Using a new diagnostic tool to predict lymph node metastasis in advanced epithelial ovarian cancer leads to simple lymphadenectomy decision rules: A multicentre study from the FRANCOGYN group

Abstract

Objective The aim of this study was to develop a new diagnostic tool to predict lymph node metastasis (LNM) in patients with advanced epithelial ovarian cancer undergoing primary cytoreductive surgery. Materials and method The FRANCOGYN group’s multicenter retrospective ovarian cancer cohort furnished the patient population on which we developed a logistic regression model. The prediction model equation enabled us to create LNM risk groups with simple lymphadenectomy decision rules associated with a user-friendly free interactive web application called shinyLNM. Results 277 patients from the FRANCOGYN cohort were included; 115 with no LNM and 162 with LNM. Three variables were independently and significantly (p<0.05) associated with LNM in multivariate analysis: pelvic and/or para-aortic LNM on CT and/or PET/CT (p<0.00), initial PCI ≥ 10 and/or diaphragmatic carcinosis (p = 0.02), and initial CA125 ≥ 500 (p = 0.02). The ROC-AUC of this prediction model after leave-one-out cross-validation was 0.72. There was no difference between the predicted and the observed probabilities of LNM (p = 0.09). Specificity for the group at high risk of LNM was 83.5%, the LR+ was 2.73, and the observed probability of LNM was 79.3%; sensitivity for the group at low-risk of LNM was 92.0%, the LR- was 0.24, and the observed probability of LNM was 25.0%. Conclusion This new tool may prove useful for improving surgical planning and provide useful information for patients.

Predictive value of PET metabolic parameters for occult lymph node metastases in PET/CT defined node-negative patients with advanced epithelial ovarian cancer

“…Many previous studies demonstrate that it was feasible to improve the diagnostic e ciency in LNM by clinical factors, radiological ndings, and radiomics features extracted from PET or CT images. A new diagnostic tool based on multivariate analysis including three variables: pelvic and/or para-aortic LNM on CT PET/CT, and initial PCI ≥ 10, initial CA125 ≥ 500 was proposed 27 . Another study used preoperative radiological scores to predict pelvic and/or para-aortic LNM 28 .…”

“…Previous studies have investigated the predictive value of PET metabolic parameters in AEOC 25,27,37 .…”

“…However, there was no study to evaluate the correlation between PET/CT-related parameters and LNM, especially OLNM. Previous studies have demonstrated that hypermetabolic LN on PET/CT, initial CA125 ≥ 500, and initial peritoneal cancer index ≥ 10 were independently and signi cantly associated with pelvic and/or para-aortic LNM 26,27 . Recently, many researchers have focused on radiomics features of PET/CT or contrast-enhanced CT in predicting LNM in AEOC, among which LNM assessment has been proven to have a certain signi cant improvement 28,29 .…”

A Nomogram for Preoperative Prediction of the Risk of Lymph Node Metastasis in Patients with Epithelial Ovarian Cancer

“…Cancer antigen-125 (CA125), a reliable biomarker, is widely used in ovarian cancer screening, diagnosis, and treatment monitoring [ 20 ]. CA125 was also identified as an independent predictor of LN involvement [ 21 , 22 ]. Moreover, the presence of bilateral tumours was suggestive of the presence of LNM [ 23 ].…”

Predictive value of PET metabolic parameters for occult lymph node metastases in PET/CT defined node-negative patients with advanced epithelial ovarian cancer

“…However, there was no study to evaluate the correlation between PET/CT-related parameters and LNM, especially OLNM. Previous studies have demonstrated that hypermetabolic LN on PET/CT, initial CA125 ≥ 500, and initial peritoneal cancer index (PCI) ≥ 10 were independently and significantly associated with pelvic and/or para-aortic LNM 26 , 27 . Recently, many researchers have focused on radiomics features of PET/CT or contrast-enhanced CT in predicting LNM in AEOC, among which LNM assessment has been proven to have a certain significant improvement 28 , 29 .…”