Model for Prediction of Optimal Debulking of Epithelial Ovarian Cancer

Abstract

Background: Primary cytoreduction surgery followed by chemotherapy is the cornerstone treatment for epithelial<br />ovarian cancer (EOC). In patients with a low probability of optimal primary surgical debulking, neoadjuvant<br />chemotherapy (NACT) followed by interval debulking increases the chance of optimal surgery. The aim of this study<br />was to develop a model to identify preoperative predictors for suboptimal cytoreduction. Methods: Medical records<br />of patients with EOC who underwent primary cytoreductive surgery in a referral tertiary gyneco-oncology center<br />were reviewed from 2007 to 2017. Data were collected on a range of characteristics including demographic features,<br />comorbidities, serum tumor markers, hematologic markers, preoperative imaging, surgical procedures, and pathologic<br />reports. Univariate and multivariate analyses were performed to clarify the ability of preoperative factors to predict<br />suboptimal primary surgery. Results: The majority of patients (71.3%) who underwent primary cytoreductive surgery<br />were optimally debulked. Based on the Youden index, the best cut-off point for the serum CA125 level to distinguish<br />suboptimal debulking was 420U/ml with 0.730 (95%CI:0.559 to 0.862) sensitivity and 0.783 (0.684 to 0.862) specificity.<br />Multiple logistic regression results showed that serum CA125 level >420 U/ ml (p value <0.001), the presence of liver<br />metastasis on preoperative imaging (p value: 0.041) and ascites (p value: 0.032) or massive ascites (p value:0.010)<br />significantly increased the risk of suboptimal debulking (logit p = 2.36 CA125 level +1.85 Liverinvolvement +1.68<br />presence of Ascites+ 2.28 Massive Ascites). Conclusion:The present study suggests that a serum CA125 level >420 U/ml,<br />the presence of ascites or massive ascites and liver metastasis are strong predictors of suboptimal primary surgery in<br />cases of EOC. Based on the constructed model, with any of these 4 factors, the probability of suboptimal debulking in<br />EOC is more than 80%.