title: Nomogram for suboptimal cytoreduction at primary surgery for advanced stage ovarian cancer.
abstract: OBJECTIVE
  Maximal cytoreduction to minimal residual tumor is the most important determinant of prognosis in patients with advanced stage epithelial ovarian cancer (EOC). Preoperative prediction of suboptimal cytoreduction, defined as residual tumor >1 cm, could guide treatment decisions and improve counseling. The objective of this study was to identify predictive computed tomographic (CT) scan and clinical parameters for suboptimal cytoreduction at primary cytoreductive surgery for advanced stage EOC and to generate a nomogram with the identified parameters, which would be easy to use in daily clinical practice.
  
  
  METHODS
  Between October 2005 and December 2008, all patients with primary surgery for suspected advanced stage EOC at six participating teaching hospitals in the South Western part of the Netherlands entered the study protocol. To investigate independent predictors of suboptimal cytoreduction, a Cox proportional hazard model with backward stepwise elimination was utilized.
  
  
  RESULTS
  One hundred and fifteen patients with FIGO stage III/IV EOC entered the study protocol. Optimal cytoreduction was achieved in 52 (45%) patients. A suboptimal cytoreduction was predicted by preoperative blood platelet count (p=0.1990; odds ratio (OR)=1.002), diffuse peritoneal thickening (DPT) (p=0.0074; OR=3.021), and presence of ascites on at least two thirds of CT scan slices (p=0.0385; OR=2.294) with a for-optimism corrected c-statistic of 0.67.
  
  
  CONCLUSIONS
  Suboptimal cytoreduction was predicted by preoperative platelet count, DPT and presence of ascites. The generated nomogram can, after external validation, be used to estimate surgical outcome and to identify those patients, who might benefit from alternative treatment approaches.
authors: Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Erasmus MC-Daniel den Hoed University Oncology Center, Groene Hilledijk 301, 3075 AE Rotterdam, The Netherlands. c.gerestein@erasmusmc.nl
authors: Cornelis G
authors: CG
authors: Gerestein
authors: Marinus J
authors: MJ
authors: Eijkemans
authors: Jeanette
authors: J
authors: Bakker
authors: Otto E
authors: OE
authors: Elgersma
authors: Maria E L
authors: ME
authors: van der Burg
authors: Geertruida S
authors: GS
authors: Kooi
authors: Curt W
authors: CW
authors: Burger
mesh_terms: D018262:Adenocarcinoma, Clear Cell / Q000473:pathology / Q000601:surgery*; D002288:Adenocarcinoma, Mucinous / Q000473:pathology / Q000601:surgery*; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D018284:Cystadenocarcinoma, Serous / Q000473:pathology / Q000601:surgery*; D016889:Endometrial Neoplasms / Q000473:pathology / Q000601:surgery*; D005260:Female; D006801:Humans; D008875:Middle Aged; D060787:Neoplasm Grading; D009367:Neoplasm Staging; D018365:Neoplasm, Residual / Q000473:pathology / Q000601:surgery*; D049451:Nomograms; D010051:Ovarian Neoplasms / Q000473:pathology / Q000601:surgery*; D011300:Preoperative Care; D011446:Prospective Studies; D014057:Tomography, X-Ray Computed; D055815:Young Adult