Prediction of nonresectability using the updated Predictive
Index value model assessed by imaging and surgery in
tubo-ovarian cancer: a prospective multicenter ISAAC study

J 2024

Prediction of nonresectability using the updated Predictive Index value model assessed by imaging and surgery in tubo-ovarian cancer: a prospective multicenter ISAAC study

MORO, Francesca, Patricia PINTO, Valentina CHIAPPA, Antonia Carla TESTA, Juan Luis ALCAZAR et. al.

Basic information

Original name

Prediction of nonresectability using the updated Predictive Index value model assessed by imaging and surgery in tubo-ovarian cancer: a prospective multicenter ISAAC study

Authors

MORO, Francesca, Patricia PINTO, Valentina CHIAPPA, Antonia Carla TESTA, Juan Luis ALCAZAR, Dorella FRANCHI, Klára BENEŠOVÁ (203 Czech Republic, belonging to the institution), Jiří JARKOVSKÝ (203 Czech Republic, belonging to the institution), Filip FRUHAUF, Martina BORCINOVA (203 Czech Republic), Andrea BURGETOVA (203 Czech Republic), Martin MASEK (203 Czech Republic), Lukas LAMBERT (203 Czech Republic), Dagmar ALTMANOVA (203 Czech Republic), Giacomo AVESANI, Camilla PANICO, Sarah ALESSI, Paola PRICOLO, Julio Vara GARCIA, Simona PALLADINO, Raffaella VIGORITO, Giuseppina CALARESO, Roman KOCIAN (203 Czech Republic), Jiri SLAMA (203 Czech Republic), Ailyn Mariela Vidal URBINATI, Francesco RASPAGLIESI, Anna FAGOTTI, Giovanni SCAMBIA, David CIBULA (203 Czech Republic) and Daniela FISCHEROVA

Edition

American journal of obstetrics and gynecology, NEW YORK, ELSEVIER, 2024, 0002-9378

Other information

Language

English

Type of outcome

Article in a journal

Field of Study

30214 Obstetrics and gynaecology

Country of publisher

United States of America

Confidentiality degree

is not subject to a state or trade secret

References:

URL

Impact factor

Impact factor: 8.700 in 2023

RIV identification code

RIV/00216224:14110/24:00138591

Organization unit

Faculty of Medicine

DOI

http://dx.doi.org/10.1016/j.ajog.2024.06.047

UT WoS

001365240900001

Keywords in English

computed tomography; laparoscopy; laparotomy; magnetic resonance; ovarian cancer; staging; ultrasonography

Abstract

V originále

Background: A laparoscopy-based scoring system was developed by Fagotti et al (Fagotti or Predictive Index value (PIV)score) based on the intraoperative presence or absence of carcinomatosis on predefined sites. Later, the authors updated the PIV score calculated only in the absence of one or both absolute criteria of nonresectability (mesenteric retraction and miliary carcinomatosis of the small bowel) (updated PIV model). Objective: The aim was to demonstrate the noninferiority of ultrasound to other imaging methods (contrast enhanced computed tomography (CT) and whole-body diffusion-weighted magnetic resonance imaging (WB-DWI)/MRI) in predicting nonresectable tumor (defined as residual disease >1 cm) using the updated PIV model in patients with tubo-ovarian cancer. The agreement between imaging and intraoperative findings as a reference was also calculated. Study Design: This was a European prospective multicenter observational study. We included patients with suspected tubo-ovarian carcinoma who underwent preoperative staging and prediction of nonresectability at ultrasound, CT, WB-DWI/MRI, and surgical exploration. Ultrasound and CT were mandatory index tests, while WB-DWI/MRI was an optional test (non-available in all centers). The predictors of nonresectability were suspicious mesenteric retraction and/or miliary carcinomatosis of the small bowel or if absent, a PIV >8 (updated PIV model). The PIV score ranges from 0 to 12 according to the presence of disease in 6 predefined intra-abdominal sites (great omentum, liver surface, lesser omentum/stomach/spleen, parietal peritoneum, diaphragms, bowel serosa/mesentery). The reference standard was surgical outcome, in terms of residual disease >1 cm, assessed by laparoscopy and/or laparotomy. The area under the receiver operating characteristic curve (AUC) to assess the performance of the methods in predicting nonresectability was reported. Concordance between index tests at the detection of disease at 6 predefined sites and intraoperative exploration as reference standard was also calculated using Cohen's kappa. Results: The study was between 2018 and 2022 in 5 European gynecological oncology centers. Data from 242 patients having both mandatory index tests (ultrasound and CT) were analyzed. 145/242 (59.9%) patients had no macroscopic residual tumor after surgery (R0) (5/145 laparoscopy and 140/145 laparotomy) and 17/242 (7.0%) had residual tumor <= 1 cm (R1) (laparotomy). In 80/242 patients (33.1%), the residual tumor was>1 cm (R2), 30 of them underwent laparotomy and maximum surgery was carried out, and 50/80 underwent laparoscopy only, because cytoreduction was not feasible in all of them. After excluding 18/242 (7.4%) patients operated on but not eligible for extensive surgery, the predictive performance of 3 imaging methods was analyzed in 167 women. The AUCs of all methods in discriminating between resectable and nonresectable tumor was 0.80 for ultrasound, 0.76 for CT, 0.71 for WB-DWI/MRI, and 0.90 for surgical exploration. Ultrasound had the highest agreement (Cohen's kappa ranging from 0.59 to 0.79) than CT and WB-DWI/MRI to assess all parameters included in the updated PIV model. Conclusion: Ultrasound showed noninferiority to CT and to WB-DWI/MRI in discriminating between resectable and nonresectable tumor using the updated PIV model. Ultrasound had the best agreement between imaging and intraoperative findings in the assessment of parameters included in the updated PIV model.

