title: A multicenter prospective trial evaluating the ability of preoperative computed tomography scan and serum CA-125 to predict suboptimal cytoreduction at primary debulking surgery for advanced ovarian, fallopian tube, and peritoneal cancer.
abstract: OBJECTIVE
  To assess the ability of preoperative computed tomography (CT) scan of the abdomen/pelvis and serum CA-125 to predict suboptimal (>1cm residual disease) primary cytoreduction in advanced ovarian, fallopian tube, and peritoneal cancer.
  
  
  METHODS
  This was a prospective, non-randomized, multicenter trial of patients who underwent primary cytoreduction for stage III-IV ovarian, fallopian tube, and peritoneal cancer. A CT scan of the abdomen/pelvis and serum CA-125 were obtained within 35 and 14 days before surgery, respectively. Four clinical and 20 radiologic criteria were assessed.
  
  
  RESULTS
  From 7/2001 to 12/2012, 669 patients were enrolled; 350 met eligibility criteria. The optimal debulking rate was 75%. On multivariate analysis, three clinical and six radiologic criteria were significantly associated with suboptimal debulking: age ≥ 60 years (p=0.01); CA-125 ≥ 500 U/mL (p<0.001); ASA 3-4 (p<0.001); suprarenal retroperitoneal lymph nodes >1cm (p<0.001); diffuse small bowel adhesions/thickening (p<0.001); and lesions >1cm in the small bowel mesentery (p=0.03), root of the superior mesenteric artery (p=0.003), perisplenic area (p<0.001), and lesser sac (p<0.001). A 'predictive value score' was assigned for each criterion, and the suboptimal debulking rates of patients who had a total score of 0, 1-2, 3-4, 5-6, 7-8, and ≥ 9 were 5%, 10%, 17%, 34%, 52%, and 74%, respectively. A prognostic model combining these nine factors had a predictive accuracy of 0.758.
  
  
  CONCLUSIONS
  We identified nine criteria associated with suboptimal cytoreduction, and developed a predictive model in which the suboptimal rate was directly proportional to a predictive value score. These results may be helpful in pretreatment patient assessment.
authors.affiliation: Gynecology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center (MSKCC), New York, NY, USA.
authors.forename: Rudy S
authors.initials: RS
authors.lastname: Suidan
authors.affiliation: Department of Gynecologic Oncology, MD Anderson Cancer Center (MDACC), Houston, TX, USA.
authors.forename: Pedro T
authors.initials: PT
authors.lastname: Ramirez
authors.affiliation: Department of Radiology, MSKCC, New York, NY, USA.
authors.forename: Debra M
authors.initials: DM
authors.lastname: Sarasohn
authors.affiliation: Department of Radiology, MSKCC, New York, NY, USA.
authors.forename: Jerrold B
authors.initials: JB
authors.lastname: Teitcher
authors.affiliation: Department of Radiology, MSKCC, New York, NY, USA.
authors.forename: Svetlana
authors.initials: S
authors.lastname: Mironov
authors.affiliation: Department of Radiology, MDACC, Houston, TX, USA.
authors.forename: Revathy B
authors.initials: RB
authors.lastname: Iyer
authors.affiliation: Department of Epidemiology and Biostatistics, MSKCC, New York, NY, USA.
authors.forename: Qin
authors.initials: Q
authors.lastname: Zhou
authors.affiliation: Department of Epidemiology and Biostatistics, MSKCC, New York, NY, USA.
authors.forename: Alexia
authors.initials: A
authors.lastname: Iasonos
authors.affiliation: Gynecology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center (MSKCC), New York, NY, USA.
authors.forename: Harold
authors.initials: H
authors.lastname: Paul
authors.affiliation: Department of Gynecologic Oncology, MD Anderson Cancer Center (MDACC), Houston, TX, USA.
authors.forename: Masayoshi
authors.initials: M
authors.lastname: Hosaka
authors.affiliation: Gynecologic Medical Oncology Service, Department of Medicine, MSKCC, New York, NY, USA; Weill Cornell Medical College, New York, NY, USA.
authors.forename: Carol A
authors.initials: CA
authors.lastname: Aghajanian
authors.affiliation: Gynecology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center (MSKCC), New York, NY, USA; Weill Cornell Medical College, New York, NY, USA.
authors.forename: Mario M
authors.initials: MM
authors.lastname: Leitao
authors.affiliation: Gynecology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center (MSKCC), New York, NY, USA; Weill Cornell Medical College, New York, NY, USA.
authors.forename: Ginger J
authors.initials: GJ
authors.lastname: Gardner
authors.affiliation: Gynecology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center (MSKCC), New York, NY, USA; Weill Cornell Medical College, New York, NY, USA.
authors.forename: Nadeem R
authors.initials: NR
authors.lastname: Abu-Rustum
authors.affiliation: Gynecology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center (MSKCC), New York, NY, USA; Weill Cornell Medical College, New York, NY, USA.
authors.forename: Yukio
authors.initials: Y
authors.lastname: Sonoda
authors.affiliation: Gynecology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center (MSKCC), New York, NY, USA; Weill Cornell Medical College, New York, NY, USA.
authors.forename: Douglas A
authors.initials: DA
authors.lastname: Levine
authors.affiliation: Department of Radiology, MSKCC, New York, NY, USA.
authors.forename: Hedvig
authors.initials: H
authors.lastname: Hricak
authors.affiliation: Gynecology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center (MSKCC), New York, NY, USA; Weill Cornell Medical College, New York, NY, USA. Electronic address: gynbreast@mskcc.org.
authors.forename: Dennis S
authors.initials: DS
authors.lastname: Chi
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D018394:CA-125 Antigen / Q000097:blood*; D005185:Fallopian Tube Neoplasms / Q000097:blood / Q000175:diagnosis* / Q000601:surgery*; D005260:Female; D006801:Humans; D008875:Middle Aged; D009367:Neoplasm Staging; D010051:Ovarian Neoplasms / Q000097:blood / Q000175:diagnosis* / Q000601:surgery*; D010534:Peritoneal Neoplasms / Q000097:blood / Q000175:diagnosis* / Q000601:surgery*; D011300:Preoperative Care; D011379:Prognosis; D011446:Prospective Studies; D014057:Tomography, X-Ray Computed
chemical_list: D018394:CA-125 Antigen
keywords: CA-125; CT scan; Ovarian cancer; Suboptimal cytoreduction