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

作者：Suidan Rudy S; Ramirez Pedro T; Sarasohn Debra M; Teitcher Jerrold B; Mironov Svetlana; Iyer Revathy B; Zhou Qin; Iasonos Alexia; Paul Harold; Hosaka Masayoshi; Aghajanian Carol A; Leitao Mario M Jr; Gardner Ginger J; Abu Rustum Nadeem R; Sonoda Yukio; Levine Douglas A; Hricak Hedvig; Chi Dennis S^*

来源：Gynecologic Oncology, 2014, 134(3): 455-461.

DOI：10.1016/j.ygyno.2014.07.002

• Ovarian cancer
• CA-125
• CT scan
• Suboptimal cytoreduction

Objective. To assess the ability of preoperative computed tomography (CT) scan of the abdomen/pelvis and serum CA-125 to predict suboptimal (>1 cm residual disease) primary cytoreduction in advanced ovarian, fallopian tube, and peritoneal cancer.
Methods. 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 CF 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.
Results. From 7/2001 to 12/2012,669 patients were enrolled; 350 met eligibility criteria. The optimal debulldng 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 >1 cm (p < 0.001); diffuse small bowel adhesions/thickening (p < 0.001); and lesions >1 cm 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.
Conclusions. 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.

• 出版日期2014-9