A predictive score for optimal cytoreduction at interval debulking surgery in epithelial ovarian cancer: A two- centers experience

Eleonora Ghisoni, Dionyssios Katsaros, Furio Maggiorotto, Massimo Aglietta, Marco Vaira, Michele De Simone, Gloria Mittica, Gaia Giannone, Manuela Robella, Sofia Genta, Fabiola Lucchino, Francesco Marocco, Fulvio Borella, Giorgio Valabrega, Riccardo Ponzone

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6 Citations (Scopus)

Abstract

Background: Optimal cytoreduction (macroscopic Residual Tumor, RT = 0) is the best survival predictor factor in epithelial ovarian cancer (EOC). It doesn't exist a consolidated criteria to predict optimal surgical resection at interval debulking surgery (IDS). The aim of this study is to develop a predictive model of complete cytoreduction at IDS. Methods: We, retrospectively, analyzed 93 out of 432 patients, with advanced EOC, underwent neoadjuvant chemotherapy (NACT) and IDS from January 2010 to December 2016 in two referral cancer centers. The correlation between clinical-pathological variables and residual disease at IDS has been investigated with univariate and multivariate analysis. A predictive score of cytoreduction (PSC) has been created by combining all significant variables. The performance of each single variable and PSC has been reported and the correlation of all significant variables with progression free survival (PFS) has been assessed. Results: At IDS, 65 patients (69,8%) had complete cytoreduction with no residual disease (R = 0). Three criteria independently predicted R > 0: age ≥ 60 years (p = 0.014), CA-125 before NACT > 550 UI/dl (p = 0.044), and Peritoneal Cancer Index (PCI) > 16 (p < 0.001). A PSC ≥ 3 has been associated with a better accuracy (85,8%), limiting the number of incomplete surgeries to 16,5%. Moreover, a PCI > 16, a PSC ≥ 3 and the presence of R > 0 after IDS were all significantly associated with shorter PFS (p < 0.001, p < 0.001 and p = 0.004 respectively). Conclusions: Our PSC predicts, in a large number of patients, complete cytoreduction at IDS, limiting the rate of futile extensive surgeries in case of presence of residual tumor (R > 0). The PSC should be prospectively validated in a larger series of EOC patients undergoing NACT-IDS.

Original languageEnglish
Article number42
JournalJournal of Ovarian Research
Volume11
Issue number1
DOIs
Publication statusPublished - May 30 2018

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Drug Therapy
Disease-Free Survival
Residual Neoplasm
Ovarian epithelial cancer
Neoplasms
Referral and Consultation
Multivariate Analysis
Survival

Keywords

  • Interval debulking surgery
  • Optimal cytoreduction
  • Ovarian cancer
  • Peritoneal cancer index
  • Predictive score

ASJC Scopus subject areas

  • Oncology
  • Obstetrics and Gynaecology

Cite this

@article{a5a74660e6d34001adc78e590b3fd63b,
title = "A predictive score for optimal cytoreduction at interval debulking surgery in epithelial ovarian cancer: A two- centers experience",
abstract = "Background: Optimal cytoreduction (macroscopic Residual Tumor, RT = 0) is the best survival predictor factor in epithelial ovarian cancer (EOC). It doesn't exist a consolidated criteria to predict optimal surgical resection at interval debulking surgery (IDS). The aim of this study is to develop a predictive model of complete cytoreduction at IDS. Methods: We, retrospectively, analyzed 93 out of 432 patients, with advanced EOC, underwent neoadjuvant chemotherapy (NACT) and IDS from January 2010 to December 2016 in two referral cancer centers. The correlation between clinical-pathological variables and residual disease at IDS has been investigated with univariate and multivariate analysis. A predictive score of cytoreduction (PSC) has been created by combining all significant variables. The performance of each single variable and PSC has been reported and the correlation of all significant variables with progression free survival (PFS) has been assessed. Results: At IDS, 65 patients (69,8{\%}) had complete cytoreduction with no residual disease (R = 0). Three criteria independently predicted R > 0: age ≥ 60 years (p = 0.014), CA-125 before NACT > 550 UI/dl (p = 0.044), and Peritoneal Cancer Index (PCI) > 16 (p < 0.001). A PSC ≥ 3 has been associated with a better accuracy (85,8{\%}), limiting the number of incomplete surgeries to 16,5{\%}. Moreover, a PCI > 16, a PSC ≥ 3 and the presence of R > 0 after IDS were all significantly associated with shorter PFS (p < 0.001, p < 0.001 and p = 0.004 respectively). Conclusions: Our PSC predicts, in a large number of patients, complete cytoreduction at IDS, limiting the rate of futile extensive surgeries in case of presence of residual tumor (R > 0). The PSC should be prospectively validated in a larger series of EOC patients undergoing NACT-IDS.",
keywords = "Interval debulking surgery, Optimal cytoreduction, Ovarian cancer, Peritoneal cancer index, Predictive score",
author = "Eleonora Ghisoni and Dionyssios Katsaros and Furio Maggiorotto and Massimo Aglietta and Marco Vaira and {De Simone}, Michele and Gloria Mittica and Gaia Giannone and Manuela Robella and Sofia Genta and Fabiola Lucchino and Francesco Marocco and Fulvio Borella and Giorgio Valabrega and Riccardo Ponzone",
year = "2018",
month = "5",
day = "30",
doi = "10.1186/s13048-018-0415-y",
language = "English",
volume = "11",
journal = "Journal of Ovarian Research",
issn = "1757-2215",
publisher = "BioMed Central",
number = "1",

