title: Prediction of incomplete primary debulking surgery in patients with advanced ovarian cancer: An external validation study of three models using computed tomography.
abstract: OBJECTIVE
  To test the ability of three prospectively developed computed tomography (CT) models to predict incomplete primary debulking surgery in patients with advanced (International Federation of Gynecology and Obstetrics stages III-IV) ovarian cancer.
  
  
  METHODS
  Three prediction models to predict incomplete surgery (any tumor residual >1cm in diameter) previously published by Ferrandina (models A and B) and by Gerestein were applied to a validation cohort consisting of 151 patients with advanced epithelial ovarian cancer. All patients were treated with primary debulking surgery in the Eastern part of the Netherlands between 2000 and 2009 and data were retrospectively collected. Three individual readers evaluated the radiographic parameters and gave a subjective assessment. Using the predicted probabilities from the models, the area under the curve (AUC) was calculated which represents the discriminative ability of the model.
  
  
  RESULTS
  The AUC of the Ferrandina models was 0.56, 0.59 and 0.59 in model A, and 0.55, 0.60 and 0.59 in model B for readers 1, 2 and 3, respectively. The AUC of Gerestein's model was 0.69, 0.61 and 0.69 for readers 1, 2 and 3, respectively. AUC values of 0.69 and 0.63 for reader 1 and 3 were found for subjective assessment.
  
  
  CONCLUSIONS
  Models to predict incomplete surgery in advanced ovarian cancer have limited predictive ability and their reproducibility is questionable. Subjective assessment seems as successful as applying predictive models. Present prediction models are not reliable enough to be used in clinical decision-making and should be interpreted with caution.
authors.affiliation: Department of Obstetrics and Gynecology, Maastricht University Medical Center, P.O. Box 5800, 6202 AZ Maastricht, The Netherlands; GROW School for Oncology and Developmental Biology, Maastricht University, P.O. Box 616, 6200 MD Maastricht, The Netherlands. Electronic address: iris.rutten@mumc.nl.
authors.forename: Iris J G
authors.initials: IJ
authors.lastname: Rutten
authors.affiliation: Department of Obstetrics and Gynecology, Maastricht University Medical Center, P.O. Box 5800, 6202 AZ Maastricht, The Netherlands; GROW School for Oncology and Developmental Biology, Maastricht University, P.O. Box 616, 6200 MD Maastricht, The Netherlands.
authors.forename: Rafli
authors.initials: R
authors.lastname: van de Laar
authors.affiliation: Department of Obstetrics and Gynecology, Maastricht University Medical Center, P.O. Box 5800, 6202 AZ Maastricht, The Netherlands; GROW School for Oncology and Developmental Biology, Maastricht University, P.O. Box 616, 6200 MD Maastricht, The Netherlands.
authors.forename: Roy F P M
authors.initials: RF
authors.lastname: Kruitwagen
authors.affiliation: Department of Radiology, Maastricht University Medical Center, P.O. Box 5800, 6202 AZ Maastricht, The Netherlands.
authors.forename: Frans C H
authors.initials: FC
authors.lastname: Bakers
authors.affiliation: Department of Radiology and Nuclear Medicine, Radboud University Nijmegen Medical Center, P.O. Box 9101, 6500 HB Nijmegen, The Netherlands.
authors.forename: Marieke J M
authors.initials: MJ
authors.lastname: Ploegmakers
authors.affiliation: Department of Radiology, Rijnstate Hospital, P.O. Box 9555, 6800 TA Arnhem, The Netherlands.
authors.forename: Teun W F
authors.initials: TW
authors.lastname: Pappot
authors.affiliation: GROW School for Oncology and Developmental Biology, Maastricht University, P.O. Box 616, 6200 MD Maastricht, The Netherlands; Department of Radiology, Maastricht University Medical Center, P.O. Box 5800, 6202 AZ Maastricht, The Netherlands; Department of Radiology, Netherlands Cancer Institute, P.O. Box 90203, 1006 BE Amsterdam, The Netherlands.
authors.forename: Regina G H
authors.initials: RG
authors.lastname: Beets-Tan
authors.affiliation: Department of Obstetrics and Gynecology, Radboud University Nijmegen Medical Center, P.O. Box 9101, 6500 HB Nijmegen, The Netherlands.
authors.forename: Leon F A G
authors.initials: LF
authors.lastname: Massuger
authors.affiliation: Department of Obstetrics and Gynecology, Radboud University Nijmegen Medical Center, P.O. Box 9101, 6500 HB Nijmegen, The Netherlands.
authors.forename: Petra L M
authors.initials: PL
authors.lastname: Zusterzeel
authors.affiliation: Department of Obstetrics and Gynecology, Maastricht University Medical Center, P.O. Box 5800, 6202 AZ Maastricht, The Netherlands; GROW School for Oncology and Developmental Biology, Maastricht University, P.O. Box 616, 6200 MD Maastricht, The Netherlands.
authors.forename: Toon
authors.initials: T
authors.lastname: Van Gorp
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000077216:Carcinoma, Ovarian Epithelial; D015331:Cohort Studies; D005260:Female; D006801:Humans; D008875:Middle Aged; D015233:Models, Statistical; D009375:Neoplasms, Glandular and Epithelial / Q000473:pathology / Q000601:surgery*; D010051:Ovarian Neoplasms / Q000473:pathology / Q000601:surgery*; D011237:Predictive Value of Tests; D011336:Probability; D014057:Tomography, X-Ray Computed / Q000379:methods* / Q000592:standards; D016896:Treatment Outcome
keywords: Complete primary cytoreductive surgery; Computed tomography; Epithelial ovarian cancer; External validation; Prediction models