J Gynecol Oncol.  2018 May;29(3):e40. 10.3802/jgo.2018.29.e40.

A score system for complete cytoreduction in selected recurrent ovarian cancer patients undergoing secondary cytoreductive surgery: predictors- and nomogram-based analyses

Affiliations
  • 1Department of Gynecologic Oncology, IRCCS National Cancer Institute, Milan, Italy. laviniamosca@aol.it

Abstract


OBJECTIVE
To test the applicability of the Arbeitsgemeinschaft Gynäkologische Onkologie (AGO) and Memorial Sloan Kettering (MSK) criteria in predicting complete cytoreduction (CC) in patients undergoing secondary cytoreductive surgery (SCS) for recurrent ovarian cancer (ROC).
METHODS
Data of consecutive patients undergoing SCS were reviewed. The Arbeitsgemeinschaft Gynäkologische Onkologie OVARian cancer study group (AGO-OVAR) and MSK criteria were retrospectively applied. Nomograms, based on AGO criteria, MSK criteria and both AGO and MSK criteria were built in order to assess the probability to achieve CC at SCS.
RESULTS
Overall, 194 patients met the inclusion criteria. CC was achieved in 161 (82.9%) patients. According to the AGO-OVAR criteria, we observed that CC was achieved in 87.0% of patients with positive AGO score. However, 45 out of 71 (63.4%) patients who did not fulfilled the AGO score had CC. Similarly, CC was achieved in 87.1%, 61.9% and 66.7% of patients for whom SCS was recommended, had to be considered and was not recommended, respectively. In order to evaluate the predictive value of the AGO-OVAR and MSK criteria we built 2 separate nomograms (c-index: 0.5900 and 0.5989, respectively) to test the probability to achieve CC at SCS. Additionally, we built a nomogram using both the aforementioned criteria (c-index: 0.5857).
CONCLUSION
The AGO and MSK criteria help identifying patients deserving SCS. However, these criteria might be strict, thus prohibiting a beneficial treatment in patients who do not met these criteria. Further studies are needed to clarify factors predicting CC at SCS.

Keyword

Ovarian Neoplasms; Recurrence; Cytoreduction Surgical Procedures

MeSH Terms

Cytoreduction Surgical Procedures
Humans
Nomograms
Ovarian Neoplasms*
Recurrence
Retrospective Studies

Figure

  • Fig. 1. OS according to CC at SCS. CC, complete cytoreduction; OS, overall survival; SCS, secondary cytoreductive surgery.

  • Fig. 2. Nomogram displaying the probability of CC according to the variables included in the AGO-OVAR score. AGO-OVAR, Arbeitsgemeinschaft Gynäkologische Onkologie OVARian cancer study group; CC, complete cytoreduction; ECOG, Eastern Cooperative Oncology Group; RD, residual disease.

  • Fig. 3. Nomogram displaying the probability of CC according to the variables included in the modified MSK criteria. CC, complete cytoreduction; DFI, disease-free interval; MSK, Memorial Sloan Kettering.

  • Fig. 4. Nomogram displaying the probability of CC according to the variables included in the AGO-OVAR score and MSK modified criteria. AGO-OVAR, Arbeitsgemeinschaft Gynäkologische Onkologie OVARian cancer study group; CC, complete cytoreduction; DFI, disease-free interval; ECOG, Eastern Cooperative Oncology Group; MSK, Memorial Sloan Kettering; RD, residual disease.


Cited by  2 articles

Artificial intelligence weights the importance of factors predicting complete cytoreduction at secondary cytoreductive surgery for recurrent ovarian cancer
Giorgio Bogani, Diego Rossetti, Antonino Ditto, Fabio Martinelli, Valentina Chiappa, Lavinia Mosca, Umberto Leone Roberti Maggiore, Stefano Ferla, Domenica Lorusso, Francesco Raspagliesi
J Gynecol Oncol. 2018;29(5):.    doi: 10.3802/jgo.2018.29.e66.

The detrimental effect of adopting interval debulking surgery in advanced stage low-grade serous ovarian cancer
Giorgio Bogani, Umberto Leone Roberti Maggiore, Biagio Paolini, Antonino Diito, Fabio Martinelli, Domenica Lorusso, Francesco Raspagliesi
J Gynecol Oncol. 2019;30(1):.    doi: 10.3802/jgo.2019.30.e4.


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