scholarly journals The role of computed tomography in predicting peritoneal carcinomatosis and upfront surgery outcome in advanced ovarian cancer

2020 ◽  
Author(s):  
Mihaela Asp ◽  
Susanne Malander ◽  
NilsOlof Wallengren ◽  
Sonja Pudaric ◽  
Johan Bengtsson ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Ovarian Cancer ◽  
Surgical Outcome ◽  
Residual Disease ◽  
Peritoneal Cancer Index ◽  
Advanced Ovarian Cancer ◽  
University Hospital ◽  
Ca 125 ◽  
Tumor Spread ◽  
Surgery Outcome

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.

Feasibility of Transabdominal Cardiophrenic Lymphnode Dissection in Advanced Ovarian Cancer: Initial Experience at a Tertiary Center

2017 ◽  
Vol 27 (6) ◽  
pp. 1268-1273 ◽  
Author(s):  
Annalisa Garbi ◽  
Vanna Zanagnolo ◽  
Nicoletta Colombo ◽  
Giovanni Aletti ◽  
Maria Teresa Achilarre ◽  
...  
Keyword(s):  
Ovarian Cancer ◽  
Surgical Procedures ◽  
Residual Disease ◽  
Peritoneal Cancer Index ◽  
Advanced Ovarian Cancer ◽  
Tube Placement ◽  
Histopathological Study ◽  
Abdominal Disease ◽  
Estimated Blood Loss ◽  
Tertiary Center

ObjectivesThe purpose of this retrospective report is to define the safety and feasibility, based on our preliminary experience, of surgical transdiaphragmatic resection of enlarged cardiophrenic lymph nodes (CPLNs), as a part of upfront debulking surgery. Supradiaphragmatic nodes located between the diaphragm and the heart are frequently a location for lymph node metastasis in advanced ovarian cancer, and their removal is aimed to obtain no gross residual disease at the primary cytoreductive surgery often requiring aggressive surgical procedures.Patients and MethodsBetween May 2012 and October 2016, a total of 22 patients among 443 with advanced high-grade serous ovarian cancer underwent cytoreductive procedures involving transdiaphragmatic resection of enlarged CPLNs at European Institute of Oncology in Milan.ResultsAll patients who underwent CPLN resection had an extensive disease (median peritoneal cancer index, 18), and more than 77% required complex surgical procedures (complexity score, 3). No residual abdominal disease less than 5 mm at the end of surgery was described in 20 (90%) out of 22. All patients but one had confirmed CPLN positive nodes at histopathological study. The average operative time was 333 min (range, 244–455 min), and the average estimated blood loss was 1000 mL (range, 400–2000 mL). Blood transfusion was necessary in 13 out of 22 patients. Only 7 (33%) out of 21 patients required chest tube placement during the postoperative period.ConclusionsTransdiaphragmatic enlarged CPLN resection seems to be safe and feasible procedure when indicated to achieve no or minimal tumor residual disease. Nevertheless, its impact on survival of patients with stage IV ovarian cancer needs to be determined.

Multi-Institutional Reciprocal Validation Study of Computed Tomography Predictors of Suboptimal Primary Cytoreduction in Patients With Advanced Ovarian Cancer

2007 ◽  
Vol 25 (4) ◽  
pp. 384-389 ◽  
Author(s):  
Allison E. Axtell ◽  
Margaret H. Lee ◽  
Robert E. Bristow ◽  
Sean C. Dowdy ◽  
William A. Cliby ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Ovarian Cancer ◽  
Predictive Models ◽  
Cross Validation ◽  
Residual Disease ◽  
Advanced Ovarian Cancer ◽  
High Accuracy ◽  
Ct Scans ◽  
Preoperative Ct ◽  
Accuracy Rates

