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

TY - JOUR

T1 - 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

AU - Karlsen, Mona Aarenstrup

AU - Fagö-Olsen, Carsten Lindberg

AU - Høgdall, Estrid Vilma Solyom

AU - Schnack, Tine Henrichsen

AU - Christensen, Ib Jarle

AU - Nedergaard, Lotte

AU - Lundvall, Lene

AU - Lydolph, Magnus Christian

AU - Engelholm, Svend Aage

AU - Høgdall, Claus Kim

PY - 2016/9/1

Y1 - 2016/9/1

N2 - 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.

AB - 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.

KW - Adult

KW - Aged

KW - Aged, 80 and over

KW - Ascites

KW - Biomarkers, Tumor

KW - CA-125 Antigen

KW - Cytoreduction Surgical Procedures

KW - Denmark

KW - Female

KW - Humans

KW - Middle Aged

KW - Multivariate Analysis

KW - Neoplasm Staging

KW - Neoplasms, Glandular and Epithelial

KW - Outcome Assessment (Health Care)

KW - Ovarian Neoplasms

KW - Predictive Value of Tests

KW - Preoperative Period

KW - Prognosis

KW - Prospective Studies

KW - Proteins

KW - ROC Curve

KW - Reproducibility of Results

KW - Ultrasonography

KW - Journal Article

U2 - 10.1007/s13277-016-5166-z

DO - 10.1007/s13277-016-5166-z

M3 - Journal article

C2 - 27440204

SN - 1010-4283

VL - 37

SP - 12619

EP - 12626

JO - Tumor Biology

JF - Tumor Biology

IS - 9

ER -