title: Radiological predictors of cytoreductive outcomes in patients with advanced ovarian cancer.
abstract: OBJECTIVE
  To assess site of disease on preoperative computed tomography (CT) to predict surgical debulking in patients with ovarian cancer.
  
  
  METHODS
  Two-phase retrospective cohort study.
  
  
  METHODS
  West London Gynaecological Cancer Centre, UK.
  
  
  METHODS
  Women with stage 3 or 4, ovarian, fallopian or primary peritoneal cancer undergoing cytoreductive surgery.
  
  
  METHODS
  Preoperative CT images were reviewed by experienced radiologists to assess the presence or absence of disease at predetermined sites. Multivariable stepwise logistic regression models determined sites of disease which were significantly associated with surgical outcomes in the test (n = 111) and validation (n = 70) sets.
  
  
  METHODS
  Sensitivity and specificity of CT in predicting surgical outcome.
  
  
  RESULTS
  Stepwise logistic regression identified that the presence of lung metastasis, pleural effusion, deposits on the large-bowel mesentery and small-bowel mesentery, and infrarenal para-aortic nodes were associated with debulking status. Logistic regression determined a surgical predictive score which was able to significantly predict suboptimal debulking (n = 94, P = 0.0001) with an area under the curve (AUC) of 0.749 (95% confidence interval [95% CI]: 0.652, 0.846) and a sensitivity of 69.2%, specificity of 71.4%, positive predictive value of 75.0% and negative predictive value of 65.2%. These results remained significant in a recent validation set. There was a significant difference in residual disease volume in the test and validation sets (P < 0.001) in keeping with improved optimal debulking rates.
  
  
  CONCLUSIONS
  The presence of disease at some sites on preoperative CT scan is significantly associated with suboptimal debulking and may be an indication for a change in surgical planning.
authors.affiliation: Department of Surgery and Cancer, Imperial College London, London, UK.
authors.forename: J
authors.initials: J
authors.lastname: Borley
authors.affiliation: Department of Surgery and Cancer, Imperial College London, London, UK.
authors.forename: C
authors.initials: C
authors.lastname: Wilhelm-Benartzi
authors.affiliation: West London Gynaecology Cancer Centre, Imperial College NHS Trust, London, UK.
authors.forename: J
authors.initials: J
authors.lastname: Yazbek
authors.affiliation: West London Gynaecology Cancer Centre, Imperial College NHS Trust, London, UK.|Department of Radiology, Imperial College Healthcare NHS Trust, London, UK.
authors.forename: R
authors.initials: R
authors.lastname: Williamson
authors.affiliation: West London Gynaecology Cancer Centre, Imperial College NHS Trust, London, UK.|Department of Radiology, Imperial College Healthcare NHS Trust, London, UK.
authors.forename: N
authors.initials: N
authors.lastname: Bharwani
authors.affiliation: West London Gynaecology Cancer Centre, Imperial College NHS Trust, London, UK.|Department of Radiology, Imperial College Healthcare NHS Trust, London, UK.
authors.forename: V
authors.initials: V
authors.lastname: Stewart
authors.affiliation: West London Gynaecology Cancer Centre, Imperial College NHS Trust, London, UK.
authors.forename: I
authors.initials: I
authors.lastname: Carson
authors.affiliation: West London Gynaecology Cancer Centre, Imperial College NHS Trust, London, UK.
authors.forename: E
authors.initials: E
authors.lastname: Hird
authors.affiliation: West London Gynaecology Cancer Centre, Imperial College NHS Trust, London, UK.
authors.forename: A
authors.initials: A
authors.lastname: McIndoe
authors.affiliation: Department of Surgery and Cancer, Imperial College London, London, UK.|West London Gynaecology Cancer Centre, Imperial College NHS Trust, London, UK.
authors.forename: A
authors.initials: A
authors.lastname: Farthing
authors.affiliation: Department of Surgery and Cancer, Imperial College London, London, UK.|West London Gynaecology Cancer Centre, Imperial College NHS Trust, London, UK.
authors.forename: S
authors.initials: S
authors.lastname: Blagden
authors.affiliation: Department of Surgery and Cancer, Imperial College London, London, UK.|West London Gynaecology Cancer Centre, Imperial College NHS Trust, London, UK.
authors.forename: S
authors.initials: S
authors.lastname: Ghaem-Maghami
mesh_terms: D000230:Adenocarcinoma / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery*; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D065426:Cytoreduction Surgical Procedures; D003661:Decision Support Techniques; D005185:Fallopian Tube Neoplasms / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery*; D005260:Female; D006801:Humans; D016015:Logistic Models; D008875:Middle Aged; D009367:Neoplasm Staging; D010051:Ovarian Neoplasms / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery*; D010534:Peritoneal Neoplasms / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery*; D011300:Preoperative Care; D015203:Reproducibility of Results; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome
keywords: Computed tomography; ovarian cancer; preoperative assessment; surgical debulking