27/#729 First clinical study reporting adoption of ERAS in CRS HIPEC as per published guidelines: time to adopt, evolve & improve

Abstract

Objectives We aimed to develop a model predicting complete cytoreduction in primary cytoreductive surgery (CRS) using clinicopathologic characteristics and 18 F-FDG PET/CT (PET)derived parameters in advanced OC. Methods We retrospectively identified patients with stage III-IV OC who underwent primary CRS between June 2013 and February 2020 at two tertiary centers for development of a prediction model and for its validation. We divided abdominal cavity into three sections in PET images. The number of lesions in each section was counted and visual grading was conducted. Then, standardized uptake value (SUV), metabolic tumor volume (MTV), and total lesion glycolysis (TLG) were estimated. We constructed various prediction models for complete cytoreduction by combination of clinicopathologic characteristics and PET-derived parameters. The model showing highest area under the receiver operating characteristic curve (AUC) was selected and its performance was evaluated for validation. Results Prediction models were designed with the development cohort (n=159). In variable selection, MTV, TLG, and the number of lesions above the renal vein were selected among PET-derived parameters with other clinical variables including CA-125 by AUC. The highest predictive performance was achieved by combination of CA-125 (<750 or ≧750 IU/ml), the number of lesions above the renal vein (<2 or ≧2) and MTV above the renal vein with AUC of 0.768. The model predicted complete cytoreduction with AUC of 0.771 in validation (n=166). Conclusions We successfully developed and validated PETbased prediction model for complete cytoreduction. It may be helpful for gynecologic oncologists to choose primary CRS or NACT in patients with stage III-IV OC in real-world practice.