Who needs Neoadjuvant chemotherapy before surgery in ovarian cancer

Publish Year: 1398
نوع سند: مقاله کنفرانسی
زبان: English
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DTOGIMED03_006

تاریخ نمایه سازی: 26 بهمن 1398

Abstract:

Primary cytoreduction surgery followed by chemotherapy is the cornerstone treatment forepithelial ovarian cancer (EOC). In patients with a low probability of optimal primary surgicaldebulking, neoadjuvant chemotherapy (NACT) followed by interval debulking increases the chanceof optimal surgery. In a study a predictive model to identify best candidates for neoadjuvantchemotherapy was constructed.Medical records of patients with EOC who underwent primary cytoreductive surgery in a referraltertiary gyneco-oncology center were reviewed from 2007 to 2017. Data were collected on a rangeof characteristics including demographic features, comorbidities, serum tumor markers,hematologic markers, preoperative imaging, surgical procedures, and pathologic reports. Univariateand multivariate analyses were performed to clarify the ability of preoperative factors to predictsuboptimal primary surgery, that is best candidates for neoadjuvant chemotherapy.The majority of patients (71.3%) who underwent primary cytoreductive surgery were optimallydebulked. Based on the Youden index, the best cut-off point for the serum CA125 level to distinguishsuboptimal debulking was 420U/ml with 0.730 (95%CI:0.559 to 0.862) sensitivity and 0.783 (0.684to 0.862) specificity. Multiple logistic regression results showed that serum CA125 level > 420 U/ ml(p value <0.001), the presence of liver metastasis on preoperative imaging (p value: 0.041) andascites (p value: 0.032) or massive ascites (p value:0.010) significantly increased the risk ofsuboptimal debulking. serum CA125 cut-off level of 420 U/ ml resulted in a 10.63 fold-increased riskof suboptimal debulking, equal to 91%. The presence of ascites or massive ascites in preoperativesonography increased the risk of suboptimal debulking 5.36 and 9.79 times, equal to 84% and 90%,respectively. results showed that liver metastasis in preoperative CT scan, increased the risk ofsuboptimal debulking6.33 times. In the cases of just liver involvement, the risk of suboptimaldebulking was 86%.The present study suggests that a serum CA125 level > 420 U/ml, the presence of ascites or massiveascites and liver metastasis are strong predictors of suboptimal primary surgery in cases of EOC.Based on the constructed model, the presence of one of the 4 factors (serum CA125 levels, massiveascites and liver involvement) in patients is the predicator of suboptimal surgery with a probabilityof more than 80%, while the presence of two of the factors rise the probability to more than 90%.

Authors

Maliheh Arab

Professor of Gyneco-Oncology. Preventive Gynecologic research center (PGRC),Shahid Beheshti University, Tehran, Iran