A Predictive Score after Neoadjuvant Chemotherapy for Optimal Cytoreduction at Interval Debulking Surgery in Advanced Epithelial Ovarian Cancer

Q4 Medicine

Bangladesh Medical Research Council Bulletin Pub Date : 2023-05-28 DOI:10.3329/bmrcb.v48i2.62302

Pabina Afroz Parveen, F. Hossain, Shah Mahfuzur Rahman, Rezwana Sharmin Lima, Anjuman Sultana, N. Sultana

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引用次数: 0

Abstract

Background: Ovarian cancer is the seventh most common cancer and eighth most common cause of death of female. More than 75% patients are diagnosed at Stage (III - IV) and their 5-year survival rate is (25-50%) . Primary debulking surgery (PDS) followed by adjuvant chemotherapy is the cornerstone treatment for advanced ovarian cancer. Unfortunately, primary debulking surgery is not always feasible and not associated with optimal cytoreduction. Recently, neoadjuvant chemotherapy followed by Interval Debulking Surgery (NACT- IDS) is increasingly adopted. (NACT-IDS) improves optimal cytoreduction and reduces complications in comparison with PDS . However, a significant proportion of patients cannot be optimally cytoreduced even after NACT-IDS and causes futile laparotomy. So, it is necessary to develop a Predictive Score for Cytoreduction (PSC) after NACT for optimal cytoreduction at (IDS). Objective: To find out a predictive score after NACT for optimal cytoreduction at IDS in advanced epithelial ovarian cancer. Method: This was a prospective observational study conducted among 55 patients of advanced ovarian cancer to develop a predictive score after NACT at IDS in department of Gynecological Oncology of BSMMU, from January 2020 to December 2020. Result: Among the 55 patients with advanced epithelial ovarian cancer 44(80%) could be optimally cytoreduced whereas in 11(20%) suboptimal cytoreduction occurred. The sensitivity, specificity, Negative predictive value (NPV), Positive predictive value (PPV) and accuracy of CA-125 for prediction of optimal cytoreduction was 87.5%, 30.8%,85.7%,34.1% and 47.3% respectively. It was observed that 37 (84.1%) have peritoneal cancer index within 0-16 in optimal cytoreduction (R0) and 3 (27.3%) in non-R0 (p value 0.001). The sensitivity, specificity, NPV, PPV and accuracy of Peritoneal Cancer Index (PCI) for prediction of optimal cytoreduction was 62.5%, 89.7%, 85.4% 74.1% and 81.8% respectively. PSC after NACT for optimal cytoreduction at (IDS) was 3 and it indicates 83.3% Patients could be optimally cytoreduced limiting the rate of suboptimal cytoreduction in 16.7%. Conclusion: The result of the present study showed that PSC after NACT influences Optimal cytoreduction (R <1cm) at (IDS). So, this study concluded that IDS after NACT should be performed in patients with a PSC up to 2 to avoid suboptimal cytoreduction. Bangladesh Medical Res Counc Bull 2022; 48: 154-159

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晚期上皮性卵巢癌间歇减癌手术新辅助化疗后最佳细胞减少的预测评分

背景：癌症是癌症第七大常见病，女性死亡原因第八大常见病。超过75%的患者被诊断为III-IV期，其5年生存率为（25-50%）。初级减瘤手术（PDS）后辅助化疗是晚期癌症的基础治疗。不幸的是，初次减瘤手术并不总是可行的，也与最佳的细胞减少无关。近年来，新辅助化疗加间隔脱瘤手术（NACT-IDS）越来越多地被采用。（NACT-IDS）与PDS相比，可改善最佳细胞减少并减少并发症。然而，即使在NACT-IDS之后，仍有相当一部分患者不能最佳地减少细胞，并导致无效的剖腹手术。因此，有必要制定NACT后细胞减少预测评分（PSC），以实现最佳细胞减少（IDS）。目的：找出晚期上皮性卵巢癌症NACT后最佳细胞减少预测分数。方法：对55例晚期癌症患者进行前瞻性观察研究，结果：在55例晚期上皮性卵巢癌症患者中，44例（80%）可获得最佳的细胞减少，而11例（20%）出现次优的细胞减少。CA-125预测最佳细胞减少的敏感性、特异性、阴性预测值（NPV）、阳性预测值（PPV）和准确率分别为87.5%、30.8%、85.7%、34.1%和47.3%。结果发现，腹膜癌症指数在最佳减容（R0）0～16范围内者37例（84.1%），在非R0范围内者3例（27.3%）（p值0.001），腹膜癌症指数（PCI）预测最佳减容的敏感性、特异性、NPV、PPV和准确度分别为62.5%、89.7%、85.4%、74.1%和81.8%。NACT后PSC在（IDS）的最佳细胞减少率为3，表明83.3%的患者可以获得最佳细胞减少，将次优细胞减少率限制在16.7%。结论：本研究结果表明，NACT后的PSC影响（IDS）处的最佳细胞减少率（R<1cm）。因此，本研究得出结论，NACT后的IDS应在PSC高达2的患者中进行，以避免次优的细胞减少。孟加拉国医学研究理事会2022；48：154-159

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来源期刊

Bangladesh Medical Research Council Bulletin Medicine-Medicine (all)

CiteScore

0.30

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0.00%

发文量

期刊介绍： The official publication of the Bangladesh Medical Research Council.