title: Usefulness of computed tomography in predicting cytoreductive surgical outcomes for ovarian cancer.
abstract: OBJECTIVE
  The objective of this study was to identify features of preoperative computed tomography (CT) scans that can best predict outcomes of primary cytoreductive surgery in ovarian cancer patients.
  
  
  METHODS
  Preoperative CT scans of 98 patients were evaluated retrospectively. Multiple logistic regression analysis was used to develop two models.
  
  
  RESULTS
  Although optimal surgical reduction was attempted in 98 patients, 12 had suboptimal results. Having tumor implants on the small or large bowel mesenteries (any size) or at other sites (cutoff index: ≥ 1 cm) was found to be significant (p < 0.001) for predicting a suboptimal cytoreduction outcome. Two predictive models were created using multiple logistic regression analysis; both consider diffuse peritoneal thickening (DPT), infrarenal para-aortic or pelvic lymph node involvement, a bowel encasement tumor (≥ 2 cm), and any tumor implants in the cul-de-sac as significant. Model 1 adds consideration to any tumors in the pelvic or retroperitoneum and has an accuracy of 90.8% for predicting a suboptimal surgery. Model 2 (accuracy of 93.9%) adds to the core of predictors the presence of tumor implants on the bowel mesenteries (≥ 2 cm), omental caking (≥ 2 cm), and ascites fluid.
  
  
  CONCLUSIONS
  Using specific CT findings from patients with ovarian cancer, we have devised two predictive models that have an accuracy of greater than 90% for predicting whether cytoreductive surgery will completely remove all tumor tissue, which should greatly aid in the differential decision-making as to whether to attempt cytoreductive surgery first, or to advance directly to neoadjuvant chemotherapy.
authors.affiliation: Department of Obstetrics and Gynecology, Osaka University Graduate School of Medicine, Osaka, Japan.
authors.forename: Kazuko
authors.initials: K
authors.lastname: Fujwara
authors.forename: Kiyoshi
authors.initials: K
authors.lastname: Yoshino
authors.forename: Takayuki
authors.initials: T
authors.lastname: Enomoto
authors.forename: Masami
authors.initials: M
authors.lastname: Fujita
authors.forename: Yutaka
authors.initials: Y
authors.lastname: Ueda
authors.forename: Takashi
authors.initials: T
authors.lastname: Miyatake
authors.forename: Toshihiro
authors.initials: T
authors.lastname: Kimura
authors.forename: Miho
authors.initials: M
authors.lastname: Muraji
authors.forename: Haruyasu
authors.initials: H
authors.lastname: Fujita
authors.forename: Tadashi
authors.initials: T
authors.lastname: Kimura
authors.forename: Masatoshi
authors.initials: M
authors.lastname: Hori
mesh_terms: D000328:Adult; D000368:Aged; D018394:CA-125 Antigen / Q000097:blood; D005260:Female; D006801:Humans; D016015:Logistic Models; D008875:Middle Aged; D009367:Neoplasm Staging; D010051:Ovarian Neoplasms / Q000097:blood / Q000000981:diagnostic imaging* / Q000473:pathology / Q000601:surgery*; D011237:Predictive Value of Tests; D012189:Retrospective Studies; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome
chemical_list: D018394:CA-125 Antigen