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Clinical Trial
. 2014 Sep;134(3):455-61.
doi: 10.1016/j.ygyno.2014.07.002. Epub 2014 Jul 11.

A multicenter prospective trial evaluating the ability of preoperative computed tomography scan and serum CA-125 to predict suboptimal cytoreduction at primary debulking surgery for advanced ovarian, fallopian tube, and peritoneal cancer

Rudy S Suidan  1 , Pedro T Ramirez  2 , Debra M Sarasohn  3 , Jerrold B Teitcher  3 , Svetlana Mironov  3 , Revathy B Iyer  4 , Qin Zhou  5 , Alexia Iasonos  5 , Harold Paul  1 , Masayoshi Hosaka  2 , Carol A Aghajanian  6 , Mario M Leitao Jr  7 , Ginger J Gardner  7 , Nadeem R Abu-Rustum  7 , Yukio Sonoda  7 , Douglas A Levine  7 , Hedvig Hricak  3 , Dennis S Chi  8
Affiliations
Clinical Trial

A multicenter prospective trial evaluating the ability of preoperative computed tomography scan and serum CA-125 to predict suboptimal cytoreduction at primary debulking surgery for advanced ovarian, fallopian tube, and peritoneal cancer

Rudy S Suidan et al. Gynecol Oncol. 2014 Sep.

Abstract

Objective: To assess the ability of preoperative computed tomography (CT) scan of the abdomen/pelvis and serum CA-125 to predict suboptimal (>1cm residual disease) primary cytoreduction in advanced ovarian, fallopian tube, and peritoneal cancer.

Methods: This was a prospective, non-randomized, multicenter trial of patients who underwent primary cytoreduction for stage III-IV ovarian, fallopian tube, and peritoneal cancer. A CT scan of the abdomen/pelvis and serum CA-125 were obtained within 35 and 14 days before surgery, respectively. Four clinical and 20 radiologic criteria were assessed.

Results: From 7/2001 to 12/2012, 669 patients were enrolled; 350 met eligibility criteria. The optimal debulking rate was 75%. On multivariate analysis, three clinical and six radiologic criteria were significantly associated with suboptimal debulking: age ≥ 60 years (p=0.01); CA-125 ≥ 500 U/mL (p<0.001); ASA 3-4 (p<0.001); suprarenal retroperitoneal lymph nodes >1cm (p<0.001); diffuse small bowel adhesions/thickening (p<0.001); and lesions >1cm in the small bowel mesentery (p=0.03), root of the superior mesenteric artery (p=0.003), perisplenic area (p<0.001), and lesser sac (p<0.001). A 'predictive value score' was assigned for each criterion, and the suboptimal debulking rates of patients who had a total score of 0, 1-2, 3-4, 5-6, 7-8, and ≥ 9 were 5%, 10%, 17%, 34%, 52%, and 74%, respectively. A prognostic model combining these nine factors had a predictive accuracy of 0.758.

Conclusions: We identified nine criteria associated with suboptimal cytoreduction, and developed a predictive model in which the suboptimal rate was directly proportional to a predictive value score. These results may be helpful in pretreatment patient assessment.

Keywords: CA-125; CT scan; Ovarian cancer; Suboptimal cytoreduction.

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Figures

Figure 1
Figure 1
CONSORT diagram of all enrolled patients. CT, computed tomography; IV, intravenous.
See this image and copyright information in PMC

References

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