title: A novel index for preoperative, non-invasive prediction of macro-radical primary surgery in patients with stage IIIC-IV ovarian cancer-a part of the Danish prospective pelvic mass study.
abstract: The purpose of this study was to develop a novel index for preoperative, non-invasive prediction of complete primary cytoreduction in patients with FIGO stage IIIC-IV epithelial ovarian cancer. Prospectively collected clinical data was registered in the Danish Gynecologic Cancer Database. Blood samples were collected within 14 days of surgery and stored by the Danish CancerBiobank. Serum human epididymis protein 4 (HE4), serum cancer antigen 125 (CA125), age, performance status, and presence/absence of ascites at ultrasonography were evaluated individually and combined to predict complete tumor removal. One hundred fifty patients with advanced epithelial ovarian cancer were treated with primary debulking surgery (PDS). Complete PDS was achieved in 41 cases (27 %). The receiver operating characteristic curves demonstrated an area under the curve of 0.785 for HE4, 0.678 for CA125, and 0.688 for age. The multivariate model (Cancer Ovarii Non-invasive Assessment of Treatment Strategy (CONATS) index), consisting of HE4, age, and performance status, demonstrated an AUC of 0.853. According to the Danish indicator level, macro-radical PDS should be achieved in 60 % of patients admitted to primary surgery (positive predictive value of 60 %), resulting in a negative predictive value of 87.5 %, sensitivity of 68.3 %, specificity of 83.5 %, and cutoff of 0.63 for the CONATS index. Non-invasive prediction of complete PDS is possible with the CONATS index. The CONATS index is meant as a supplement to the standard preoperative evaluation of each patient. Evaluation of the CONATS index combined with radiological and/or laparoscopic findings may improve the assessment of the optimal treatment strategy in patients with advanced epithelial ovarian cancer.
authors.affiliation: Gynecologic Clinic, University Hospital of Copenhagen, Rigshospitalet, Blegdamsvej 9, DK-2100, Copenhagen, Denmark. mona.aarenstrup.karlsen@regionh.dk.|Molecular Unit, Department of Pathology, Herlev University Hospital, Herlev Ringvej 75, DK-2730, Herlev, Denmark. mona.aarenstrup.karlsen@regionh.dk.
authors.forename: Mona Aarenstrup
authors.initials: MA
authors.lastname: Karlsen
authors.affiliation: Gynecologic Clinic, University Hospital of Copenhagen, Rigshospitalet, Blegdamsvej 9, DK-2100, Copenhagen, Denmark.
authors.forename: Carsten
authors.initials: C
authors.lastname: Fagö-Olsen
authors.affiliation: Molecular Unit, Department of Pathology, Herlev University Hospital, Herlev Ringvej 75, DK-2730, Herlev, Denmark.
authors.forename: Estrid
authors.initials: E
authors.lastname: Høgdall
authors.affiliation: Gynecologic Clinic, University Hospital of Copenhagen, Rigshospitalet, Blegdamsvej 9, DK-2100, Copenhagen, Denmark.
authors.forename: Tine Henrichsen
authors.initials: TH
authors.lastname: Schnack
authors.affiliation: Molecular Unit, Department of Pathology, Herlev University Hospital, Herlev Ringvej 75, DK-2730, Herlev, Denmark.
authors.forename: Ib Jarle
authors.initials: IJ
authors.lastname: Christensen
authors.affiliation: Department of Pathology, University Hospital of Copenhagen, Rigshospitalet, Blegdamsvej 9, DK-2100, Copenhagen, Denmark.
authors.forename: Lotte
authors.initials: L
authors.lastname: Nedergaard
authors.affiliation: Gynecologic Clinic, University Hospital of Copenhagen, Rigshospitalet, Blegdamsvej 9, DK-2100, Copenhagen, Denmark.
authors.forename: Lene
authors.initials: L
authors.lastname: Lundvall
authors.affiliation: Department of Autoimmunology and Biomarkers, Statens Serum Institute, Artillerivej 5, DK-2300, Copenhagen, Denmark.
authors.forename: Magnus Christian
authors.initials: MC
authors.lastname: Lydolph
authors.affiliation: Department of Radiation Oncology, University Hospital of Copenhagen, Rigshospitalet, Blegdamsvej 9, DK-2100, Copenhagen, Denmark.
authors.forename: Svend Aage
authors.initials: SA
authors.lastname: Engelholm
authors.affiliation: Gynecologic Clinic, University Hospital of Copenhagen, Rigshospitalet, Blegdamsvej 9, DK-2100, Copenhagen, Denmark.
authors.forename: Claus
authors.initials: C
authors.lastname: Høgdall
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001201:Ascites / Q000000981:diagnostic imaging; D014408:Biomarkers, Tumor / Q000097:blood*; D018394:CA-125 Antigen / Q000097:blood; D000077216:Carcinoma, Ovarian Epithelial; D065426:Cytoreduction Surgical Procedures / Q000379:methods; D003718:Denmark; D005260:Female; D006801:Humans; D008875:Middle Aged; D015999:Multivariate Analysis; D009367:Neoplasm Staging; D009375:Neoplasms, Glandular and Epithelial / Q000097:blood* / Q000473:pathology / Q000601:surgery; D017063:Outcome Assessment, Health Care / Q000379:methods* / Q000706:statistics & numerical data; D010051:Ovarian Neoplasms / Q000097:blood* / Q000473:pathology / Q000601:surgery; D011237:Predictive Value of Tests; D057234:Preoperative Period; D011379:Prognosis; D011446:Prospective Studies; D011506:Proteins / Q000032:analysis; D012372:ROC Curve; D015203:Reproducibility of Results; D014463:Ultrasonography / Q000379:methods; D000081102:WAP Four-Disulfide Core Domain Protein 2
chemical_list: D014408:Biomarkers, Tumor; D018394:CA-125 Antigen; D011506:Proteins; D000081102:WAP Four-Disulfide Core Domain Protein 2; C569698:WFDC2 protein, human
keywords: HE4; Multidisciplinary team meetings; Neoadjuvant chemotherapy; Non-invasive prediction model; Ovarian cancer; Primary debulking surgery