title: Use of complex surgical procedures, patterns of tumor spread, and CA-125 predicts a risk of incomplete cytoreduction: a Korean Gynecologic Oncology Group study (KGOG-3022).
abstract: OBJECTIVE
  We aimed to develop a risk model to predict a risk of suboptimal cytoreduction in primary surgery of ovarian cancer.
  
  
  METHODS
  The clinical records and computed tomography (CT) data of 358 patients with stages II-IV epithelial ovarian cancer were reviewed. Tumor spread patterns identified by principal component analysis, CA-125, and a newly developed surgical skill index were integrated into a logistic model along with other variables. Internal validation was performed using bootstrapped re-sampling and calibration was assessed by goodness-of-fit test.
  
  
  RESULTS
  Among the 358 patients, optimal cytoreduction, which was defined as no residual tumor, was achieved in 145 patients (40.5%). The surgical capacity of an individual institution was estimated by a surgical skill index, which was the frequency of complex surgeries in patients with advanced disease. In a multivariate model, two distinctive CT patterns of tumor spread (diffuse spread pattern and upper abdominal extension pattern), a surgical skill index, and serum CA-125 independently predicted a risk of suboptimal cytoreduction (P=0.006, P=0.013, P=0.031, and P=0.001, respectively). The model showed a C-statistic of .73 (95% confidence interval .67 to .79), which was significantly higher than tumor stage or ascites. Rigorous internal validation by bootstrapped re-sampling successfully confirmed the model.
  
  
  CONCLUSIONS
  We identified two distinct tumor spread patterns of ovarian cancer, which can be integrated to improve a prediction model. Our model may be useful in patient referral or clinical trials for patient stratification.
authors: Department of Radiology, College of Medicine, Yonsei University, Seoul, Republic of Korea.
authors: Dae Chul
authors: DC
authors: Jung
authors: Sokbom
authors: S
authors: Kang
authors: Seung-Cheol
authors: SC
authors: Kim
authors: Jae Weon
authors: JW
authors: Kim
authors: Joo-Hyun
authors: JH
authors: Nam
authors: Sang-Young
authors: SY
authors: Ryu
authors: Seok Ju
authors: SJ
authors: Seong
authors: Byoung-Gie
authors: BG
authors: Kim
mesh_terms: D000328:Adult; D000368:Aged; D018394:CA-125 Antigen / Q000097:blood; D000077216:Carcinoma, Ovarian Epithelial; D005260:Female; D013509:Gynecologic Surgical Procedures / Q000379:methods / Q000592:standards; D006801:Humans; D016015:Logistic Models; D008565:Membrane Proteins / Q000097:blood; D008875:Middle Aged; D015233:Models, Statistical; D009367:Neoplasm Staging; D009375:Neoplasms, Glandular and Epithelial / Q000097:blood / Q000473:pathology* / Q000601:surgery*; D010051:Ovarian Neoplasms / Q000097:blood / Q000473:pathology* / Q000601:surgery*; D025341:Principal Component Analysis; D015203:Reproducibility of Results; D012306:Risk; D014057:Tomography, X-Ray Computed; D055815:Young Adult
chemical_list: D018394:CA-125 Antigen; C451759:MUC16 protein, human; D008565:Membrane Proteins
keywords: Computed tomography; Cytoreductive surgery; Optimal cytoreduction; Ovarian cancer; Spread pattern; Surgical skill index