Purpose Identify features on preoperative computed tomography (CT) scans to predict suboptimal primary cytoreduction in patients treated for advanced ovarian cancer in institution A. Reciprocally cross validate the predictors identified with those from two previously published cohorts from institutions B and C. Patients and Methods Preoperative CT scans from patients with stage III/IV epithelial ovarian cancer who underwent primary cytoreduction in institution A between 1999 and 2005 were retrospectively reviewed by radiologists blinded to surgical outcome. Fourteen criteria were assessed. Crossvalidation was performed by applying predictive model A to the patients from cohorts B and C, and reciprocally applying predictive models B and C to cohort A. Results Sixty-five patients from institution A were included. The rate of optimal cytoreduction (≤ 1 cm residual disease) was 78%. Diaphragm disease and large bowel mesentery implants were the only CT predictors of suboptimal cytoreduction on univariate (P < .02) and multivariate analysis (P < .02). In combination (model A), these predictors had a sensitivity of 79%, a specificity of 75%, and an accuracy of 77% for suboptimal cytoreduction. When model A was applied to cohorts B and C, accuracy rates dropped to 34% and 64%, respectively. Reciprocally, models B and C had accuracy rates of 93% and 79% in their original cohorts, which fell to 74% and 48% in cohort A. Conclusion The high accuracy rates of CT predictors of suboptimal cytoreduction in the original cohorts could not be confirmed in the cross validation. Preoperative CT predictors should be used with caution when deciding between surgical cytoreduction and neoadjuvant chemotherapy.

Pre-operative assessment of intra-abdominal disease spread in epithelial ovarian cancer: a comparative study between ultrasound and computed tomography

2019 ◽  
Vol 29 (2) ◽  
pp. 227-233 ◽  
Author(s):  
Juan Luis Alcázar ◽  
María Caparros ◽  
Maria Arraiza ◽  
José Ángel Mínguez ◽  
Stefano Guerriero ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Ovarian Cancer ◽  
Epithelial Ovarian Cancer ◽  
Diagnostic Performance ◽  
Residual Disease ◽  
Kappa Index ◽  
Debulking Surgery ◽  
Abdominal Tumor ◽  
Tumor Spread ◽  
Abdominal Disease

ObjectiveTo compare the diagnostic performance of ultrasound and computed tomography (CT) for detecting pelvic and abdominal tumor spread in women with epithelial ovarian cancer.MethodsAn observational cohort study of 93 patients (mean age 57.6 years) with an ultrasound diagnosis of adnexal mass suspected of malignancy and confirmed histologically as epithelial ovarian cancer was undertaken. In all cases, transvaginal and transabdominal ultrasound as well as CT scans were performed to assess the extent of the disease within the pelvis and abdomen prior to surgery. The exploration was systematic, analyzing 12 anatomical areas. All patients underwent surgical staging and/or cytoreductive surgery with an initial laparoscopy for assessing resectability. The surgical and pathological findings were considered as the 'reference standard'. Sensitivity and specificity of ultrasound and CT scanning were calculated for the different anatomical areas and compared using the McNemar test. Agreement between ultrasound and CT staging and the surgical stage was estimated using the weighted kappa index.ResultsThe tumorous stage was International Federation of Gynecology and Obstetrics (FIGO) stage I in 26 cases, stage II in 11 cases, stage III in 47 cases, and stage IV in nine cases. Excluding stages I and IIA cases (n=30), R0 (no macroscopic residual disease) was achieved in 36 women (62.2%), R1 (macroscopic residual disease <1 cm) was achieved in 13 women (25.0%), and R2 (macroscopic residual disease >1 cm) debulking surgery occurred in three women (5.8%). Eleven patients (11.8%) were considered not suitable for optimal debulking surgery during laparoscopic assessment. Overall sensitivity of ultrasound and CT for detecting disease was 70.3% and 60.1%, respectively, and specificity was 97.8% and 93.7%, respectively. The agreement between radiological stage and surgical stage for ultrasound (kappa index 0.69) and CT (kappa index 0.70) was good for both techniques. Overall accuracy to determine tumor stage was 71% for ultrasound and 75% for CT.ConclusionDetailed ultrasound examination renders a similar diagnostic performance to CT for assessing pelvic/abdominal tumor spread in women with epithelial ovarian cancer.

scholarly journals The clinical and pathological characteristics and survival of patients with advanced ovarian cancer

2021 ◽  
Vol 52 (3) ◽  
pp. 205-210
Author(s):  
Miroslav Popović ◽  
Tanja Milić-Radić ◽  
Arnela Cerić-Banićević
Keyword(s):  
Ovarian Cancer ◽  
Residual Disease ◽  
Advanced Ovarian Cancer ◽  
Figo Stage ◽  
Ovarian Tumour ◽  
Ca 125 ◽  
Optimal Cytoreduction ◽  
Chi Square ◽  
Pathological Characteristics ◽  
Significant Difference

