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PREDICTION OF SUBOPTIMAL CYTOREDUCTION IN ADVANCED OVARIAN CANCER

DOI: https://doi.org/10.29296/25877305-2021-01-05
Issue: 
1
Year: 
2021

E. Syrkashev; Assistant Professor A. Solopova, MD V.I. Kulakov National Medical Research Center
for Obstetrics, Gynecology and Perinatology

Epithelial ovarian cancer is the fifth most common cause of death in women in developed countries. The 5-year survival rate is 92% for a localized process and 29% for patients with advanced disease with peritoneal metastases. The standard treatment for epithelial ovarian cancer is primary cytoreduction followed by platinum-based chemotherapy. When it is impossible, neoadjuvant chemotherapy is performed. Purpose of the study. Comparative evaluation of MRI and MSCT in identifying peritoneal distant spread in OC with determination of the most informative method for predicting suboptimal cytoreduction. Materials and methods. The study is based on the analysis of visual diagnostic results and surgical treatment of 46 women with OC. Before primary cytoreduction, all patients underwent mp-MRI (22) and MSCT (27). The local distribution and the presence of secondary spread were evaluated. For each method the diagnostic information for predicting suboptimal cytoreduction were analyzed and ROC AUC analysis was performed. Results. In 15.2% (7) of cases, stage IIIa / b was established, in 52.2% (24) – IIIc and in 32.6% (15) – IV stage of the disease (FIGO). High grade serous carcinoma was observed in 91.3% (42), and low grade – in 8.7% (4). The sensitivity, specificity and accuracy in determining secondary spread for MSCT were 0.65, 0.96, and 0.85, for MRI – 0.85, 0.89 and 0.87. The positive and negative predictive value of MSCT is 0.91 and 0.79, MRI is 0.91 and 0.87. Complete cytoreduction was performed in 34 (73.9%) cases, optimal – in 7 (15.2%), non-optimal – in 5 (10.9%) cases (including 2 with vital indications). The area under curve for MRI in predicting suboptimal cytoreduction by the sum of points ranged from 0.81 (according to ESMO / ESGO criteria) to 0.85. The ROC AUC based on the naive Bayesian classifier model was 0.88, which reflects the advantage of the weighted estimate of predictors based on their significance over the score Conclusions. MRI is superior to MSCT in the diagnostic informativeness of determining secondary spread of ovarian cancer. MRI has higher sensitivity for determining tumor metastases at the level of the most significant localizations from the point of view of cytoreductive intervention according to ESMO / ESGO data. The scale for assessing the respectability on the diagnostic criteria developed was superior to the approach based on the ESMO / ESGO criteria in its predictive accuracy.

Keywords: 
gynecology
oncology
ovarian cancer
suboptimal cytoreduction



References: 
  1. Siegel R.L., Miller K.D., Jemal A. Cancer statistics, 2019. CA Cancer J Clin. 2019; 69 (1): 7–34. DOI: 10.3322/caac.21551
  2. Castellani F., Nganga E.C., Dumas L. et al. Imaging in the pre-operative staging of ovarian cancer. Abdom Radiol. 2019; 44 (2): 685–96. DOI: 10.1007/s00261-018-1779-6
  3. American Cancer Society. American Cancer Society. Cancer Facts & Figures 2018. Atlanta: American Cancer Society, 2018..
  4. van’t Sant I. et al. Diagnostic performance of imaging for the detection of peritoneal metastases: a meta-analysis. Eur Radiol. 2020; 30 (6): 3101–12. DOI: 10.1007/s00330-019-06524-x
  5. Mikuła-Pietrasik J., Uruski P., Tykarski A. et al. The peritoneal ‘soil’ for a cancerous ‘seed’: a comprehensive review of the pathogenesis of intraperitoneal cancer metastases. Cell Mol Life Sci. 2018; 75 (3): 509–25. DOI: 10.1007/s00018-017-2663-1
  6. Vergote I., Leunen K., Amant F. Primary surgery or neoadjuvant chemotherapy in ovarian cancer: what is the value of comparing apples with oranges? Gynecologic Oncology. 2012; 124 (1): 1–2. DOI: 10.1016/j.ygyno.2011.11.010
  7. Manning-Geist B.L. et al. A novel classification of residual disease after interval debulking surgery for advanced-stage ovarian cancer to better distinguish oncologic outcome. Am J Obstet Gynecol. 2019; 221 (4): 326.e1-326.e7. DOI: 10.1016/j.ajog.2019.05.006
  8. Colombo N. et al. ESMO-ESGO consensus conference recommendations on ovarian cancer: Pathology and molecular biology, early and advanced stages, borderline tumours and recurrent disease. Ann Oncol. 2019; 30 (5): 672–705. DOI: 10.1093/annonc/mdz062
  9. Sisovska I. et al. Current FIGO staging classification for cancer of ovary, fallopian tube and peritoneum. Ces Gynekol. 2017; 82 (3): 230–6.
  10. Forstner R., Sala E., Kinkel K. et al. ESUR guidelines: ovarian cancer staging and follow-up. Eur Radiol. 2010; 20 (1): 2773–80. DOI: 10.1007/s00330-010-1886-4
  11. Javadi S., Ganeshan D.M., Qayyum A. et al. Ovarian cancer, the revised FIGO staging system, and the role of imaging. Am J Roentgenol. 2016; 206 (6): 1351–60. DOI: 10.2214/AJR.15.15199
  12. Gadelhak B. et al. Extended abdominopelvic MRI versus CT at the time of adnexal mass characterization for assessing radiologic peritoneal cancer index (PCI) prior to cytoreductive surgery. Abdom Radiol. 2019; 44 (6): 2254–61. DOI: 10.1007/s00261-019-01939-y
  13. Low R.N., Barone R.M., Lucero J. Comparison of MRI and CT for Predicting the Peritoneal Cancer Index (PCI) Preoperatively in Patients Being Considered for Cytoreductive Surgical Procedures. Ann Surg Oncol. 2015; 22 (5): 1708–15. DOI: 10.1245/s10434-014-4041-7
  14. Rizzo S. et al. Pre-operative evaluation of epithelial ovarian cancer patients: Role of whole body diffusion weighted imaging MR and CT scans in the selection of patients suitable for primary debulking surgery. A single-centre study. Eur J Radiol. 2020; 123:108786. DOI: 10.1016/j.ejrad.2019.108786
  15. Coakley F.V. et al. Peritoneal Metastases: Detection with Spiral CT in Patients with Ovarian Cancer. Radiology. 2002; 223 (2): 495–9. DOI: 10.1148/radiol.2232011081
  16. Low R.N., Barone R.M., Lacey C. et al. Peritoneal tumor: MR imaging with dilute oral barium and intravenous gadolinium-containing contrast agents compared with unenhanced MR imaging and CT. Radiology. 1997; 204 (2): 513–20. DOI: 10.1148/radiology.204.2.9240546
  17. Koh J.-L., Yan T.D., Glenn D. et al. Evaluation of preoperative computed tomography in estimating peritoneal cancer index in colorectal peritoneal carcinomatosis. Ann Surg Oncol. 2009; 16 (2): 327–33. DOI: 10.1245/s10434-008-0234-2