title: A risk model for secondary cytoreductive surgery in recurrent ovarian cancer: an evidence-based proposal for patient selection.
abstract: BACKGROUND
  To develop a risk model for predicting complete secondary cytoreductive surgery (SCR) in patients with recurrent ovarian cancer.
  
  
  METHODS
  Individual data of 1075 patients with recurrent ovarian cancer undergoing SCR from 7 worldwide centers were pooled and analyzed. The risk model was developed based on the factors impacting on SCR surgical outcome. Additional data on 117 patients who were not included in the development of the model were used for external validation and to assess the discrimination of the model.
  
  
  RESULTS
  Of the 1075 patients, 434 (40.4%) underwent complete resection. Complete secondary cytoreduction was associated with six variables: FIGO stage (odds ratio [OR] = 1.32, 95% confidence interval [95% CI]: 0.97-1.80), residual disease after primary cytoreduction (OR = 1.69, 95% CI: 1.26-2.27), progression-free interval (OR = 2.27, 95% CI: 1.71-3.01), Eastern Cooperative Oncology Group (ECOG) performance status (OR = 2.23, 95% CI: 1.45-3.44), CA125 (OR = 1.85, 95% CI: 1.41-2.44), and ascites at recurrence (OR = 2.79, 95% CI: 1.88-4.13). These variables were entered into the risk model and assigned scores ranging from 0 to 11.9. Patients with total scores of 0-4.7 were categorized as the low-risk group, in which the proportion of complete cytoreduction was 53.4% compared with 20.1% in the high-risk group (OR = 4.55, 95% CI: 3.43-6.04). In external validation, the sensitivity and specificity was 83.3% and 57.6%, respectively. Area under the curve of the receiver-operating characteristics for predicting complete SCR was 0.68 (95% CI: 0.60-0.79).
  
  
  CONCLUSIONS
  This model and scoring system may well predict the outcome of SCR and could potentially be useful in future clinical trials to determine which patients with recurrent ovarian cancer should have SCR as part of their management.
authors: Ovarian Cancer Program, Department of Gynecologic Oncology, Fudan University Cancer Hospital, Shanghai, China.
authors: Wen-Juan
authors: WJ
authors: Tian
authors: Dennis S
authors: DS
authors: Chi
authors: Jalid
authors: J
authors: Sehouli
authors: Claes G
authors: CG
authors: Tropé
authors: Rong
authors: R
authors: Jiang
authors: Ali
authors: A
authors: Ayhan
authors: Gennaro
authors: G
authors: Cormio
authors: Yan
authors: Y
authors: Xing
authors: Georg-Peter
authors: GP
authors: Breitbach
authors: Elena Ioana
authors: EI
authors: Braicu
authors: Catherine A
authors: CA
authors: Rabbitt
authors: Halldis
authors: H
authors: Oksefjell
authors: Christina
authors: C
authors: Fotopoulou
authors: Hans-Gerd
authors: HG
authors: Meerpohl
authors: Andreas
authors: A
authors: du Bois
authors: Jonathan S
authors: JS
authors: Berek
authors: Rong-Yu
authors: RY
authors: Zang
authors: Philipp
authors: P
authors: Harter
mesh_terms: D018262:Adenocarcinoma, Clear Cell / Q000401:mortality* / Q000473:pathology / Q000601:surgery; D002288:Adenocarcinoma, Mucinous / Q000401:mortality* / Q000473:pathology / Q000601:surgery; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D018284:Cystadenocarcinoma, Serous / Q000401:mortality* / Q000473:pathology / Q000601:surgery; D005260:Female; D006801:Humans; D007390:International Agencies; D008875:Middle Aged; D015233:Models, Statistical; D009364:Neoplasm Recurrence, Local / Q000175:diagnosis* / Q000401:mortality* / Q000601:surgery; D009367:Neoplasm Staging; D010051:Ovarian Neoplasms / Q000401:mortality* / Q000473:pathology / Q000601:surgery; D010052:Ovariectomy; D018579:Patient Selection; D012307:Risk Factors; D015996:Survival Rate; D016896:Treatment Outcome; D055815:Young Adult