}

TY - JOUR

T1 - A predictive score for optimal cytoreduction at interval debulking surgery in epithelial ovarian cancer

T2 - A two- centers experience

AU - Ghisoni, Eleonora

AU - Katsaros, Dionyssios

AU - Maggiorotto, Furio

AU - Aglietta, Massimo

AU - Vaira, Marco

AU - De Simone, Michele

AU - Mittica, Gloria

AU - Giannone, Gaia

AU - Robella, Manuela

AU - Genta, Sofia

AU - Lucchino, Fabiola

AU - Marocco, Francesco

AU - Borella, Fulvio

AU - Valabrega, Giorgio

AU - Ponzone, Riccardo

PY - 2018/5/30

Y1 - 2018/5/30

N2 - Background: Optimal cytoreduction (macroscopic Residual Tumor, RT = 0) is the best survival predictor factor in epithelial ovarian cancer (EOC). It doesn't exist a consolidated criteria to predict optimal surgical resection at interval debulking surgery (IDS). The aim of this study is to develop a predictive model of complete cytoreduction at IDS. Methods: We, retrospectively, analyzed 93 out of 432 patients, with advanced EOC, underwent neoadjuvant chemotherapy (NACT) and IDS from January 2010 to December 2016 in two referral cancer centers. The correlation between clinical-pathological variables and residual disease at IDS has been investigated with univariate and multivariate analysis. A predictive score of cytoreduction (PSC) has been created by combining all significant variables. The performance of each single variable and PSC has been reported and the correlation of all significant variables with progression free survival (PFS) has been assessed. Results: At IDS, 65 patients (69,8%) had complete cytoreduction with no residual disease (R = 0). Three criteria independently predicted R > 0: age ≥ 60 years (p = 0.014), CA-125 before NACT > 550 UI/dl (p = 0.044), and Peritoneal Cancer Index (PCI) > 16 (p < 0.001). A PSC ≥ 3 has been associated with a better accuracy (85,8%), limiting the number of incomplete surgeries to 16,5%. Moreover, a PCI > 16, a PSC ≥ 3 and the presence of R > 0 after IDS were all significantly associated with shorter PFS (p < 0.001, p < 0.001 and p = 0.004 respectively). Conclusions: Our PSC predicts, in a large number of patients, complete cytoreduction at IDS, limiting the rate of futile extensive surgeries in case of presence of residual tumor (R > 0). The PSC should be prospectively validated in a larger series of EOC patients undergoing NACT-IDS.

AB - Background: Optimal cytoreduction (macroscopic Residual Tumor, RT = 0) is the best survival predictor factor in epithelial ovarian cancer (EOC). It doesn't exist a consolidated criteria to predict optimal surgical resection at interval debulking surgery (IDS). The aim of this study is to develop a predictive model of complete cytoreduction at IDS. Methods: We, retrospectively, analyzed 93 out of 432 patients, with advanced EOC, underwent neoadjuvant chemotherapy (NACT) and IDS from January 2010 to December 2016 in two referral cancer centers. The correlation between clinical-pathological variables and residual disease at IDS has been investigated with univariate and multivariate analysis. A predictive score of cytoreduction (PSC) has been created by combining all significant variables. The performance of each single variable and PSC has been reported and the correlation of all significant variables with progression free survival (PFS) has been assessed. Results: At IDS, 65 patients (69,8%) had complete cytoreduction with no residual disease (R = 0). Three criteria independently predicted R > 0: age ≥ 60 years (p = 0.014), CA-125 before NACT > 550 UI/dl (p = 0.044), and Peritoneal Cancer Index (PCI) > 16 (p < 0.001). A PSC ≥ 3 has been associated with a better accuracy (85,8%), limiting the number of incomplete surgeries to 16,5%. Moreover, a PCI > 16, a PSC ≥ 3 and the presence of R > 0 after IDS were all significantly associated with shorter PFS (p < 0.001, p < 0.001 and p = 0.004 respectively). Conclusions: Our PSC predicts, in a large number of patients, complete cytoreduction at IDS, limiting the rate of futile extensive surgeries in case of presence of residual tumor (R > 0). The PSC should be prospectively validated in a larger series of EOC patients undergoing NACT-IDS.

KW - Interval debulking surgery

KW - Optimal cytoreduction

KW - Ovarian cancer

KW - Peritoneal cancer index

KW - Predictive score

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