Development and Validation of a Predictive Score for Preoperative Diagnosis of Early Stage Epithelial Ovarian Cancer

Abstract

Objective: To develop and validate a simplified multi-parameter risk-based scoring system for preoperative diagnosis of early stage epithelial ovarian cancer. Methods: All women presented with adnexal mass and were scheduled for operation at Phrapokklao hospital during September 2013 -December 2017 were included and categorized according to their histopathologic reports into early stage ovarian cancer groups and benign ovarian tumor groups. Multivariable logistic regression was used to explore for potential predictors. The selected logistic coefficients were transformed into risk-based scoring system. Internal validation was done with bootstrapping procedure. Results: A total of 270 participants were included in analysis and predictive model development, 54 in early stage ovarian cancer group and 216 in benign ovarian tumor group. Menopausal status, two abnormal ultrasound findings (presence of solid component or ascites), tumor size and serum CA-125 level were used for derivation of the scoring system. The score-based model showed area under ROC of 0.88 (95%CI 0.82-0.93). The developed scoring system ranged from 0 to 51 was classified into 3 subcategories for clinical practicability. The positive predictive values for the presence of early stage ovarian cancer were 2.07 (95%CI 0.43-6.05) for low risk patient, for moderate risk patient,) for high risk patient. Conclusion: This simplified risk-based scoring system for preoperative diagnosis of early stage ovarian cancer could aid general physicians or general gynecologists in evaluation of patients presenting with ovarian tumors and help gynecologic oncologists in management planning and prioritization of patients for operation.

Do women with benign versus malignant ovarian masses demonstrate variable clinical presentation?

“…The chances of malignancy increased with age and menopausal status, both showing a positive relation to presence of cancer, similar to reports by Okugawa et al 7 Malignant tumors were more common in postmenopausal women (81% versus 29%, p<0.001) in a study by Simsek et al 8 Early menopause has been proposed as a risk factor for ovarian cancer. 9 Menopausal status had a higher correlation with early stage ovarian cancer as reported by Chirdchim et al 10 In this study, 84% women with benign tumors were less than 60 years of age. The mean age of women with cancer was 53.46 years compared to 33.21 years in benign tumors.…”

Early-Stage Ovarian Malignancy Score versus Risk of Malignancy Indices: Accuracy and Clinical Utility for Preoperative Diagnosis of Women with Adnexal Masses

“…Moreover, the EOM scoring system appropriately adjusts the influence of the serum CA-125 level into the model by categorizing this classic marker into three categories, assigning a weighted score to each. In our prior work, we proposed two cutoff points, at ≥15 and ≥30, for the implementation of the EOM score in practice [ 23 ]. The finding from this study adds weight to the existing evidence that the lower cutoff (≥15) is suitable for triage purposes, while the higher cutoff (≥30) might be more appropriate for diagnosis and giving guidance for the prioritization of patients for surgery.…”

“…Table 1 illustrates the components and score rating of each risk model. The Early-stage Ovarian Malignancy score or the EOM score was recently developed from the dataset used in the primary data analysis prior to this study [23]. The EOM score is a combination of five simple predictors: menopausal status, tumor size, the presence of a solid component, the presence of ascites, and serum CA-125.…”

“…In 2019, the Early-stage Ovarian Malignancy (EOM) score was developed from a study in a cohort of women with benign ovarian tumors and early-stage ovarian cancer [ 23 ]. The EOM score was calculated based on the same parameters as the RMI.…”

Prediction Model for Preoperative Diagnosis of Ovarian Cancer Using Tumor Markers, CBC, and LFT

“…The stage of ovarian cancer is determined by the International Federation of Gynecology and Obstetrics (FIGO) system for describing how much cancer is in the body and determining how serious the cancer is. The initial treatment of patients at early stages is planned, while cytoreductive surgery is usually considered for patients at the advanced stage of ovarian cancer [2]. An important treatment can be decided based on a preoperative diagnosis for patients with high or low risk.…”