Introduction: Ovarian cancer has the highest mortality rate of all gynaecologic malignancies. The aim of this study was the evaluation of the clinical pathological characteristics and survival analysis of primarily operated patients with advanced stages of malignant epithelial ovarian tumour. Methods: The research was conducted as a cohort study with 59 patients with FIGO stage III and IV, which were primarily operated between 1 January 2008 and 31 December 2010 (three years). Age, comorbidities, BMI, presence of ascites, the level of the marker CA-125, histopathology and FIGO stage were analysed. The survival rate was estimated at the level of 1, 3 and 5 years. Results: The median age was 53 years (range 29-86). The most common histopathological type was serous (66.1 %) and the most common FIGO stage was 3a (49.2 %). Optimal cytoreduction was performed in 35.5 % of patients, 84.7 % of patients survived for one year, 44.1 % three years and 37.3 % for five years. The median survival was 26.25 months (range 0-91). Chi-square test showed significant difference between the number of months of survival and: the value of CA125 (t = 2.004, p = 0.050), cytoreduction (p < 0.001) and FIGO stage (p < 0.01). Conclusion: According to the results of this study, optimal cytoreduction and FIGO stage significantly influence survival (p < 0.001). Optimal cytoreduction (< 2 cm of residual disease) had the highest prognostic value for survival. A total five-year survival in this study was 37.3 %.

Pazopanib (Paz) monotherapy in Asian women who have not progressed after first-line chemotherapy for advanced ovarian, Fallopian tube, or primary peritoneal carcinoma.

2013 ◽  
Vol 31 (15_suppl) ◽  
pp. 5512-5512 ◽  
Author(s):  
Rongyu Zang ◽  
Lingying Wu ◽  
Jianqing Zhu ◽  
Beihua Kong ◽  
Byoung-Gie Kim ◽  
...  
Keyword(s):  
Ovarian Cancer ◽  
Fallopian Tube ◽  
Residual Disease ◽  
Advanced Ovarian Cancer ◽  
Figo Stage ◽  
Small Sample ◽  
Stage Ii ◽  
Ca 125 ◽  
Asian Women ◽  
Debulking Surgery

5512 Background: Paz, an oral multikinase inhibitor of VEGF, PDGF and c-Kit has showed activity in advanced ovarian cancer. This study evaluated paz as maintenance therapy in Asian women with advanced ovarian cancer. Methods: Subjects with FIGO stage II, III, or IV ovarian, fallopian tube, or primary peritoneal cancer whose disease had not progressed after debulking surgery and followed by chemotherapy were randomized 1:1 to paz 800 mg once daily or placebo for up to 24 months. Primary endpoint was PFS by RECIST v1.0 based on visit date. If a progression occurred between the 2 scheduled visits (6 mos apart), progression was considered to have occurred at the next scheduled scan date. This minimized potential bias due to any imbalance of visit frequency between the arms. Results: 145 Asian subjects were randomized; 144 were treated. Mean age was 52.9 years. At diagnosis 17% were FIGO stage II, 73% stage III and 10% stage IV. After debulking surgery, 30% (n = 44) had no residual disease and 41% (n = 59) had. 47% (28/59) had residual disease ≤1cm. Prior to randomization, all subjects received median 8 cycles of chemotherapy; all subjects received platinum and taxane. At randomization 81% had ECOG status 0, 97% were disease free and all had normal CA-125. At clinical data cut-off median PFS was 18.1 months in both arms. Because of the small sample size a HR was not calculated but the KM curves indicated a trend in favor of paz from 6 to 18 mos; the curves crossed after 18 mos. The adverse event (AE) profile for paz was similar to previous reports except rates of hypertension and neutropenia were higher. The most frequent AEs (≥ 20%) on the paz arm were hypertension (76%), neutropenia (64%), leucopenia (53%), diarrhea (47%), hair color changes (40%), palm-plantar erythrodysaethesia syndrome (29%), ALT increase (28%), thrombocytopenia (24%), AST increase (22%) and TSH increase (21%). Most of these AEs were Grade 1-2. Conclusions: The results of this study alone cannot confirm the efficacy of paz maintenance treatment in Asian women with ovarian cancer, but should be interpreted in conjunction of AGO-OVAR16 study. Clinical trial information: NCT01227928.

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