Preoperative prediction of surgical outcome in advanced ovarian cancer by computed tomographic scan and Eastern Cooperative Oncology Group-performance status
DOI:
https://doi.org/10.18203/2320-1770.ijrcog20183775Keywords:
Cytoreduction, CT scan, ECOG-PS, Ovarian cancer, Predictive modelsAbstract
Background: Ovarian cancer represents the sixth most common cancer in women with almost 2 lakh new cases diagnosed every year. Present study was done to investigate the role of preoperative Computed Tomographic scan (CT) and Eastern Cooperative Group Performance Status (ECOG-PS) in the prediction of surgical outcome in advanced ovarian cancer.
Methods: It is a Prospective cohort study of 41 cases of advanced ovarian cancer. Patients fulfilling the inclusion criteria were included after obtaining informed consent. A detailed history with general examination of the patient and relevant preoperative investigations were carried out. A preoperative Contrast Enhanced Computerised Tomography scan (CECT) was obtained and relevant CT parameters were analysed by a senior radiologist. Surgical outcome and its correlation with the CT scan findings and ECOG-PS were calculated by statistical analysis.
Results: Among the 41 patients 23(56%) had optimal cytoreduction. Among the CT parameters, omental extension to spleen, stomach, lesser sac (specificity-100%, PPV-100%, NPV-60.5%), suprarenal lymph nodes >1 cm (specificity-100%, PPV-100%, NPV-59%), infrarenal lymph nodes >2 cm (specificity-95.7%%, PPV-66.7%, NPV-59.7%) were found as better predictors for suboptimal cytoreduction. ECOG-PS didn’t have a statistically significant association with surgical outcome.
Conclusions: Presence of omental extension to adjacent structures and suprarenal lymphnodes on CT scan predicted suboptimal cytoreduction with 100% specificity. Though CT served as a valid tool in the preoperative prediction of surgical outcome in advanced ovarian malignancy, these results cannot be extrapolated to the general population nor can this be universally applied in determining the mode of treatment. Future studies are required to validate the findings of the present study on a larger scale.
References
Martinek IE, Kehoe S. When should surgical cytoreduction in advanced ovarian cancer take place? J oncol. 2010;2010:1-6.
Bristow RE. Primary cytoreductive surgery for advanced stage ovarian cancer:Indications for radical resection. Cancerologia 2. 2007;Suppl1:s31-s36.
Tangjitgamol S, Hanprasertpong J, Cubelli M, Zamagni C. Neoadjuvant chemotherapy and cytoreductive surgery in epithelial ovarian cancer. World J Obstet Gynecol. 2013;2(4):153-66.
Mousavi AS, Mazhari M, Mitra M, Gurlani MM, Behtash N, Akhavan S. Can primary optimal cytoreduction be predicted in advanced epithelial ovarian cancer preoperatively? World J Surg Oncol. 2010;8:11.
Dowdy SC, Mullany SA, Brandt KR, Huppert BJ, Cliby WA. The utility of CT scans in predicting the suboptimal cytoreductive surgery in women with advanced ovarian carcinoma. Cancer. 2004;101(2):346-52.
Hoskins WJ, McGurie WP, Brady MF, Homseley HD, Creasman WT, Berman M et al. The effect of diameter of largest residual disease on survival after primary cytoreductive surgery in patients with suboptimal residual epithelial ovarian carcinoma. Am J Obstet Gynecol. 1994;170:974-80.
Ferrandina G, Sallustio G, Fagotti A, Vizzielli G, Paglia A, Cucci E et al. Role of CT scan based and clinical evaluation in the preoperative prediction of optimal cytoreduction in advanced ovarian cancer: a prospective trial. BJC. 2009;101:1066-73.
Nelson BE, Rosenfield AT, Schwartz PE. Preoperative abdominopelvic computed tomographic prediction of optimal cytoreduction in epithelial ovarian carcinoma. J Clin Oncol. 1993;11(1):166-72.
