A triage strategy in advanced ovarian cancer management based on multiple predictive models for R0 resection: a prospective cohort study

Abstract

ObjectiveTo present the surgical outcomes of advanced epithelial ovarian cancer (AEOC) since the implementation of a personalized approach and to validate multiple predictive models for R0 resection.MethodsPersonalized strategies included: 1) Non-invasive model: preoperative clinico-radiological assessment according to Suidan criteria with a predictive score for all individuals. Patients with a score 0–2 were recommended for primary debulking surgery (PDS, group A), or otherwise were counseled on the choices of PDS, neoadjuvant chemotherapy (NAC, group B) or staging laparoscopy (S-LPS). 2) Minimally invasive model: S-LPS with a predictive index value (PIV) according to Fagotti. Individuals with a PIV <8 underwent PDS (group C) or otherwise received NAC (group D). Intraoperative assessment (with Eisenkop, peritoneal cancer index [PCI], and Aletti scores) and surgical results were prospectively collected.ResultsBetween September 2015 and August 2017, 161 pathologically confirmed epithelial ovarian cancer patients were included. A total of 52 (32.3%) patients had a predictive score of 0–2, and 109 (67.7%) patients had a score ≥3. Among these individuals, 41 (25.5%) patients received S-LPS. Finally, 110 (68.3%) patients underwent PDS (A+C), and 51 (31.7%) patients received NAC (B+D). The R0 resection rates in PDS and NAC patients were 56.4% and 60.8%, respectively. The area under the curve (AUC) of Suidan criteria was 0.548 for group (A+C). The AUC of Fagotti score was 0.702 for group C. The AUC of Eisenkop, PCI, and Aletti scores were 0.808, 0.797, and 0.524, respectively.ConclusionThe Suidan criteria were not effective in these AEOC patients. S-LPS was helpful in decision-making for PDS and should be endorsed in the future.

Ovarian Carcinosarcoma with Retroperitoneal Para-Aortic Lymph Node Dissemination Followed by an Unusual Postoperative Complication: A Case Report with a Brief Literature Review

“…There are limited data on aetiology, diagnosis, prognostic factors and treatment of OCS. However, studies concluded that prognostic factors and treatment of carcinosarcomas are associated with epithelial components, as carcinosarcomas are carcinomas with epithelial–mesenchymal transition and heterologous differentiation [ 1 , 4 , 6 , 20 , 21 , 22 , 23 , 24 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 , 46 ]. Adhesion between the small bowel and the abdominal aorta leading to obstructive ileus is a possible complication after para-aortic lymph node dissection.…”

“…However, the definition of optimal cytoreduction has changed over the years. Currently, optimal cytoreduction is defined as no macroscopic residual disease [ 29 ]. Although the role of cytoreduction in ovarian carcinoma is well established, some studies have reported no benefit of cytoreduction in OCS [ 4 , 30 , 31 ].…”

“…The treatment of OCS is summarized in Figure 8 [ 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 , 46 ].…”

Preoperative colonoscopy in patients with a supposed primary ovarian cancer

“…Fagotti et al and Feng et al concluded that preoperative laparoscopic staging is useful in making decisions about primary debulking surgery. [28,29]…”

Comparison of Survival Between Primary Debulking Surgery Versus Neoadjuvant Chemotherapy for Ovarian Cancers in a Personalized Treatment Cohort

“…Since 2015, the specialized ovarian cancer unit at our institution has implemented a personalized surgical approach for the treatment of OC patients ( 7 ). We adopted two-tier predictive models for R0 resection; specifically, a preoperative clinic-radiological assessment for all OC patients and a laparoscopic assessment, when necessary.…”