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 Journal Article
| Authors: | Suidan, R. S.; Ramirez, P. T.; Sarasohn, D. M.; Teitcher, J. B.; Mironov, S.; Iyer, R. B.; Zhou, Q.; Iasonos, A.; Paul, H.; Hosaka, M.; Aghajanian, C. A.; Leitao, M. M. Jr; Gardner, G. J.; Abu-Rustum, N. R.; Sonoda, Y.; Levine, D. A.; Hricak, H.; Chi, D. S. |
| Article Title: | 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 |
| Abstract: | 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. 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. 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. 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. Copyright © 2014 Elsevier Inc. All rights reserved. |
| Keywords: | adult; aged; aged, 80 and over; middle aged; clinical trial; preoperative care; cancer staging; neoplasm staging; prospective study; prospective studies; ovarian cancer; ovarian neoplasms; computer assisted tomography; ovary cancer; peritoneal neoplasms; tomography, x-ray computed; blood; multicenter study; ovary tumor; ca 125 antigen; ca-125; ca-125 antigen; fallopian tube neoplasms; peritoneum tumor; uterine tube tumor; ct scan; very elderly; humans; prognosis; human; female; article; suboptimal cytoreduction |
| Journal Title: | Gynecologic Oncology |
| Volume: | 134 |
| Issue: | 3 |
| ISSN: | 0090-8258 |
| Publisher: | Elsevier Inc. |
| Date Published: | 2014-09-01 |
| Start Page: | 455 |
| End Page: | 461 |
| Language: | English |
| DOI: | 10.1016/j.ygyno.2014.07.002 |
| PUBMED: | 25019568 |
| PROVIDER: | scopus |
| PMCID: | PMC4387777 |
| DOI/URL: | |
| Notes: | Export Date: 1 December 2014 -- Source: Scopus |
Altmetric
Citation Impact
BMJ Impact Analytics
MSK Authors
Related MSK Work