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Randomized Controlled Trial
. 2018 Jun;149(3):525-530.
doi: 10.1016/j.ygyno.2018.03.043. Epub 2018 Mar 15.

Correlation between Surgeon's assessment and radiographic evaluation of residual disease in women with advanced stage ovarian cancer reported to have undergone optimal surgical cytoreduction: An NRG Oncology/Gynecologic Oncology Group study

Ramez N Eskander  1 , James Kauderer  2 , Krishnansu S Tewari  3 , Robert S Mannel  4 , Robert E Bristow  5 , David M O'Malley  6 , Stephen C Rubin  7 , Gretchen E Glaser  8 , Chad A Hamilton  9 , Keiichi Fujiwara  10 , Warner K Huh  11 , Frederick Ueland  12 , Jean-Marie Stephan  13 , Robert A Burger  14
Affiliations
Randomized Controlled Trial

Correlation between Surgeon's assessment and radiographic evaluation of residual disease in women with advanced stage ovarian cancer reported to have undergone optimal surgical cytoreduction: An NRG Oncology/Gynecologic Oncology Group study

Ramez N Eskander et al. Gynecol Oncol. 2018 Jun.

Abstract

Purpose: We sought to determine the level of concordance among surgeons' assessment of residual disease (RD) and pre-treatment computed tomography (CT) findings among women who underwent optimal surgical cytoreduction for advanced stage ovarian cancer.

Methods: This is a post-trial ad hoc analysis of a phase 3 randomized clinical trial evaluating the impact of bevacizumab in primary and maintenance therapy for patients with advanced stage ovarian cancer following surgical cytoreduction. All subjects underwent imaging of the chest/abdomen/pelvis to establish a post-surgical baseline prior to the initiation of chemotherapy. Information collected on trial was utilized to compare surgeon's operative assessment of RD, to pre-treatment imaging.

Results: Of 1873 enrolled patients, surgical outcome was described as optimal (RD≤1cm) in 639 subjects. Twelve patients were excluded as they did not have a baseline, pretreatment imaging, leaving 627 participants for analysis. The average interval from surgery to baseline scan was 26days (range: 1-109). In 251 cases (40%), the post-operative scan was discordant with surgeon assessment, demonstrating RD>1cm in size. RD>1cm was most commonly identified in the right upper quadrant (28.4%), retroperitoneal para-aortic lymph nodes (RD>1.5cm; 28.2%) and the left upper quadrant (10.7%). Patients with RD>1cm on pre-treatment CT (discordant) exhibited a significantly greater risk of disease progression (HR 1.30; 95% CI 1.08-1.56; p=0.0059).

Conclusions: Among patients reported to have undergone optimal cytoreduction, 40% were found to have lesions >1cm on postoperative, pretreatment imaging. Although inflammatory changes and/or rapid tumor regrowth could account for the discordance, the impact on PFS and distribution of RD may suggest underestimation by the operating surgeon.

Trial registration: ClinicalTrials.gov NCT00262847.

Keywords: GOG; NRG; Ovarian cancer; Radiographic evaluation; Surgeon's assessment; Surgical cytoreduction.

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Conflict of interest statement

Conflicts of Interest

Dr. Eskander wishes to disclose that he received personal fees from AZ Oncology, Clovis Oncology and Genentech.

Dr. Tewari reports that his institution received a research grant from Genentech and that he has participated on 2 advisory boards for Genentech.

Dr. O’Malley reports personal fees from Clovis, Astra Zeneca, Tesara, Myriad, Amgen, Novocure, Janssen Oncology, Health Analytics, outside the submitted work for advisory boards and/or consulting and that his institution receives money from multiple industrial sponsored trials that he is the local PI on.

Dr. Fujiwara reports that he has received grants from Kaken, Shionogi and Chugai, grants and personal fees from Astra Zeneca, Pfizer, Eisai, MSD, Taiho, Zeria, Ono, GSK and Lilly. Dr. Fujiwara also reports that he has received grants from Immunogen and Oncotherapy as well as personal fees from Nihon Kayaku, Novartis, Kyowahakko Kirin, Janssen, Asahikasei Medical and Daiichi Sankyo, outside of the submitted work.

Dr. Burger reports personal fees and other from Amgen, AstraZeneca, Genentech/Roche, Clovis Oncology, personal fees from Gradalis, Invitae, Janssen Research & Development, Morphotek, NuCana, Tesaro, VBL Therapeutics, outside the submitted work.

All other authors have nothing to disclose.

Figures

Figure 1:
Figure 1:
Time interval from surgery to baseline computed tomography scan
Figure 2:
Figure 2:
Location of residual disease identified on baseline scan
Figure 3:
Figure 3:
Progression free survival in the discordant and concordant cohorts
See this image and copyright information in PMC

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