title: A multicenter assessment of the ability of preoperative computed tomography scan and CA-125 to predict gross residual disease at primary debulking for advanced epithelial ovarian cancer.
abstract: OBJECTIVE
  To assess the ability of preoperative computed tomography scan and CA-125 to predict gross residual disease (RD) at primary cytoreduction in advanced ovarian cancer.
  
  
  METHODS
  A prospective, non-randomized, multicenter trial of patients who underwent primary debulking for stage III-IV epithelial ovarian cancer previously identified 9 criteria associated with suboptimal (>1cm residual) cytoreduction. This is a secondary post-hoc analysis looking at the ability to predict any RD. Four clinical and 18 radiologic criteria were assessed, and a multivariate model predictive of RD was developed.
  
  
  RESULTS
  From 7/2001-12/2012, 350 patients met eligibility criteria. The complete gross resection rate was 33%. On multivariate analysis, 3 clinical and 8 radiologic criteria were significantly associated with the presence of any RD: age≥60years (OR=1.5); CA-125≥600U/mL (OR=1.3); ASA 3-4 (OR=1.6); lesions in the root of the superior mesenteric artery (OR=4.1), splenic hilum/ligaments (OR=1.4), lesser sac >1cm (OR=2.2), gastrohepatic ligament/porta hepatis (OR=1.4), gallbladder fossa/intersegmental fissure (OR=2); suprarenal retroperitoneal lymph nodes (OR=1.3); small bowel adhesions/thickening (OR=1.1); and moderate-severe ascites (OR=2.2). All ORs were significant with p<0.01. A 'predictive score' was assigned to each criterion based on its multivariate OR, and the rate of having any RD for patients who had a total score of 0-2, 3-5, 6-8, and ≥9 was 45%, 68%, 87%, and 96%, respectively.
  
  
  CONCLUSIONS
  We identified 11 criteria associated with RD, and developed a predictive model in which the rate of having any RD was directly proportional to a predictive score. This model may be helpful in treatment planning.
authors.affiliation: Gynecology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center (MSKCC), New York, NY, United States; Department of Gynecologic Oncology and Reproductive Medicine, The University of Texas MD Anderson Cancer Center (MDACC), Houston, TX, United States.
authors.forename: Rudy S
authors.initials: RS
authors.lastname: Suidan
authors.affiliation: Department of Gynecologic Oncology and Reproductive Medicine, The University of Texas MD Anderson Cancer Center (MDACC), Houston, TX, United States.
authors.forename: Pedro T
authors.initials: PT
authors.lastname: Ramirez
authors.affiliation: Department of Radiology, MSKCC, New York, NY, United States.
authors.forename: Debra M
authors.initials: DM
authors.lastname: Sarasohn
authors.affiliation: Department of Radiology, MSKCC, New York, NY, United States.
authors.forename: Jerrold B
authors.initials: JB
authors.lastname: Teitcher
authors.affiliation: Department of Radiology, MDACC, Houston, TX, United States.
authors.forename: Revathy B
authors.initials: RB
authors.lastname: Iyer
authors.affiliation: Department of Epidemiology and Biostatistics, MSKCC, New York, NY, United States.
authors.forename: Qin
authors.initials: Q
authors.lastname: Zhou
authors.affiliation: Department of Epidemiology and Biostatistics, MSKCC, New York, NY, United States.
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, United States.
authors.forename: John
authors.initials: J
authors.lastname: Denesopolis
authors.affiliation: Gynecology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center (MSKCC), New York, NY, United States; Weill Cornell Medical College, New York, NY, United States.
authors.forename: Oliver
authors.initials: O
authors.lastname: Zivanovic
authors.affiliation: Gynecology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center (MSKCC), New York, NY, United States; Weill Cornell Medical College, New York, NY, United States.
authors.forename: Kara C
authors.initials: KC
authors.lastname: Long Roche
authors.affiliation: Gynecology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center (MSKCC), New York, NY, United States; Weill Cornell Medical College, New York, NY, United States.
authors.forename: Yukio
authors.initials: Y
authors.lastname: Sonoda
authors.affiliation: Department of Gynecologic Oncology and Reproductive Medicine, The University of Texas MD Anderson Cancer Center (MDACC), Houston, TX, United States.
authors.forename: Robert L
authors.initials: RL
authors.lastname: Coleman
authors.affiliation: Gynecology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center (MSKCC), New York, NY, United States; Weill Cornell Medical College, New York, NY, United States.
authors.forename: Nadeem R
authors.initials: NR
authors.lastname: Abu-Rustum
authors.affiliation: Department of Radiology, MSKCC, New York, NY, United States.
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, United States; Weill Cornell Medical College, New York, NY, United States. Electronic address: gynbreast@mskcc.org.
authors.forename: Dennis S
authors.initials: DS
authors.lastname: Chi
mesh_terms: D034861:Abdominal Wall / Q000473:pathology; D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D001201:Ascites / Q000453:epidemiology; D018394:CA-125 Antigen / Q000097:blood*; D000077216:Carcinoma, Ovarian Epithelial; D065426:Cytoreduction Surgical Procedures; D006801:Humans; D008198:Lymph Nodes / Q000473:pathology; D017538:Mesenteric Artery, Superior / Q000473:pathology; D008875:Middle Aged; D015999:Multivariate Analysis; D009361:Neoplasm Invasiveness; D009367:Neoplasm Staging; D018365:Neoplasm, Residual; D018297:Neoplasms, Cystic, Mucinous, and Serous / Q000097:blood / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery*; D009375:Neoplasms, Glandular and Epithelial / Q000097:blood / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery*; D016017:Odds Ratio; D009852:Omentum / Q000473:pathology; D010051:Ovarian Neoplasms / Q000097:blood / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery*; D011446:Prospective Studies; D012187:Retroperitoneal Space; D013154:Spleen; D000267:Tissue Adhesions / Q000453:epidemiology; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome
chemical_list: D018394:CA-125 Antigen
keywords: CA-125; CT scan; Gross residual disease; Ovarian cancer; Primary debulking