Follow-up study of the correlation between postoperative computed tomographic scan and primary surgeon assessment in patients with advanced ovarian, tubal, or peritoneal carcinoma reported to have undergone primary surgical cytoreduction to residual disease of 1 cm or smaller.
BACKGROUND
We previously reported a 52% correlation between the primary surgeon's assessment and the postoperative computed tomographic (CT) scan findings of residual disease in patients reported to have undergone cytoreduction to residual disease of 1 cm or smaller. This is a follow-up analysis of survival and prognostic factors for patients who had concordant and discordant postoperative CT scan findings.


METHODS
Patients scheduled for primary cytoreductive surgery for presumed advanced ovarian carcinoma were offered enrollment in a prospective study evaluating the ability of preoperative CT scan to predict cytoreductive outcome. If cytoreduction to residual disease of 1 cm or smaller was reported, a CT scan was done 7 to 35 days postoperatively. The CT scan findings were graded by protocol radiologists using a qualitative analysis scale from 1 (normal) to 5 (definitely malignant).


RESULTS
From January 2001 to September 2006, 285 patients were enrolled; 67 patients were eligible. Postoperative CT scans confirmed the primary surgeon's assessment of no residual disease larger than 1 cm in 38 cases (57%). In 29 cases (43%), the radiologist found residual disease larger than 1 cm and reported it as probably or definitely malignant. Comparing concordant versus discordant findings, there was no significant difference in median progression-free survival (21 vs 17 months; P = 0.365) or overall survival (60 vs 43 months; P = 0.146). Age (P = 0.040), stage (P = 0.038), and residual disease of 0.5 mm or smaller versus 0.6 to 1.0 cm (P = 0.018) were significant for overall survival on multivariate analysis.


CONCLUSIONS
On this follow-up analysis, only age, stage, and residual disease were significant prognostic factors for overall survival. Discordant findings between the primary surgeon's assessment and the postoperative CT scan findings of residual disease was not an independent prognostic factor.
Chi
Dennis S
DS
Gynecology Service, Department of Surgery, Memorial Sloan-Kettering Cancer Center, MRI-1026, 1275 York Ave, New York, NY 10021, USA. gynbreast@mskcc.org
Barlin
Joyce N
JN
Ramirez
Pedro T
PT
Levenback
Charles F
CF
Mironov
Svetlana
S
Sarasohn
Debra M
DM
Iyer
Revathy B
RB
Dao
Fanny
F
Hricak
Hedvig
H
Barakat
Richard R
RR
D018262:Adenocarcinoma, Clear Cell / Q000175:diagnosis / Q000601:surgery; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D018284:Cystadenocarcinoma, Serous / Q000188:drug therapy / Q000473:pathology / Q000601:surgery*; D005185:Fallopian Tube Neoplasms / Q000175:diagnosis* / Q000601:surgery; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000175:diagnosis / Q000601:surgery; D009367:Neoplasm Staging; D018365:Neoplasm, Residual / Q000175:diagnosis* / Q000601:surgery; D010051:Ovarian Neoplasms / Q000175:diagnosis* / Q000601:surgery; D010534:Peritoneal Neoplasms / Q000175:diagnosis* / Q000601:surgery; D011182:Postoperative Care; D011379:Prognosis; D011446:Prospective Studies; D015996:Survival Rate; D014057:Tomography, X-Ray Computed