基于腹腔镜的评分系统对晚期卵巢癌可切除性评估的外部验证：简化评分的线索

External validation of a laparoscopic-based score to evaluate resectability of advanced ovarian cancers: clues for a simplified score.

作者信息

Brun Jean-Luc, Rouzier Roman, Uzan Serge, Daraï Emile

机构信息

Department of Obstetrics and Gynaecology, Hôpital Tenon, Assistance Publique des Hôpitaux de Paris, F-75020 Paris, France.

出版信息

Gynecol Oncol. 2008 Sep;110(3):354-9. doi: 10.1016/j.ygyno.2008.04.042. Epub 2008 Jun 24.

DOI:10.1016/j.ygyno.2008.04.042

PMID:18572226

Abstract

BACKGROUND

The relevance of laparoscopy-based score in identifying patients with advanced ovarian cancer for optimal cytoreductive surgery has been evaluated.

METHODS

55 patients with stage III-IV ovarian cancer, having undergone both laparoscopy and laparotomy for cytoreductive surgery, were retrospectively analyzed. Seven parameters were assessed: omental cake, peritoneal carcinosis, diaphragmatic carcinosis, mesenteric retraction, bowel infiltration, stomach infiltration, liver metastases. Each parameter was assigned 2 points if present and 0 if not (Fagotti score). Sensitivity, specificity, positive (PPV) and negative (NPV) predictive values, and accuracy were calculated for each parameter. Receiver Operating Characteristic (ROC) curve analysis was used to predict the surgical outcome.

RESULTS

A laparoscopy-based score of >or=8 was associated with suboptimal cytoreduction with sensitivity, specificity, PPV, NPV, and accuracy of 46%, 89%, 89%, 44%, and 60% respectively. ROC curve analysis gave an Area Under the Curve (AUC) of 0.74. A modified score was set up by selecting 4 of the 7 parameters which satisfied the inclusion criteria in our population: diaphragmatic carcinosis, mesenteric retraction, stomach infiltration, liver metastases. Thirteen patients (12%) had a modified score of >or=4 and 42 patients (88%) had a score of <4 with an optimal cytoreduction rate of 0% and 43% respectively (P=0.002). A modified score of >or=4 was associated with suboptimal cytoreduction with sensitivity, specificity, PPV, NPV, and accuracy of 35%, 100%, 100%, 43%, and 56% respectively. ROC curve analysis gave an AUC of 0.68.

CONCLUSION

This simplified laparoscopy-based score was at least as accurate as the Fagotti score to predict resectability.

摘要

背景

评估了基于腹腔镜检查的评分在识别晚期卵巢癌患者以进行最佳细胞减灭术方面的相关性。

方法

回顾性分析55例III-IV期卵巢癌患者，这些患者均接受了腹腔镜检查和剖腹手术以进行细胞减灭术。评估了七个参数：大网膜饼、腹膜癌、膈肌癌、肠系膜退缩、肠浸润、胃浸润、肝转移。每个参数若存在则赋值2分，若不存在则赋值0分（法戈蒂评分）。计算每个参数的敏感性、特异性、阳性预测值（PPV）和阴性预测值（NPV）以及准确性。采用受试者操作特征（ROC）曲线分析来预测手术结果。

结果

基于腹腔镜检查的评分≥8分与次优细胞减灭相关，其敏感性、特异性、PPV、NPV和准确性分别为46%、89%、89%、44%和60%。ROC曲线分析得出曲线下面积（AUC）为0.74。通过从7个参数中选择4个满足我们研究人群纳入标准的参数建立了改良评分：膈肌癌、肠系膜退缩、胃浸润、肝转移。13例患者（12%）改良评分为≥4分，42例患者（88%）评分为<4分，最佳细胞减灭率分别为0%和43%（P = 0.002）。改良评分为≥4分与次优细胞减灭相关，其敏感性、特异性、PPV、NPV和准确性分别为35%、100%、100%、43%和56%。ROC曲线分析得出AUC为0.68。