Cite

MORO, Francesca, Patricia PINTO, Valentina CHIAPPA, Antonia Carla TESTA, Juan Luis ALCAZAR, Dorella FRANCHI, Klára BENEŠOVÁ, Jiří JARKOVSKÝ, Filip FRUHAUF, Martina BORCINOVA, Andrea BURGETOVA, Martin MASEK, Lukas LAMBERT, Dagmar ALTMANOVA, Giacomo AVESANI, Camilla PANICO, Sarah ALESSI, Paola PRICOLO, Julio Vara GARCIA, Simona PALLADINO, Raffaella VIGORITO, Giuseppina CALARESO, Roman KOCIAN, Jiri SLAMA, Ailyn Mariela Vidal URBINATI, Francesco RASPAGLIESI, Anna FAGOTTI, Giovanni SCAMBIA, David CIBULA and Daniela FISCHEROVA. Prediction of nonresectability using the updated Predictive Index value model assessed by imaging and surgery in tubo-ovarian cancer: a prospective multicenter ISAAC study. American journal of obstetrics and gynecology. NEW YORK: ELSEVIER, 2024, vol. 231, No 6, p. 1-14. ISSN 0002-9378. Available from: https://dx.doi.org/10.1016/j.ajog.2024.06.047.

@article{2470302,
   author = {Moro, Francesca and Pinto, Patricia and Chiappa, Valentina and Testa, Antonia Carla and Alcazar, Juan Luis and Franchi, Dorella and Benešová, Klára and Jarkovský, Jiří and Fruhauf, Filip and Borcinova, Martina and Burgetova, Andrea and Masek, Martin and Lambert, Lukas and Altmanova, Dagmar and Avesani, Giacomo and Panico, Camilla and Alessi, Sarah and Pricolo, Paola and Garcia, Julio Vara and Palladino, Simona and Vigorito, Raffaella and Calareso, Giuseppina and Kocian, Roman and Slama, Jiri and Urbinati, Ailyn Mariela Vidal and Raspagliesi, Francesco and Fagotti, Anna and Scambia, Giovanni and Cibula, David and Fischerova, Daniela},
   article_location = {NEW YORK},
   article_number = {6},
   doi = {http://dx.doi.org/10.1016/j.ajog.2024.06.047},
   keywords = {computed tomography; laparoscopy; laparotomy; magnetic resonance; ovarian cancer; staging; ultrasonography},
   language = {eng},
   issn = {0002-9378},
   journal = {American journal of obstetrics and gynecology},
   title = {Prediction of nonresectability using the updated Predictive Index value model assessed by imaging and surgery in tubo-ovarian cancer: a prospective multicenter ISAAC study},
   url = {https://www.sciencedirect.com/science/article/pii/S0002937824007403?via%3Dihub},
   volume = {231},
   year = {2024}
}

