A Prediction Model for Optimal Primary Debulking Surgery Based on Preoperative Computed Tomography Scans and Clinical Factors in Patients With Advanced Ovarian Cancer: A Multicenter Retrospective Cohort Study

Abstract

ObjectiveThis study assessed the predictive value of preoperative computed tomography (CT) scans and clinical factors for optimal debulking surgery (ODS) in patients with advanced ovarian cancer (AOC).MethodsPatients with AOC in International Federation of Gynecology and Obstetrics (FIGO) stage III-IV who underwent primary debulking surgery (PDS) between 2016 and 2019 from nine tertiary Chinese hospitals were included. Large-volume ascites, diffuse peritoneal thickening, omental cake, retroperitoneal lymph node enlargement (RLNE) below and above the inferior mesenteric artery (IMA), and suspected pelvic bowel, abdominal bowel, liver surface, liver parenchyma and portal, spleen, diaphragm and pleural lesions were evaluated on CT. Preoperative factors included age, platelet count, and albumin and CA125 levels.ResultsOverall, 296 patients were included, and 250 (84.5%) underwent ODS. The prediction model included age >60 years (P=0.016; prediction index value, PIV=1), a CA125 level >800 U/ml (P=0.033, PIV=1), abdominal bowel metastasis (P=0.034, PIV=1), spleen metastasis (P<0.001, PIV=2), diaphragmatic metastasis (P=0.014, PIV=2), and an RLNE above the IMA (P<0.001, PIV=2). This model had superior discrimination (AUC=0.788>0.750), and the Hosmer-Lemeshow test indicated its stable calibration (P=0.600>0.050). With the aim of maximizing the accuracy of prediction and minimizing the rate of inappropriate explorations, a total PIV ≥5 achieved the highest accuracy of 85.47% and identified patients who underwent suboptimal PDS with a specificity of 100%.ConclusionsWe developed a prediction model based on two preoperative clinical factors and four radiological criteria to predict unsatisfactory debulking surgery in patients with AOC. The accuracy of this prediction model needs to be validated and adjusted in further multicenter prospective studies.

Overall Survival and Related Factors of Advanced-stage Epithelial Ovarian Cancer Patients Underwent Debulking Surgery in Jakarta, Indonesia: A Single-center Experience

“…We found that age did not significantly differ among two groups of debulking surgery, similar to prior study [57]. In contrast, a multivariate analysis from Gu et al [58] found age >60 years become a significant predictor for suboptimal debulking surgery with OR 2.39 possibly due to younger cut-off of elderly we used in this study. Other variables such as obesity were not significant predictors of suboptimal debulking surgery in contrast with Suknikhom et al [17].…”

30-Year Experience With 22 Cases of Malignant Transformation Arising From Ovarian Mature Cystic Teratoma: A Rare Disease

“…The other one patient was at advanced age and had a poor performance status that could not tolerate primary cytoreduction. After receiving NACT, the tumor burden of all three patients were significantly reduced by CA125 and CT scans ( 22 , 23 ). Among all 22 patients, 90.9% of patients underwent standard ovarian surgery, including cytoreductive surgery (63.6%), ovarian cancer staging surgery (18.2%), and fertility preservation staging surgery (9.1%).…”

A prediction nomogram for suboptimal debulking surgery in patients with serous ovarian carcinoma based on MRI T1 dual-echo imaging and diffusion-weighted imaging

“…In this study, we assessed the preoperative objective, simple, and easily identifiable predictors of SDS and developed a risk prediction model. The AUCs of our model (training set = 0.951, internal validation set = 0.868, external validation set = 0.773) were higher than those of other models [12,14,18] (Fig. 4).…”

“…In models predicting SDS, most studies have included CA-125 as one of the variables. The cutoff value of CA-125 was 500 U/mL by Suidan [ 11 ], 800 U/mL by Yu Gu [ 14 ], and 420 U/mL by Maliheh [ 17 ]. However, the cutoff value of the present study was 1484 U/mL, which is significantly higher than those of the aforementioned studies.…”

“…Our study only included conventional MRI sequences; as a result, the MRI scans (3.0 or 1.5 T) do not differ in the assessment of image variables in our model. Based on previous studies [11,[13][14][15][16], the following MRI features were carefully observed and recorded: (1) Ovarian mass features, namely, solid (the solid component accounted for more than two-thirds), complex cystic and solid (the solid component accounted for one-to two-thirds), and mainly cystic (the solid component accounted for less than one-third); (2) relationship between the sigmoid colon/rectum and ovarian mass or mass implanted in Douglas' pouch on MR-T1-DEI (referred to as the relationship); we classified it into four grades: 0, clear (a hook edge sign existed between the sigmoid colon/rectum and ovarian mass or mass implanted in Douglas' pouch), which means that the boundary between the two is clear; 1, close (the hook edge disappeared, but the shape of the sigmoid colon/rectum and mass can be vaguely distinguished); 2, bridge sign (the hook edge disappeared, and the two were limited adhered); and 3, fusion (the hook edge disappeared, and the two fused into a block); (3) metastases of distant organs in the abdomen; (4) bladder invasion; (5) diaphragmatic metastasis; (6) nodules or masses implanted on the omentum/peritoneum; (7) hydroureter; (8) retroperitoneal lymphadenectasis; and (9) amount of ascites (small, defined as ascites confined to the pelvic; medium-to-large, defined as ascites beyond the pelvis).…”