Multi-Institutional Reciprocal Validation Study of Computed Tomography Predictors of Suboptimal Primary Cytoreduction in Patients With Advanced Ovarian Cancer

Abstract

Purpose Identify features on preoperative computed tomography (CT) scans to predict suboptimal primary cytoreduction in patients treated for advanced ovarian cancer in institution A. Reciprocally cross validate the predictors identified with those from two previously published cohorts from institutions B and C. Patients and Methods Preoperative CT scans from patients with stage III/IV epithelial ovarian cancer who underwent primary cytoreduction in institution A between 1999 and 2005 were retrospectively reviewed by radiologists blinded to surgical outcome. Fourteen criteria were assessed. Crossvalidation was performed by applying predictive model A to the patients from cohorts B and C, and reciprocally applying predictive models B and C to cohort A. Results Sixty-five patients from institution A were included. The rate of optimal cytoreduction (≤ 1 cm residual disease) was 78%. Diaphragm disease and large bowel mesentery implants were the only CT predictors of suboptimal cytoreduction on univariate (P < .02) and multivariate analysis (P < .02). In combination (model A), these predictors had a sensitivity of 79%, a specificity of 75%, and an accuracy of 77% for suboptimal cytoreduction. When model A was applied to cohorts B and C, accuracy rates dropped to 34% and 64%, respectively. Reciprocally, models B and C had accuracy rates of 93% and 79% in their original cohorts, which fell to 74% and 48% in cohort A. Conclusion The high accuracy rates of CT predictors of suboptimal cytoreduction in the original cohorts could not be confirmed in the cross validation. Preoperative CT predictors should be used with caution when deciding between surgical cytoreduction and neoadjuvant chemotherapy.

Comparative study of pre-operative CT scan and per-operative findings in carcinoma ovary

“…Previous investigators assessing the utility of preoperative CT scan in this setting have retrospectively identified different radiologic predictors. [14][15][16][17][18] Axtell et al's analysis of 65 patients showed diaphragm disease and large bowel mesentery implants to be significant factors. 15 Dowdy et al's review of 89 patients found diffuse peritoneal thickening to be the only variable significantly associated with suboptimal debulking which is comparable to our study.…”

“…These scores were added together for a score of 0 to 10 which was compared to the surgical results. [14][15][16]22,23 Blood samples for measurement of CA125, within four weeks prior to surgery. CA125 was assessed by enzyme immunoassay (Roche E170) using a sandwich method with chemoluminescence.…”

“…14,17,18 Accuracy of prediction using such parameters ranges between 71 and 93%. [14][15][16] However, discrepancies across the studies and reliability of the results are also conceivably related to the time frame, and duration of accrual as variations and/or improvements in the imaging techniques, equipment, and performances have occurred over time, and also diverge across different imaging centres.…”

Mini-laparotomy in advanced ovarian cancer

“…This modality of assessment, in experienced hands, has been shown to have PPV of 87% and NPV of 100% [20][21][22]. However, laparoscopic assessment requires an experienced surgical team and laparoscopic resources.…”

Optimizing the management of patients with ovarian cancer

“…Дополнительные возможности ранней диагно-стики РЯ появились при появлении принципиально нового подхода -идентификация различных сое-динений, участвующих в процессах канцерогенеза [1,[12][13][14], в том числе, протеолитических ферментов (протеаз), которые принимают участие практически во всех звеньях канцерогенеза -пролиферации, диф-ференциации, ангиогенезе, инвазии, метастазирова-нии [4,[15][16][17][18].…”