Preoperative Predictors for Residual Tumor after Surgery in Patients with Ovarian Carcinoma

Abstract

Objectives: Suboptimal debulking (>1 cm residual tumor) results in poor survival rates for patients with an advanced stage of ovarian cancer. The purpose of this study was to develop a prediction model, based on simple preoperative parameters, for patients with an advanced stage of ovarian cancer who are at risk of suboptimal cytoreduction despite maximal surgical effort. Methods: Retrospective analysis of 187 consecutive patients with a suspected clinical diagnosis of advanced-stage ovarian cancer undergoing upfront debulking between January 1998 and December 2003. Preoperative parameters were Karnofsky performance status, ascites and serum concentrations of CA 125, hemoglobin, albumin, LDH and blood platelets. The main outcome parameter was residual tumor >1 cm. Univariate and multivariate logistic regression was employed for testing possible prediction models. A clinically applicable graphic model (nomogram) for this prediction was to be developed. Results: Serum concentrations of CA 125 and blood platelets in the group with residual tumor >1 cm were higher in comparison to the optimally cytoreduced group (p < 0.0001 and <0.01, respectively). Serum albumin and hemoglobin levels were lower in the group with residual tumor (p < 0.0001 and <0.05, respectively). The frequency of preoperative ascites was higher in the group with residual tumor (p < 0.0005). The prediction model, consisting of CA 125 and albumin, for remaining with residual tumor showed an area under the receiver operating characteristics curve of 0.79. A nomogram for probability of residual tumor >1 cm based on serum levels of CA 125 and albumin was established. Conclusion: Postoperative residual tumor despite maximal surgical effort can be predicted by preoperative CA 125 and serum albumin levels. With a nomogram based on these two parameters, probability of postoperative residual tumor in each individual patient can be predicted. This proposed nomogram may be valuable in daily routine practice for counseling and to select treatment modality.

Impact of ascites volume on clinical outcomes in ovarian cancer: A cohort study

“…Prior studies have correlated pre-operative ascites with surgical and perioperative clinical outcomes [10, 16, 17] including the ability to achieve optimal or complete (R0) cytoreduction. The present study confirms the findings of these smaller cohorts that identified ascites as a risk factor for sub-optimal cytoreduction [10], a factor well known to predict worse clinical outcomes [18].…”

Chemotherapy and patient co-morbidity in ventral site hernia development

“…We recognize that serum albumin levels would have been an interesting variable to consider, particularly given that this protein has been studied extensively as an indirect measure of nutrition and appears to be associated with inferior outcomes in ovarian cancer surgery. 27 Moreover, since cervical cancer patients undergo adjuvant chemotherapy and would be more vulnerable to a ventral hernia, the study would have benefited from the inclusion of these patients. We suspect an absence of these patients or any additional inadvertently excluded subjects was attributed to either a coding issue limiting the chart selection process, or because of general surgery referrals.…”

Role of Systemic Inflammatory Response in Predicting Survival in Patients with Primary Operable Cancer

“…Low serum albumin and hemoglobin levels have been reported to predict residual tumor after debulking surgery for ovarian cancer [106].…”

“…A recent study by Yoshida and colleagues in 2008 [106] observed that an elevated pretreatment C-reactive protein level (>5 mg/l) was associated with a poorer cancer-specific survival following treatment of muscle-invasive bladder cancer with chemo-radiotherapy.…”