The extent of gynaecological cancer : Evaluation, outcome and quality of life

Sammanfattning: The overall aim of this thesis was to enhance treatment planning for gynaecological cancer patients and identify women that are more likely to have impaired quality of life (QoL) after treatment. In a retrospective cohort study on ovarian cancer, the peritoneal cancer index (PCI) was examined in relation to incomplete cytoreductive surgeries (CRS) and surgical complications (n=167). The PCI was found to be an excellent predictor of incomplete CRS (AUC 0.94). Complete CRS was obtained for only 67.2% of the patients with a PCI score higher than 24, who also experienced an increased rate of complications (p = 0.008). In a prospective study, radiologic PCI assessed with integrated PET/MRI and DW-MRI was compared with the surgical PCI as the gold standard (n=34). The median total PCI for PET/MRI (21.5) was closer to the surgical PCI (24.5) (p = 0.6) than to DW-MRI (20.0, p = 0.007). PET/MRI was more accurate (p = 0.3) for evaluating patients at primary diagnosis and for evaluating high tumour burden in inoperable patients.In a nationwide study, endometrial cancer patients included in the Swedish Quality Registry for Gynaecologic Cancer 2017-2019 (n=1401) were analysed with the aim of describing methods of evaluating myometrial invasion (MI). The main methods for the MI assessment were transvaginal sonography (59%) and MRI (28%). The sensitivity of transvaginal sonography (65.6%) was lower than for the other methods.In a longitudinal questionnaire-study, QoL in women with advanced gynaecological cancer was compared to women with local disease (n=372). No difference in QoL was found at the one-year follow-up. With multiple regression analyses, previous psychiatric illness, high BMI and comorbidities were identified as risk factors for impaired QoL.In conclusion, the PCI is an excellent predictor of incomplete CRS, and PCI ≥24 is a possible cut-off. PET/MRI is superior to DW-MRI for estimating total PCI. The assessment of MI in endometrial cancer in Sweden is usually performed with transvaginal sonography, but the sensitivity is lower than for other methods. Women with advanced gynaecological cancer have equally good QoL one year after diagnosis as women with limited disease, and psychiatric illness, high BMI, and comorbidities are risk factors for impaired mental health.