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. 2015 Sep;138(3):554-9.
doi: 10.1016/j.ygyno.2015.06.010. Epub 2015 Jun 17.

Incorporation of postoperative CT data into clinical models to predict 5-year overall and recurrence free survival after primary cytoreductive surgery for advanced ovarian cancer

Irene A Burger  1 , Debra A Goldman  2 , Hebert Alberto Vargas  3 , Michael W Kattan  4 , Changhon Yu  4 , Lei Kou  4 , Vaagn Andikyan  5 , Dennis S Chi  5 , Hedvig Hricak  3 , Evis Sala  3
Affiliations

Incorporation of postoperative CT data into clinical models to predict 5-year overall and recurrence free survival after primary cytoreductive surgery for advanced ovarian cancer

Irene A Burger et al. Gynecol Oncol. 2015 Sep.

Abstract

Purpose: The use of multivariable clinical models to assess postoperative prognosis in ovarian cancer increased. All published models incorporate surgical debulking. However, postoperative CT can detect residual disease (CT-RD) in 40% of optimally resected patients. The aim of our study was to investigate the added value of incorporating CT-RD evaluation into clinical models for assessment of overall survival (OS) and progression free survival (PFS) in patients after primary cytoreductive surgery (PCS).

Methods: 212 women with PCS for advanced ovarian cancer between 01/1997 and 12/2011, and a contrast enhanced abdominal CT 1-7 weeks after surgery were included in this IRB approved retrospective study. Two radiologists blinded to clinical data, evaluated all CT for the presence of CT-RD, and Cohen's kappa assessed agreement. Cox proportional hazards regression with stepwise selection was used to develop OS and PFS models, with CT-RD incorporated afterwards. Model fit was assessed with bootstrapped Concordance Probability Estimates (CPE), accounting for over-fitting bias by correcting the initial estimate after repeated subsampling.

Results: Readers agreed on the majority of cases (179/212, k=0.68). For OS and PFS, CT-RD was significant after adjusting for clinical factors with a CPE 0.663 (p=0.0264) and 0.649 (p=0.0008). CT-RD was detected in 37% of patients assessed as optimally debulked (RD<1cm) and increased the risk of death (HR: 1.58, 95% CI: 1.06-2.37%).

Conclusion: CT-RD is a significant predictor after adjusting for clinical factors for both OS and PFS. Incorporating CT-RD into the clinical model improved the prediction of OS and PFS in patients after PCS for advanced ovarian cancer.

Keywords: Debulking; Ovarian carcinoma; Residual disease; Survival.

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Conflict of interest statement

Conflict of Interest: There is no potential conflict of interest relevant to this article.

Figures

Figure 1
Figure 1. A) Overall and B) Progression Free Survival after cytoreductive surgery
Figure 2
Figure 2
A) Overall Survival Nomogram and B) Model Calibration. Instruction: Locate the patient's preoperative albumin value on the axis. Draw upwards to the Points axis to determine the value for the patient's preoperative albumin regarding the survival probability. Repeat this for the other axes and sum up the points for each predictor. Locate this value on the Total Points axis and draw a straight line down to the patient's probability to survive 5 years.
Figure 3
Figure 3. A) Progression Free Survival Nomogram and B) Model Calibration
See this image and copyright information in PMC

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