations present in the sample was considered for multiploid tumors (light gray bars). (B) Representative flow cytometric histogram plots of two samples and DNA diploid internal control.

Table 2 Association between ploidy and clinical pathological variables in peritoneal carcinomatosis

Clinical variable	Multiploid	Hypodiploid	Diploid	Hyperdiploid	P-value
Median PCI (range)	23.5 (8–30)	18 (6–31)	20.5 (7–39)	19.5 (4–39)	0.851
Median age (range) (years)	63 (45–75)	57 (40–76)	48.5 (29–76)	55.5 (33–79)	0.657
Recurrence	No (%)				P-value
No	2 (22.2)	4 (28.6)	6 (50)	11 (61.1)	0.992
Yes	7 (77.8)	10 (71.4)	6 (50)	7 (38.9)
Proliferation rate	No (%)				P-value
Low (<14.9%)	na	5 (35.7)	9 (75.0)	8 (44.4)	0.725
High (≥14.9%)	na	9 (64.3)	3 (25.0)	10 (55.6)

Notes: The PCI is used to assess the extent of peritoneal cancer throughout the peritoneal cavity. For this purpose, the peritoneal cavity is divided into 13 regions to which a score is given based on the size of the largest tumor nodule (score 0, no tumor; score 1, lesions <0.5 cm; score 2, 0.5–5 cm; score 3, lesions >5 cm). The PCI is calculated by adding the scores of all 13 regions together with a maximum score of 39.

Abbreviations: PCI, peritoneal cancer index; na, not assessed.

Figure 2 Box plot showing the distribution of SPF values depending on ploidy. P<0.05 was considered significant.

Abbreviation: SPF, S-phase fraction.

Table 3 Association between SPF and clinical pathological variables

Clinical variable	Statistics	SPF (%)	P-value
PCI	rs	0.29	0.063
Age	rs	−0.03	0.866

Recurrence	Median value (range)	P-value
No	17.635 (1.58–65.51)	0.056
Yes	11.26 (2.57–42.08)

Abbreviations: SPF, S-phase fraction; PCI, peritoneal cancer index; r_s, Spearman’s correlation coefficient.

Figure 3 Kaplan–Meier plots of overall survival according to analysis of (A) ploidy status and (B) SPF at cut-off of 14.9%. The significance level (P) was determined by log-rank test.

Abbreviations: SPF, S-phase fraction; ns, not significant.

Table 4 In vitro sensitivity (%) of the different ploidy subgroups to all tested drugs

Ploidy status	Adriamycin	Cisplatin	Taxol	Carboplatin	Gemcitabine
Multiploid	33.3	28.6	11.1	0	0
Diploid	41.7	40	16.7	0	0
Hyperdiploid	41.2	25	17.6	13.3	6.7
Hypodiploid	81.8	54.5	21.4	25	9
P-value	0.0336	0.14	0.58	0.17	0.52