Is Postoperative Computed Tomography Evaluation a Prognostic Indicator in Patients with Optimally Debulked Advanced Ovarian Cancer?

Abstract

Objective: To compare the surgeon's intraoperative assessment of residual tumor (RT) disease with that identified on postoperative computed tomography (CT) in patients undergoing optimal primary surgical cytoreduction (RT <1 cm) and to identify the prognostic significance of postoperative CT scan of RT. Methods: Patients with FIGO stage III-IV ovarian cancer treated at the Gynecologic Oncology Unit of the National Cancer Institute between November 2011 and March 2013, who underwent optimal primary cytoreduction and were entered in prospective controlled clinical trials requiring a baseline postoperative CT evaluation within 30 days, were enrolled. All CT scans were reviewed by a dedicated radiologist to evaluate RT. Median follow-up was 16 months. Results: 64 out of 160 patients met the eligibility criteria. RT = 0, 0.1 < RT < 0.5 cm, and 0.6 < RT < 1 cm was reported in 53 (82.8%), 9 (14.1%) and 2 (3.1%) cases, respectively. Postoperative CT disagreed with RT in 13 out of 64 (20.3%) cases. Progression-free survival (PFS) of patients with a positive and negative postoperative CT scan of RT was 5 months (95% CI 1-15 months) and 28 months (95% CI 2-46 months), respectively (p < 0.0001). Evidence of the disease using postoperative CT was an independent prognostic factor in multivariate analysis (HR = 8.87, 95% CI = 3.23-24.31, p < 0.0001). Conclusions: Evidence of the disease using postoperative CT was associated with a significant decrease in PFS in patients who underwent optimal primary cytoreduction. RT status as evaluated with early postoperative CT may have an important role in prognostic assessment.

Outcome according to residual disease (surgeon's report vs pre‐chemotherapy imaging) in patients with bevacizumab‐treated ovarian cancer: Analysis of the ROSiA study

“…The 21% discordance rate in our analysis is lower than that reported in many of the analyses described above but similar to the rate reported by Lorusso et al in their single‐center retrospective study of patients treated in first‐line chemotherapy trials. The Italian investigators reported 20% discordance between surgeon‐reported “optimal” cytoreduction (to <1 cm) and postoperative scans in 64 patients with FIGO stage III/IV OC . More specifically, CT scans showed a residual tumor in 11 (21%) of 53 patients with surgeon‐reported NVR.…”

“…Residual disease measuring >1 cm was reported most commonly in the right upper quadrant and central abdomen in Chi et al's series and the central abdomen and left upper quadrant in Sala et al's study. In Lorusso et al's study, which is perhaps most similar to ours, the most common disease locations were upper abdominal lymph nodes. Based on results from ROSiA and other trials in the literature, we recommend a thorough exploration of the upper retroperitoneum and upper abdomen in patients whose surgery is considered to achieve NVR.…”

“…We were unable to replicate or validate analyses according to complexity score, disease site, or comorbidity index as ROSiA was not designed with this intent and collection of all relevant information was not planned. The various analyses also differed in their definition of PFS, which was calculated from the start of study treatment (chemotherapy or bevacizumab) in ROSiA but from the date of surgery in the retrospective studies described above . It would also be interesting to understand whether patients with surgeon‐reported NVR and radiologically detected nontarget lesions (a population expected to have low‐volume disease, similar to those with surgeon‐reported NVR but target lesions) had a worse prognosis than those with concordant surgically and radiologically determined NVR (no target lesions).…”

“…The potential confounding effect of variation in the delay between surgery and treatment was not explored in ROSiA. However, none of the three studies that explored this hypothesis revealed a significant association between residual disease and time elapsed between surgery and imaging …”

“…The data reflect routine clinical practice across divergent healthcare systems with varying surgical practices and standards. Furthermore, it focuses on the concept of NVR, whereas previously reported analyses (except the Italian study by Lorusso et al) used a 1 cm cutoff to identify discordance between surgeons’ reports and imaging.…”