Validation of three predictive models for suboptimal cytoreductive surgery in advanced ovarian cancer

Abstract

The standard treatment for advanced ovarian cancer (AOC) is cytoreduction surgery and adjuvant chemotherapy. Tumor volume after surgery is a major prognostic factor for these patients. The ability to perform complete cytoreduction depends on the extent of disease and the skills of the surgical team. Several predictive models have been proposed to evaluate the possibility of performing complete cytoreductive surgery (CCS). External validation of the prognostic value of three predictive models (Fagotti index and the R3 and R4 models) for predicting suboptimal cytoreductive surgery (SCS) in AOC was performed in this study. The scores of the 3 models were evaluated in one hundred and three consecutive patients diagnosed with AOC treated in a tertiary hospital were evaluated. Clinicopathological features were collected prospectively and analyzed retrospectively. The performance of the three models was evaluated, and calibration and discrimination were analyzed. The calibration of the Fagotti, R3 and R4 models showed odds ratios of obtaining SCSs of 1.5, 2.4 and 2.4, respectively, indicating good calibration. The discrimination of the Fagotti, R3 and R4 models showed an area under the ROC curve of 83%, 70% and 81%, respectively. The negative predictive values of the three models were higher than the positive predictive values for SCS. The three models were able to predict suboptimal cytoreductive surgery for advanced ovarian cancer, but they were more reliable for predicting CCS. The R4 model discriminated better because it includes the laparotomic evaluation of the peritoneal carcinomatosis index.

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

“…In Thailand, advancedstage became a significant predictor for suboptimal surgery (OR = 4.78, p < 0.001) [17]. 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.…”

“…The results showed that serous EOC (OR = 8.25) and FIGO staging (OR = 11.13) significantly enhanced the chance to experience suboptimal surgical cytoreduction. The prior study reaffirmed that subtype [55], particularly serous EOC [56] and stage of disease [55], [57], were associated significantly and became predictors to suboptimal debulking surgery. In Thailand, advancedstage became a significant predictor for suboptimal surgery (OR = 4.78, p < 0.001) [17].…”

Predicting incomplete cytoreduction in patients with advanced ovarian cancer

“…To optimize that rate, different calculation models included the findings of CT scans, laparoscopy, and laparotomy, identifying a marker constellation of a PCI of 20 and more and bowel obstruction as significant for incomplete cytoreduction. As bowel obstruction is rather rare despite high tumor loads and reason for surgical intervention anyhow, this model may not be suitable for all patients in everyday business to prevent futile surgery ( 34 ).…”

Scoring Systems of Peritoneal Dissemination for the Prediction of Operative Completeness in Advanced Ovarian Cancer

“…Several previous studies developed scoring systems for predicting operative results in PDS for patients with AOC (16,(18)(19)(20)(21). Among them, the predictive value has been mainly focused on suboptimal surgery, and the data on their predictive values for complete PDS are controversial.…”