Role of CT scan-based and clinical evaluation in the preoperative prediction of optimal cytoreduction in advanced ovarian cancer: a prospective trial

Abstract

BACKGROUND: In advanced ovarian cancer, maximal efforts have to be attemptedto achieve optimal cytoreduction, as this represents the keystone in the therapeutic management. This large, prospective study aims at investigating the role of computed tomography (CT) scan in predicting the feasibility of optimal cytoreduction in ovarian cancer. METHODS: A total of 195 consecutive patients with clinical/radiographic suspicion of advanced ovarian/peritoneal cancer were enrolled at the Gynecologic Oncology Unit, Catholic University of Rome and Campobasso, Italy. Preoperative CT scans were performed with a high-speed scanner (CT Hi Speed Nx/i Pro; 2-slice; GE Medical System). All patients underwent standard laparotomy, and maximal surgical effort was attempted. The following CT parameters were used: peritoneal thickening, peritoneal implants 42 cm, bowel mesentery involvement, omental cake, pelvic sidewall involvement and/or hydroureter, suprarenal aortic lymph nodes 41 cm, infrarenal aortic lymph nodes 42 cm, superficial liver metastases 42 cm and/or intraparenchimal liver metastases any size, large volume ascites (4500 ml). Clinical data included were age, Ca125 serum levels, and ECOG-PS. Radiographic and clinical features exhibiting a specificity 475%, a positive and negative predictive value 450%, an accuracy 460% in predicting surgical outcome were assigned a point value of 2. With this scoring system, a predictive index (PI) was calculated for each patient. RESULTS: The PI scores ranged from 0 to 6, and from 0 to 8, in Model 1 (including only radiographic parameters) and in Model 2 (including radiographic and clinical data). The AUC was 0.78 þ 0.035 in Model 1, and 0.81 þ 0.031 in Model 2. Therefore, the addition of ECOG-PS data led to the improvement of the diagnostic performances (z ¼ 2.41, P-value o0.05). CONCLUSIONS: Computed scan still represents a valid tool to predict ovarian cancer optimal cytoreduction; the predictive ability of a CT scan-based model is improved by integrating ECOG-PS data.

Comparative study of pre-operative CT scan and per-operative findings in carcinoma ovary

“…Age of patients ranged from 40 to 74years. This was in accordance with studies done by G Ferrandina et al 30 where the median age was 59 years (range: 31-85) and Gerestein C et al 35 where the median age of patients was 62.4 years (range 15.9-83.6 years). On staging laparotomy, we observed that 74.5% patients presented to us at an advanced stage (Stage III and IV).…”

“…This was similar to studies done by Bristow et al and G Ferrandina et al where accuracy was 80.5% and 78.5% respectively. 14,30 The sensitivity and specificity were also comparable -60% and 88.8% in our study to 71.4% and 90% (Bristow et al).…”

“…18,33 Enlarged retroperitoneal lymph nodes was detected with an accuracy , sensitivity and specificity of 69.5%,85.7% and 54.8%, respectively in our study which corresponded to results of studies done by G Ferrandina et al where accuracy was 81.9% and specificity was 91.8% and Meyer et al where sensitivity was 60% and specificity100%. 17,30 Diaphragm and base of lung are difficult to differentiate so they were taken together. It was found that CT scan could detect metastasis to this region with accuracy, sensitivity and specificity of 74.5%, 16.6% and 100% respectively.…”

Predictive modeling for determination of microscopic residual disease at primary cytoreduction: An NRG Oncology/Gynecologic Oncology Group 182 Study

“…Although this prediction model showed promising performance characteristics, two subsequent studies used patients from other institutions to externally validate the model and noted that accuracy dropped to 48% 21 -65%. 23 Similarly, the accuracy of two prediction models for patients with <1cm of residual disease developed by investigators from Italy 26 demonstrated a drop in AUC from 0.78 and 0.81 to 0.56-0.59 and 0.55-0.60 respectively when assessed in an independent patient cohort by investigators in the Netherlands. 27 In the current study, patients from 73 institutions participating in GOG-182 reflected a diversity of surgical skill levels while providing standardization of adjuvant therapy.…”

Predicting Surgical Outcome in Patients With International Federation of Gynecology and Obstetrics Stage III or IV Ovarian Cancer Using Computed Tomography

“…Two studies were prospective, whereas the other 9 studies had a retrospective design. 23,24 Description of the variables and outcome was well performed. Analysis was of low quality in 3 studies; in these studies, no clear description of model-building strategy was given.…”