TY  - JOUR
ID  - 2470302
AU  - Moro, Francesca - Pinto, Patricia - Chiappa, Valentina - Testa, Antonia Carla - Alcazar, Juan Luis - Franchi, Dorella - Benešová, Klára - Jarkovský, Jiří - Fruhauf, Filip - Borcinova, Martina - Burgetova, Andrea - Masek, Martin - Lambert, Lukas - Altmanova, Dagmar - Avesani, Giacomo - Panico, Camilla - Alessi, Sarah - Pricolo, Paola - Garcia, Julio Vara - Palladino, Simona - Vigorito, Raffaella - Calareso, Giuseppina - Kocian, Roman - Slama, Jiri - Urbinati, Ailyn Mariela Vidal - Raspagliesi, Francesco - Fagotti, Anna - Scambia, Giovanni - Cibula, David - Fischerova, Daniela
PY  - 2024
TI  - Prediction of nonresectability using the updated Predictive Index value model assessed by imaging and surgery in tubo-ovarian cancer: a prospective multicenter ISAAC study
JF  - American journal of obstetrics and gynecology
VL  - 231
IS  - 6
SP  - 1-14
EP  - 1-14
PB  - ELSEVIER
SN  - 00029378
KW  - computed tomography
KW  - laparoscopy
KW  - laparotomy
KW  - magnetic resonance
KW  - ovarian cancer
KW  - staging
KW  - ultrasonography
UR  - https://www.sciencedirect.com/science/article/pii/S0002937824007403?via%3Dihub
N2  - Background: A laparoscopy-based scoring system was developed by Fagotti et al (Fagotti or Predictive Index value (PIV)score) based on the intraoperative presence or absence of carcinomatosis on predefined sites. Later, the authors updated the PIV score calculated only in the absence of one or both absolute criteria of nonresectability (mesenteric retraction and miliary carcinomatosis of the small bowel) (updated PIV model). Objective: The aim was to demonstrate the noninferiority of ultrasound to other imaging methods (contrast enhanced computed tomography (CT) and whole-body diffusion-weighted magnetic resonance imaging (WB-DWI)/MRI) in predicting nonresectable tumor (defined as residual disease >1 cm) using the updated PIV model in patients with tubo-ovarian cancer. The agreement between imaging and intraoperative findings as a reference was also calculated. Study Design: This was a European prospective multicenter observational study. We included patients with suspected tubo-ovarian carcinoma who underwent preoperative staging and prediction of nonresectability at ultrasound, CT, WB-DWI/MRI, and surgical exploration. Ultrasound and CT were mandatory index tests, while WB-DWI/MRI was an optional test (non-available in all centers). The predictors of nonresectability were suspicious mesenteric retraction and/or miliary carcinomatosis of the small bowel or if absent, a PIV >8 (updated PIV model). The PIV score ranges from 0 to 12 according to the presence of disease in 6 predefined intra-abdominal sites (great omentum, liver surface, lesser omentum/stomach/spleen, parietal peritoneum, diaphragms, bowel serosa/mesentery). The reference standard was surgical outcome, in terms of residual disease >1 cm, assessed by laparoscopy and/or laparotomy. The area under the receiver operating characteristic curve (AUC) to assess the performance of the methods in predicting nonresectability was reported. Concordance between index tests at the detection of disease at 6 predefined sites and intraoperative exploration as reference standard was also calculated using Cohen's kappa. Results: The study was between 2018 and 2022 in 5 European gynecological oncology centers. Data from 242 patients having both mandatory index tests (ultrasound and CT) were analyzed. 145/242 (59.9%) patients had no macroscopic residual tumor after surgery (R0) (5/145 laparoscopy and 140/145 laparotomy) and 17/242 (7.0%) had residual tumor <= 1 cm (R1) (laparotomy). In 80/242 patients (33.1%), the residual tumor was>1 cm (R2), 30 of them underwent laparotomy and maximum surgery was carried out, and 50/80 underwent laparoscopy only, because cytoreduction was not feasible in all of them. After excluding 18/242 (7.4%) patients operated on but not eligible for extensive surgery, the predictive performance of 3 imaging methods was analyzed in 167 women. The AUCs of all methods in discriminating between resectable and nonresectable tumor was 0.80 for ultrasound, 0.76 for CT, 0.71 for WB-DWI/MRI, and 0.90 for surgical exploration. Ultrasound had the highest agreement (Cohen's kappa ranging from 0.59 to 0.79) than CT and WB-DWI/MRI to assess all parameters included in the updated PIV model. Conclusion: Ultrasound showed noninferiority to CT and to WB-DWI/MRI in discriminating between resectable and nonresectable tumor using the updated PIV model. Ultrasound had the best agreement between imaging and intraoperative findings in the assessment of parameters included in the updated PIV model.
ER  -

MORO, Francesca, Patricia PINTO, Valentina CHIAPPA, Antonia Carla TESTA, Juan Luis ALCAZAR, Dorella FRANCHI, Klára BENEŠOVÁ, Jiří JARKOVSKÝ, Filip FRUHAUF, Martina BORCINOVA, Andrea BURGETOVA, Martin MASEK, Lukas LAMBERT, Dagmar ALTMANOVA, Giacomo AVESANI, Camilla PANICO, Sarah ALESSI, Paola PRICOLO, Julio Vara GARCIA, Simona PALLADINO, Raffaella VIGORITO, Giuseppina CALARESO, Roman KOCIAN, Jiri SLAMA, Ailyn Mariela Vidal URBINATI, Francesco RASPAGLIESI, Anna FAGOTTI, Giovanni SCAMBIA, David CIBULA and Daniela FISCHEROVA. Prediction of nonresectability using the updated Predictive Index value model assessed by imaging and surgery in tubo-ovarian cancer: a prospective multicenter ISAAC study. \textit{American journal of obstetrics and gynecology}. NEW YORK: ELSEVIER, 2024, vol.~231, No~6, p.~1-14. ISSN~0002-9378. Available from: https://dx.doi.org/10.1016/j.ajog.2024.06.047.

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