Concordance of Radiological, Laparoscopic and Laparotomic Scoring to Predict Complete Cytoreduction in Women with Advanced Ovarian Cancer

Abstract

Objective: To identify the best method among the radiologic, laparoscopic and laparotomic scoring assessment to predict the outcomes of cytoreductive surgery in patients with advanced ovarian cancer (AOC).

Methods: Patients with AOC who underwent pre-operative computed tomography (CT) scan, laparoscopic evaluation, and cytoreductive surgery between August 2016 and February 2021 were retrospectively reviewed. Predictive Index (PI) score and Peritoneal Cancer Index (PCI) scores were used to estimate the tumor load and predict the residual disease in the primary debulking surgery (PDS) and interval debulking surgery (IDS) after neoadjuvant chemotherapy (NACT) groups. Concordance percentages were calculated between the two scores.

Results: Among 100 eligible patients, 69 underwent PDS, and 31 underwent NACT and IDS. Complete cytoreduction was achieved in 72.5% of patients in the PDS group and 77.4% in the IDS. In patients undergoing PDS, the laparoscopic PI and the laparotomic PCI had the best accuracies for complete cytoreduction (R0) [area under the curve (AUC) = 0.78 and AUC = 0.83, respectively]. In the IDS group, the laparotomic PI (AUC = 0.75) and the laparoscopic PCI (AUC= 0.87) were associated with the best accuracy in R0 prediction. Furthermore, radiological assessment, through PI and PCI, was associated with the worst accuracy in either PDS or IDS group (PI in PDS: AUC = 0.64; PCI in PDS: AUC = 0.64; PI in IDS: AUC = 0.46; PCI in IDS: AUC = 0.47).

Conclusion: The laparoscopic score assessment had high accuracy for optimal cytoreduction in AOC patients undergoing PDS or IDS. Integrating diagnostic laparoscopy in the decision-making algorithm to accurately triage AOC patients to different treatment strategies seems necessary.

Keywords: cytoreductive surgery; interval debulking surgery; neoadjuvant chemotherapy; ovarian cancer; peritoneal cancer index score; prediction model; predictive index score; primary debulking surgery.

Figure 1

Agreement between laparoscopic and radiological predictive index (PI) in women who underwent primary debulking surgery.

Figure 2

Agreement between laparotomic and radiological peritoneal cancer index (PCI) in women who underwent primary debulking surgery.

Figure 3

Receiver operating characteristic (ROC) curve comparing radiologic (blue line), laparoscopic (red line), and laparotomic (green line) predictive index (PI) in women who underwent primary debulking surgery.

Figure 4

Receiver operating characteristic (ROC) curve comparing radiologic (blue line), laparoscopic (red line) and laparotomic (green line) peritoneal cancer index (PCI) in women who underwent primary debulking surgery.

Figure 5

Agreement between laparoscopic and radiologic predictive index (PI) modified for interval debulking surgery (IDS).

Figure 6

Agreement between laparotomic and radiologic peritoneal cancer index (PCI) in women undergoing interval debulking surgery.

Figure 7

Receiver operating characteristic (ROC) curve comparing radiologic (blue line), laparoscopic (red line), and laparotomic (green line) predictive index (PI) modified for interval debulking surgery.

Figure 8

Receiver operating characteristic (ROC) curve comparing radiologic (blue line), laparoscopic (red line) and laparotomic (green line) peritoneal cancer index (PCI) in women who underwent interval debulking surgery.