Is complete cytoreductive surgery feasible in this patient with ovarian cancer?

Abstract

BackgroundPost-operative residual tumor size is the main prognostic factor in advanced epithelial ovarian cancer. Our objective was to develop a score for predicting the feasibility of complete cytoreductive surgery in patients with advanced epithelial ovarian cancer. Material and methodsUsing data from a retrospective cohort of 123 patients with advanced ovarian cancer, we developed a score for predicting complete cytoreductive surgery, by performing multiple logistic regression after a jackknife procedure. ResultsThree criteria were independently associated with incomplete cytoreductive surgery confirmed by surgery: age >60 years (adjusted odds ratio [aOR], 6.37; 95% confidence interval [95%CI], 1.9–21.3), diaphragmatic carcinomatosis by computed tomography (aOR, 3.34; 95%CI, 1.1–9.9), and a Peritoneal Cancer Index >10 by diagnostic laparoscopy (aOR, 3.8; 95%CI, 1.4–10.2). A 10-point score was developed based on these three criteria. The area-under-the-curve of the score was 0.76 (95%CI, 0.67–0.86). The score discriminated between groups with low and high risks of incomplete cytoreductive surgery (4.4% [95% CI, 0–10.5] and 42.9% [95% CI, 26.3–59.4], respectively). Using a cutoff of 4, sensitivity of the score was 92.8% (95%CI, 83.2–100) and specificity was 77% (95%CI, 67.1–84.9) for predicting incomplete cytoreductive surgery. ConclusionThis easy-to-calculate score may prove useful to identify patients with ovarian peritoneal carcinomatosis in whom complete cytoreductive surgery is feasible.