A multicenter prospective trial evaluating the ability of preoperative computed tomography scan and serum CA-125 to predict suboptimal cytoreduction at primary debulking surgery for advanced ovarian, fallopian tube, and peritoneal cancer

Objective To assess the ability of preoperative computed tomography (CT) scan of the abdomen/pelvis and serum CA-125 to predict suboptimal (> 1 cm residual disease) primary cytoreduction in advanced ovarian, fallopian tube, and peritoneal cancer. Methods This was a prospective, non-randomized, multicenter trial of patients who underwent primary cytoreduction for stage III–IV ovarian, fallopian tube, and peritoneal cancer. A CT scan of the abdomen/pelvis and serum CA-125 were obtained within 35 and 14 days before surgery, respectively. Four clinical and 20 radiologic criteria were assessed. Results From 7/2001 to 12/2012, 669 patients were enrolled; 350 met eligibility criteria. The optimal debulking rate was 75%. On multivariate analysis, three clinical and six radiologic criteria were significantly associated with suboptimal debulking: age ≥ 60 years (p = 0.01); CA-125 ≥ 500 U/mL (p < 0.001); ASA 3–4 (p < 0.001); suprarenal retroperitoneal lymph nodes > 1 cm (p < 0.001); diffuse small bowel adhesions/thickening (p < 0.001); and lesions > 1 cm in the small bowel mesentery (p = 0.03), root of the superior mesenteric artery (p = 0.003), perisplenic area (p < 0.001), and lesser sac (p < 0.001). A ‘predictive value score’ was assigned for each criterion, and the suboptimal debulking rates of patients who had a total score of 0, 1–2, 3–4, 5–6, 7–8, and ≥ 9 were 5%, 10%, 17%, 34%, 52%, and 74%, respectively. A prognostic model combining these nine factors had a predictive accuracy of 0.758. Conclusions We identified nine criteria associated with suboptimal cytoreduction, and developed a predictive model in which the suboptimal rate was directly proportional to a predictive value score. These results may be helpful in pretreatment patient assessment.