Pleural effusion detected at CT prior to primary cytoreduction for stage III or IV ovarian carcinoma: Effect on survival Journal Article


Authors: Mironov, O.; Ishill, N. M.; Mironov, S.; Vargas, H. A.; Zheng, J.; Moskowitz, C. S.; Sonoda, Y.; Papas, R. S.; Chi, D. S.; Hricak, H.
Article Title: Pleural effusion detected at CT prior to primary cytoreduction for stage III or IV ovarian carcinoma: Effect on survival
Abstract: Purpose: To determine the prognostic importance of pleural effusions on preoperative computed tomographic (CT) images in patients with advanced epithelial ovarian cancer. Materials and Methods: The institutional review board waived informed consent for this HIPAA-compliant study of 203 patients with International Federation of Obstetrics and Gynecology stage III (n = 172) or IV (n = 31) epithelial ovarian cancer who underwent CT before primary cytoreductive surgery between 1997 and 2004 (mean age, 61 years; range, 37-96 years). Two radiologists retrospectively evaluated chest and/or abdominal CT images for pleural malignancy and the presence, size, and laterality of pleural effusions. To evaluate survival, Kaplan-Meier methods were used, with log-rank P values for comparisons. Multivariate analyses were conducted by using Cox proportional hazards regression. κ Statistics were calculated for interreader agreement. Results: Median survival was 50 months (95% confidence interval [CI]: 45, 55 months) for patients with stage III disease and 41 months (95% CI: 27, 58 months) for patients with stage IV disease. Readers 1 and 2 found pleural effusions in 40 and 41 stage III and 20 and 21 stage IV patients, respectively. At multivariate analysis, after controlling for stage, age at surgery, preoperative serum CA-125 level, debulking status, and ascites, moderate-to-large pleural effusion on CT images was significantly associated with worse overall survival (reader 1: hazard ratio = 2.27 [95% CI: 1.31, 3.92], P < .01; reader 2: hazard ratio = 2.25 [95% CI: 1.26, 4.01], P = .02). Preoperative CA-125 level, debulking status, and ascites were also significant survival predictors (P ≤ .03 for all for both readers). Readers agreed substantially in distinguishing small from moderate-to-large effusions (κ = 0.764). Conclusion: Moderate-to-large pleural effusion on preoperative CT images in patients with stage III or IV epithelial ovarian cancer was independently associated with poorer overall survival after controlling for age, preoperative CA-125 level, surgical stage, ascites, and cytoreductive status. © RSNA, 2011.
Keywords: adult; aged; major clinical study; overall survival; ascites; cancer staging; cytoreductive surgery; computer assisted tomography; image analysis; retrospective study; health status; preoperative period; ovary carcinoma; pleura effusion; cross-sectional study; ca 125 antigen
Journal Title: Radiology
Volume: 258
Issue: 3
ISSN: 0033-8419
Publisher: Radiological Society of North America, Inc.  
Date Published: 2011-03-01
Start Page: 776
End Page: 784
Language: English
DOI: 10.1148/radiol.10100162
PROVIDER: scopus
PUBMED: 21193598
PMCID: PMC3713162
DOI/URL:
Notes: --- - "Export Date: 23 June 2011" - "CODEN: RADLA" - "Source: Scopus"
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MSK Authors
  1. Junting Zheng
    133 Zheng
  2. Dennis S Chi
    496 Chi
  3. Yukio Sonoda
    286 Sonoda
  4. Chaya S. Moskowitz
    173 Moskowitz
  5. Svetlana Mironov
    37 Mironov
  6. Hedvig Hricak
    333 Hricak
  7. Nicole Marie Leoce
    86 Leoce