title: Pleural effusion detected at CT prior to primary cytoreduction for stage III or IV ovarian carcinoma: effect on survival.
abstract: OBJECTIVE
  To determine the prognostic importance of pleural effusions on preoperative computed tomographic (CT) images in patients with advanced epithelial ovarian cancer.
  
  
  METHODS
  The institutional review board waived informed consent for this HIPAA-compliant study of 203 patients with International Federation of Obstetrics and Gynecology stage III (n = 172) or IV (n = 31) epithelial ovarian cancer who underwent CT before primary cytoreductive surgery between 1997 and 2004 (mean age, 61 years; range, 37-96 years). Two radiologists retrospectively evaluated chest and/or abdominal CT images for pleural malignancy and the presence, size, and laterality of pleural effusions. To evaluate survival, Kaplan-Meier methods were used, with log-rank P values for comparisons. Multivariate analyses were conducted by using Cox proportional hazards regression. κ Statistics were calculated for interreader agreement.
  
  
  RESULTS
  Median survival was 50 months (95% confidence interval [CI]: 45, 55 months) for patients with stage III disease and 41 months (95% CI: 27, 58 months) for patients with stage IV disease. Readers 1 and 2 found pleural effusions in 40 and 41 stage III and 20 and 21 stage IV patients, respectively. At multivariate analysis, after controlling for stage, age at surgery, preoperative serum CA-125 level, debulking status, and ascites, moderate-to-large pleural effusion on CT images was significantly associated with worse overall survival (reader 1: hazard ratio = 2.27 [95% CI: 1.31, 3.92], P < .01; reader 2: hazard ratio = 2.25 [95% CI: 1.26, 4.01], P = .02). Preoperative CA-125 level, debulking status, and ascites were also significant survival predictors (P ≤ .03 for all for both readers). Readers agreed substantially in distinguishing small from moderate-to-large effusions (κ = 0.764).
  
  
  CONCLUSIONS
  Moderate-to-large pleural effusion on preoperative CT images in patients with stage III or IV epithelial ovarian cancer was independently associated with poorer overall survival after controlling for age, preoperative CA-125 level, surgical stage, ascites, and cytoreductive status.
authors.affiliation: Department of Radiology, Memorial Sloan-Kettering Cancer Center, 1275 York Ave, Room C-278, New York, NY 10065, USA.
authors.forename: Oleg
authors.initials: O
authors.lastname: Mironov
authors.forename: Nicole M
authors.initials: NM
authors.lastname: Ishill
authors.forename: Svetlana
authors.initials: S
authors.lastname: Mironov
authors.forename: Hebert Alberto
authors.initials: HA
authors.lastname: Vargas
authors.forename: Junting
authors.initials: J
authors.lastname: Zheng
authors.forename: Chaya S
authors.initials: CS
authors.lastname: Moskowitz
authors.forename: Yukio
authors.initials: Y
authors.lastname: Sonoda
authors.forename: Ralph S
authors.initials: RS
authors.lastname: Papas
authors.forename: Dennis S
authors.initials: DS
authors.lastname: Chi
authors.forename: Hedvig
authors.initials: H
authors.lastname: Hricak
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D014408:Biomarkers, Tumor / Q000032:analysis; D018394:CA-125 Antigen / Q000032:analysis; D005260:Female; D006801:Humans; D008875:Middle Aged; D009367:Neoplasm Staging; D010051:Ovarian Neoplasms / Q000473:pathology* / Q000601:surgery; D010996:Pleural Effusion / Q000000981:diagnostic imaging* / Q000209:etiology; D011379:Prognosis; D016016:Proportional Hazards Models; D015996:Survival Rate; D014057:Tomography, X-Ray Computed / Q000379:methods*
chemical_list: D014408:Biomarkers, Tumor; D018394:CA-125 Antigen