Evaluation of Computed Tomography Scan and CA 125 Response in Predicting Operability in Advanced Ovarian Cancer and Assessing Survival Outcome in Interval Cytoreductive Surgery

Abstract Background Epithelial ovarian cancer is usually diagnosed at advanced stages. To choose the best therapeutic approach, an accurate assessment of the tumor spread is crucial. This study aimed to determine whether numeric scoring, the amount of ascites, and the presence of cardiophrenic nodes (CPLNs) visualized by computed tomography (CT), can predict the tumor extent and improve the outcome of AOC upfront surgery. Methods This single center retrospective analysis of 194 patients diagnosed with AOC included 119 patients treated with upfront surgery at the Skåne University Hospital, Lund, Sweden, from January 2016 to December 2018. CT based peritoneal cancer index (PCI) scores, enlarged cardiophrenic lymph nodes (CPLNs), and the amount of ascites were correlated to the surgical PCI (S-PCI) and the completeness of the cytoreductive surgery.The patients were grouped according to the residual disease (RD) and the overall survival (OS) rates for the three groups were determined using Kaplan-Meier curves. Linear regression and the interclass correlation (ICC) analyses were used to determine the relationship between CT-PCI and S-PCI. Results The survival rate was significantly higher in patients with no macroscopic residual disease compared those with residual disease <10 mm (p<0.03) or residual disease ≥10 mm (p<0.005). S-PCI and large ascites volumes were correlated with the risk of suboptimal residual disease (for ascites > 1000 ml, OR 5.5626 (1.665-19.007) p<0.019; for S-PCI, OR 1.24 (1.141-1.348), p<0.001). CT-PCI, CA-125 level and CPLN were not predictive of the cytoreductive surgery results in the adjusted data to days from CT to operation and for ascites. CT-PCI correlated well to S-PCI ((95%) CI: 0.397 (0.252-0.541) p<0.001). Conclusions CT is a reliable tool for assessing the extent of the disease in AOC, but it has limitations in predicting surgical outcome. This study was unable to show an association between the CT-PCI and surgical outcome when the data were adjusted and ascites, CA-125 level, days between the CT examination to surgery and CPLN. Ascites volumes exceeding 1000 ml increased the risk of residual disease and thereby worse outcome. That certain areas (e.g., small bowel region) are particularly critical when evaluating surgical outcome using preoperative CT-PCI warrants further investigation.

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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

Gynecologic Oncology ◽

10.1016/j.ygyno.2014.07.002 ◽

2014 ◽

Vol 134 (3) ◽

pp. 455-461 ◽

Cited By ~ 107

Author(s):

Rudy S. Suidan ◽

Pedro T. Ramirez ◽

Debra M. Sarasohn ◽

Jerrold B. Teitcher ◽

Svetlana Mironov ◽

...

Keyword(s):

Computed Tomography ◽

Fallopian Tube ◽

Prospective Trial ◽

Ca 125 ◽

Computed Tomography Scan ◽

Debulking Surgery ◽

Peritoneal Cancer ◽

Primary Debulking Surgery ◽

Tomography Scan

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A multicenter assessment of the ability of preoperative computed tomography scan and serum CA-125 to predict gross residual disease at primary debulking surgery for advanced ovarian, fallopian tube and peritoneal cancer

Gynecologic Oncology ◽

10.1016/j.ygyno.2015.01.023 ◽

2015 ◽

Vol 137 ◽

pp. 11

Author(s):

R.S. Suidan ◽

P.T. Ramirez ◽

D. Sarasohn ◽

J. Teitcher ◽

S. Mironov ◽

...

Keyword(s):

Computed Tomography ◽

Fallopian Tube ◽

Residual Disease ◽

Ca 125 ◽

Computed Tomography Scan ◽

Debulking Surgery ◽

Peritoneal Cancer ◽

Primary Debulking Surgery ◽

Tomography Scan

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Adipose tissue area as a predictor for the efficacy of apatinib in platinum-resistant ovarian cancer: an exploratory imaging biomarker analysis of the AEROC trial

BMC Medicine ◽

10.1186/s12916-020-01733-4 ◽

2020 ◽

Vol 18 (1) ◽

Author(s):

Xin Huang ◽

Chuanbo Xie ◽

Jie Tang ◽

Wenzhuo He ◽

Fan Yang ◽

...

Keyword(s):

Computed Tomography ◽

Ovarian Cancer ◽

Adipose Tissue ◽

Response Rate ◽

Objective Response ◽

Oral Etoposide ◽

Computed Tomography Scan ◽

Platinum Resistant ◽

Platinum Refractory ◽

Tomography Scan

Abstract Background Vascular endothelial growth factor (VEGF)-targeted therapy is effective in patients with ovarian cancer. Whether adipose tissue (AT) could predict the efficacy of VEGF receptor (VEGFR) inhibitors in ovarian cancer is unknown. We aimed to evaluate the ability of distinct AT depots to predict the efficacy of apatinib, a VEGFR inhibitor, in recurrent ovarian cancers included in the AEROC trial. Methods The AEROC was a single-arm phase 2 trial of apatinib and oral etoposide in patients with platinum-resistant or platinum-refractory ovarian cancer. Apatinib was administered continuously, and oral etoposide was administered every 21 days for a maximum of six cycles. This was a post hoc study based on the AEROC trial. Areas of visceral AT (VAT), subcutaneous AT (SAT), and intermuscular AT (IMAT) were measured using computed tomography scan at baseline to assess their association with the objective response rate, progression-free survival, and overall survival. Results Of the 35 treated patients, 31 patients with at least one post-baseline efficacy assessment by computed tomography scan were included in this study. After adjusting for apatinib exposure, high VAT (odds ratio [OR], 0.16; 95% confidence interval [CI], 0.03–0.90, P = 0.037) and SAT (OR, 0.16; 95% CI, 0.03–0.87, P = 0.034) were significantly associated with a higher objective response rate. Further, decreased risks of disease progression and death were associated with high VAT (hazard ratio [HR], 0.39; 95% CI, 0.17–0.92, P = 0.031, and HR, 0.12; 95% CI, 0.04–0.40, P < 0.001, respectively), SAT (HR, 0.35; 95% CI, 0.15–0.83, P = 0.027, and HR, 0.24; 95% CI, 0.08–0.67, P = 0.007, respectively), and IMAT (HR, 0.20; 95% CI, 0.06–0.74, P = 0.016, and HR, 0.13; 95% CI, 0.03–0.62, P = 0.011, respectively). Conclusions High areas of VAT, SAT, and IMAT were significantly associated with better outcomes in patients with platinum-resistant or platinum-refractory ovarian cancer who received VEGFR inhibitors. AT assessments may be valuable as patient-specific imaging biomarkers for predicting response to VEGFR inhibitors. Trial registration ClinicalTrials.gov identifier: NCT02867956.

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