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 Journal Article


Authors: Burger, I. A.; Goldman, D. A.; Vargas, H. A.; Kattan, M. W.; Yu, C.; Kou, L.; Andikyan, V.; Chi, D. S.; Hricak, H.; Sala, E.
Article Title: 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
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 < 1 cm) 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. © 2015 Elsevier Inc.
Keywords: survival; adult; aged; major clinical study; overall survival; postoperative period; advanced cancer; follow up; preoperative evaluation; cytoreductive surgery; progression free survival; computer assisted tomography; retrospective study; risk assessment; diagnostic value; minimal residual disease; contrast enhancement; ovary carcinoma; ovarian carcinoma; debulking; abdominal radiography; recurrence free survival; computed tomography scanner; residual disease; diagnostic test accuracy study; cancer prognosis; human; female; priority journal; article
Journal Title: Gynecologic Oncology
Volume: 138
Issue: 3
ISSN: 0090-8258
Publisher: Elsevier Inc.  
Date Published: 2015-09-01
Start Page: 554
End Page: 559
Language: English
DOI: 10.1016/j.ygyno.2015.06.010
PROVIDER: scopus
PUBMED: 26093061
PMCID: PMC4989241
DOI/URL:
Notes: Export Date: 2 October 2015 -- Source: Scopus
Altmetric Score
MSK Authors
  1. Evis Sala
    95 Sala
  2. Dennis S Chi
    496 Chi
  3. Hedvig Hricak
    330 Hricak
  4. Debra Alyssa Goldman
    94 Goldman
  5. Irene Andrea Burger
    10 Burger