Open AccessA pre-operative predictive score to evaluate the feasibility of complete cytoreductive surgery in patients with epithelial ovarian cancer
Author(s) -
Marion Chesnais,
Fabrice Lécuru,
Myriam Mimouni,
Charlotte Ngô,
Arnaud Fauconnier,
Cyrille Huchon
Publication year - 2017
Publication title -
plos one
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.99
H-Index - 332
ISSN - 1932-6203
DOI - 10.1371/journal.pone.0187245
Subject(s) - medicine , cytoreductive surgery , odds ratio , ovarian cancer , laparoscopy , retrospective cohort study , confidence interval , surgery , epithelial ovarian cancer , population , cancer , environmental health
Objective Postoperative residual tumor is the major prognostic factor in ovarian cancer. The feasibility of complete cytoreductive surgery is assessed by laparoscopy. Our goal was to develop a predictive score prior to laparoscopy to evaluate the feasibility of complete cytoreductive surgery in patients with epithelial ovarian cancer. Methods We developed a score to predict incomplete cytoreductive surgery by performing multiple logistic regressions after bootstrap procedures on data from a retrospective cohort of 247 patients with advanced ovarian cancer. This score was validated on a different population of 45 patients with ovarian cancer. Results Four criteria were independently associated with incomplete cytoreduction, confirmed by surgery: BMI ≥ 30 kg/m 2 (adjusted odds ratio [aOR], 3.07; 95% confidence interval [95% CI], 1.0–9.6), CA125 > 100 IU/L (aOR, 3.99; 95% CI, 1.6–10.1), diaphragmatic and/or omental carcinomatosis by CT-Scan (aOR, 5.82; 95% CI, 2.6–13.1), and positive parenchymal metastases by PET/CT (aOR, 3.59; 95% CI, 1.0–12.8). The 100-point score was based on these criteria. The area-under-the-curve of the score was 0.79 (95% CI, 0.73–0.86). In the validation group, no patient ranked in the high-risk group of incomplete cytoreductive surgery had a complete upfront cytoreductive surgery (95% CI 0–16). Three of 29 patients for whom primary complete cytoreduction was not possible were classified in the group at low risk of incomplete cytoreductive surgery (12%; 95% CI 4–27). Conclusion This pre-operative score may be useful for distinguishing which patients may have complete cytoreductive surgery from those who will receive neoadjuvant chemotherapy, while avoiding unnecessary laparoscopy.