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

Advanced Epithelial Ovarian Cancer

Authors

  • Pabina Afroz Parveen Deputation in Gynecological Oncology Department, Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh.
  • Fawzia Hossain Department of Gynecological Oncology, BSMMU, Dhaka, Bangladesh.
  • Shah Mahfuzur Rahman Academic wing, IPH, Dhaka, Bangladesh.
  • Rezwana Sharmin Lima Deputation in BSMMU, Dhaka, Bangladesh, 5Deputation in BSMMU, Dhaka, Bangladesh.
  • Anjuman Sultana Deputation in Bangabandhu Sheikh Mujib Medical Univeristy (BSMMU), Dhaka, Bangladesh.
  • Nahida Sultana Deputation in Bangabandhu Sheikh Mujib Medical Univeristy (BSMMU), Dhaka, Bangladesh.

DOI:

https://doi.org/10.3329/bmrcb.v48i2.62302

Keywords:

Neoadjuvant chemotherapy, Advanced Epithelial ovarian cancer (EOC), optimal cytoreduction (R0), suboptimal cytoreduction (non-R0), Predictive Score for Cytoreduction (PSC), Peritoneal Cancer Index (PCI)

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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Published

2023-05-28

How to Cite

Parveen, P. A., Hossain, F., Rahman, S. M., Lima, R. S., Sultana, A., & Sultana, N. (2023). A Predictive Score after Neoadjuvant Chemotherapy for Optimal Cytoreduction at Interval Debulking Surgery in Advanced Epithelial Ovarian Cancer: Advanced Epithelial Ovarian Cancer. Bangladesh Medical Research Council Bulletin, 48(2), 154–159. https://doi.org/10.3329/bmrcb.v48i2.62302

Issue

Vol. 48 No. 2 (2022)

Section

Research Papers

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Copyright (c) 2022 Pabina Afroz Parveen, Fawzia Hossain, Shah Mahfuzur Rahman, Rezwana Sharmin Lima, Anjuman Sultana, Nahida Sultana

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