J Gynecol Oncol.  2018 Sep;29(5):e65. 10.3802/jgo.2018.29.e65.

A triage strategy in advanced ovarian cancer management based on multiple predictive models for R0 resection: a prospective cohort study

• Feng Z
• Wen H
• Jiang Z
• Liu S
• Ju X
• Chen X
• Xia L
• Xu J
• Bi R
• Wu X

• KMID: 2417461
• DOI: http://doi.org/10.3802/jgo.2018.29.e65

Abstract

OBJECTIVE
To present the surgical outcomes of advanced epithelial ovarian cancer (AEOC) since the implementation of a personalized approach and to validate multiple predictive models for R0 resection.
METHODS
Personalized strategies included: 1) Non-invasive model: preoperative clinico-radiological assessment according to Suidan criteria with a predictive score for all individuals. Patients with a score 0-2 were recommended for primary debulking surgery (PDS, group A), or otherwise were counseled on the choices of PDS, neoadjuvant chemotherapy (NAC, group B) or staging laparoscopy (S-LPS). 2) Minimally invasive model: S-LPS with a predictive index value (PIV) according to Fagotti. Individuals with a PIV < 8 underwent PDS (group C) or otherwise received NAC (group D). Intraoperative assessment (with Eisenkop, peritoneal cancer index [PCI], and Aletti scores) and surgical results were prospectively collected.
RESULTS
Between September 2015 and August 2017, 161 pathologically confirmed epithelial ovarian cancer patients were included. A total of 52 (32.3%) patients had a predictive score of 0-2, and 109 (67.7%) patients had a score ≥ 3. Among these individuals, 41 (25.5%) patients received S-LPS. Finally, 110 (68.3%) patients underwent PDS (A+C), and 51 (31.7%) patients received NAC (B+D). The R0 resection rates in PDS and NAC patients were 56.4% and 60.8%, respectively. The area under the curve (AUC) of Suidan criteria was 0.548 for group (A+C). The AUC of Fagotti score was 0.702 for group C. The AUC of Eisenkop, PCI, and Aletti scores were 0.808, 0.797, and 0.524, respectively.
CONCLUSION
The Suidan criteria were not effective in these AEOC patients. S-LPS was helpful in decision-making for PDS and should be endorsed in the future.

Keyword

Predictive Model; Scoring Method; Surgical Outcomes; Perioperative Complications; R0 Resection; No Residual Disease

MeSH Terms

Area Under Curve
Cohort Studies*
Drug Therapy
Humans
Laparoscopy
Ovarian Neoplasms*
Prospective Studies*
Research Design
Triage*