Meyer JI, Kennedy AW, Friedman R, Ayoub A, Zepp RC. Ovarian carcinoma: value of CT in predicting success of debulking surgery. Am J Roentgenol. 1995;165(4):875-8.
Bristow RE, Duska LR, Lambrou NC, Fishman EK, O'Neill MJ, Trimble E et al. A model for predicting surgical outcome in patients with advanced ovarian carcinoma using computed tomography. Cancer. 2000;89(7):1532-40.
Axtell AE, Lee MH, Bristow RE, Dowdy SC, Cliby WA, Raman S et al. Multi-institutional reciprocal validation study of computed tomography predictors of suboptimal primary cytoreduction in patients with advanced ovarian cancer. J Clin Oncol. 2007;25(4):384-9.
Borley J, Wilhelm-Benartzi C, Yazbek J, Williamson R, Bharwani N, Stewart V et al. Radiological predictors of cytoreductive outcomes in patients with advanced ovarian cancer. BJOG. 2015;122(6):843-9.
Neijt JP, ten Bokkel Huinink WW, van der Burg ME, van Oosterom AT, Willemse PH, Heintz AP et al. Randomized trial comparing two combination chemotherapy regimens (CHAP-5 v CP) in advanced ovarian carcinoma. J Clin Oncol. 1987;5(8):1157-68.
Hoskins WJ, Bundy BN, Thigpen JT, Omura GA. The influence of cytoreductive surgery on recurrence-free interval and survival in small-volume stage III epithelial ovarian cancer: a Gynecologic Oncology Group Study. Gynecol Oncol. 1992;47:159-66.
Bertelsen K. Tumor reduction surgery and long-term survival in advanced ovarian cancer: a DACOVA study. Gynecol Oncol. 1990;38:2039.
Venesmaa P. Epithelial ovarian cancer: impact of surgery and chemotherapy on survival during 1977–1990. Obstet Gynecol. 1994;84:8-11.
Dauplat J, Le Bouëdec G, Pomel C, Scherer C. Cytoreductive surgery for advanced stages of ovarian cancer. Semin Surg Oncol. 2000;19(1):42-8.
Piver MS, Lele SB, Marchetti DL, Baker TR, Tsukada Y, Emrich LJ. Impact of aggressive debulking surgery and cisplatin-based chemotherapy on progression free survival in stage III and IV ovarian carcinoma. J Clin Oncol.1988;6:983-9.
Wu PC, Lang JH, Huang RL, Qu JY, Wang H, Tang MY et al. Lymph node metastasis and retroperitoneal lymphadenectomy in ovarian cancer. Baillieres Clin Obstet Gynaecol. 1989;3:143-55.
Eisenkop SM, Spirtos NM, Montag TW, Nalick RH, Wang HJ. The impact of subspecialty training on the management of advanced ovarian cancer. Gynecol Oncol.1992;47:203-9.
Michel G, De Iaco P, Castaigne D, el-Hassan MJ, Lobreglio R, Lhommé C et al. Extensive cytoreductive surgery in advanced ovarian carcinoma. Eur J Gynaec Oncol. 1997;18:9-15.
Eisenkop SM, Friedman RL, Wang HJ. Complete cytoreductive surgery is feasible and maximizes survival in patients with advanced epithelial ovarian cancer: a prospective study. Gynecol Oncol. 1998;69:103=8.
Iyer VR, Lee SI. MRI, CT and PET/CT for Ovarian Cancer Detection and Adnexal Lesion Characterization. Am J Roentgenol. 2010;194:311-21.
Fagotti A, Ferrandina G, Fanfani F, Garganese G, Vizzielli G, Carone et al. Prospective validation of a laparoscopic predictive model for optimal cytoreduction in advanced ovarian carcinoma. Am J Obstet Gynecol. 2008;199:642.e1-642.e6.
