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CT-Based Fagotti Scoring System for Non-Invasive Prediction of Cytoreduction Surgery Outcome in Patients with Advanced Ovarian Cancer

 Na Young Kim  ;  Dae Chul Jung  ;  Jung Yun Lee  ;  Kyung Hwa Han  ;  Young Taik Oh 
 KOREAN JOURNAL OF RADIOLOGY, Vol.22(9) : 1481-1489, 2021-09 
Journal Title
Issue Date
Cytoreduction Surgical Procedures ; Female ; Humans ; Laparoscopy* ; Middle Aged ; Neoplasm Staging ; Ovarian Neoplasms* / diagnostic imaging ; Ovarian Neoplasms* / pathology ; Ovarian Neoplasms* / surgery ; Retrospective Studies ; Tomography, X-Ray Computed
Cytoreductive surgery ; Laparoscopy ; Multidetector computed tomography ; Ovarian cancer ; Residual tumor
Objective: To construct a CT-based Fagotti scoring system by analyzing the correlations between laparoscopic findings and CT features in patients with advanced ovarian cancer.

Materials and methods: This retrospective cohort study included patients diagnosed with stage III/IV ovarian cancer who underwent diagnostic laparoscopy and debulking surgery between January 2010 and June 2018. Two radiologists independently reviewed preoperative CT scans and assessed ten CT features known as predictors of suboptimal cytoreduction. Correlation analysis between ten CT features and seven laparoscopic parameters based on the Fagotti scoring system was performed using Spearman's correlation. Variable selection and model construction were performed by logistic regression with the least absolute shrinkage and selection operator method using a predictive index value (PIV) ≥ 8 as an indicator of suboptimal cytoreduction. The final CT-based scoring system was internally validated using 5-fold cross-validation.

Results: A total of 157 patients (median age, 56 years; range, 27-79 years) were evaluated. Among 120 (76.4%) patients with a PIV ≥ 8, 105 patients received neoadjuvant chemotherapy followed by interval debulking surgery, and the optimal cytoreduction rate was 90.5% (95 of 105). Among 37 (23.6%) patients with PIV < 8, 29 patients underwent primary debulking surgery, and the optimal cytoreduction rate was 93.1% (27 of 29). CT features showing significant correlations with PIV ≥ 8 were mesenteric involvement, gastro-transverse mesocolon-splenic space involvement, diaphragmatic involvement, and para-aortic lymphadenopathy. The area under the receiver operating curve of the final model for prediction of PIV ≥ 8 was 0.72 (95% confidence interval: 0.62-0.82).

Conclusion: Central tumor burden and upper abdominal spread features on preoperative CT were identified as distinct predictive factors for high PIV on diagnostic laparoscopy. The CT-based PIV prediction model might be useful for patient stratification before cytoreduction surgery for advanced ovarian cancer.
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1. College of Medicine (의과대학) > Dept. of Obstetrics and Gynecology (산부인과학교실) > 1. Journal Papers
1. College of Medicine (의과대학) > Dept. of Radiology (영상의학교실) > 1. Journal Papers
Yonsei Authors
Oh, Young Taik(오영택) ORCID logo https://orcid.org/0000-0002-4438-8890
Lee, Jung-Yun(이정윤) ORCID logo https://orcid.org/0000-0001-7948-1350
Jung, Dae Chul(정대철) ORCID logo https://orcid.org/0000-0001-5769-5083
Han, Kyung Hwa(한경화)
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