Residual tumor using CT scan based on modified radiologic Lakhman Index after optimal cytoreduction in advanced ovarian cancer: advantages of a simplified method.

Abstract

Background: Advanced ovarian cancer is the deadliest gynecological malignancy, with treatment combining cytoreductive surgery and platinum/taxane chemotherapy. Surgical success is defined by residual tumor size, but visual assessment may underestimate residual disease. Postoperative computed tomography (CT) scans can detect residual tumors in up to 49% of cases initially deemed tumor-free. Structured radiologic reporting, such as the Peritoneal Carcinomatosis Index (PCI), improves accuracy and prognosis correlation. This study aims to validate a simplified structured reporting method based on the Lakhman index.

Methods: Patients with advanced ovarian cancer (FIGO stages II and IV) diagnosed between 2007 and 2019 at Hospital La Fe Valencia were included in the study. All underwent cytoreductive surgery with R0 or R1 outcomes, followed by a postoperative CT scan performed between the third and eighth weeks after surgery and before the initiation of chemotherapy. Two gynecologic oncology-specialized radiologists independently analyzed the CT scans in a double-blind manner. They assessed the images using the Lakhman Index, which divides the abdominopelvic cavity into eight regions. Additionally, they applied the Qualitative Assessment (QA) scale to determine the presence of tumor disease in each region, classifying them as QA 1-2 (definitely/probably normal), QA 3 (indeterminate) and QA 4-5 (probably/definitely metastatic).

Results: The study analyzed a cohort of 117 patients. Radiological evaluation detected macroscopic measurable tumor disease in 44%-49% of patients following optimal primary cytoreduction (R0 or R1). Kappa analysis showed a moderate level of concordance between the two radiologists (0.589). Findings from both radiologists (A and B) were significantly associated with reduced disease-free survival (DFS) and overall survival (OS) in patients with macroscopic disease compared to those without (P<0.05).

Conclusions: The identification of radiological tumor presence on standardized, systematic postoperative CT scans prior to adjuvant chemotherapy is linked to the prognosis of patients with advanced ovarian cancer.