Center for Gynecological Oncology and Gynecology, Sanno Hospital, Tokyo, Japan.
Diagnostic Imaging Department, The Cancer Institute Hospital of Japanese Foundation for Cancer Research, Tokyo, Japan.
Jpn J Clin Oncol. 2021 Feb 8;51(2):205-212. doi: 10.1093/jjco/hyaa145.
Computed tomography of the abdomen and pelvis is a useful imaging modality for identifying origin and extent of ovarian cancer before primary debulking surgery. However, the International Federation of Gynecology and Obstetrics staging for ovarian cancer is determined based on surgico-pathological findings. The purpose of this study is to determine whether computed tomography staging can be the surrogate for surgico-pathological International Federation of Gynecology and Obstetrics staging in advanced ovarian cancer undergoing neoadjuvant chemotherapy.
Computed tomography staging was compared with surgico-pathological International Federation of Gynecology and Obstetrics staging in primary debulking surgery arm patients in a randomized controlled trial comparing primary debulking surgery and neoadjuvant chemotherapy (JCOG0602). The cancer of primary debulking surgery arm was identically diagnosed regarding the origin and extent with the cancer of neoadjuvant chemotherapy arm before accrual, using imaging studies (computed tomography and/or magnetic resonance imaging), cytological examination (ascites, pleural effusion or tumor contents fluid) and tumor marker (CA125 > 200 U/mL and CEA < 20 ng/mL). Institutional computed tomography staging was also compared with computed tomography staging by central review.
Among 149 primary debulking surgery arm patients, 147 patients who underwent primary debulking surgery immediately were analyzed. Positive predictive values and sensitivity of computed tomography staging for surgical stage III disease (extra-pelvic peritoneal disease and/or retroperitoneal lymph node metastasis) were 99%. Meanwhile, positive predictive values for the presence of small (≤2 cm) extra-pelvic peritoneal disease were low; <20% in omentum. Accuracy of institutional computed tomography staging was comparable with computed tomography staging by central review.
Preoperative computed tomography staging in each institution can be the surrogate for surgico-pathological diagnosis in stage III disease of ovarian cancer patients undergoing neoadjuvant chemotherapy without diagnostic surgery, but reliability of diagnosis of stage IIIB disease is inadequate.Clinical trial registration: UMIN000000523(UMIN-CTR).
腹部和骨盆的计算机断层扫描（CT）是一种有用的成像方式，可在原发性肿瘤细胞减灭术（primary debulking surgery，PDS）之前识别卵巢癌的起源和范围。然而，国际妇产科联合会（International Federation of Gynecology and Obstetrics，FIGO）的卵巢癌分期是基于手术病理发现的。本研究旨在确定在接受新辅助化疗的晚期卵巢癌患者中，CT 分期是否可以替代手术病理的 FIGO 分期。
在一项比较 PDS 和新辅助化疗的随机对照试验（JCOG0602）中，对 PDS 组患者的 CT 分期与手术病理的 FIGO 分期进行了比较。在入组前，通过影像学检查（CT 和/或磁共振成像）、细胞学检查（腹水、胸腔积液或肿瘤内容物）和肿瘤标志物（CA125>200 U/mL 和 CEA <20 ng/mL），对新辅助化疗组和 PDS 组患者的肿瘤起源和范围进行了相同的诊断。还比较了机构 CT 分期和中心审查的 CT 分期。
在 149 例 PDS 组患者中，对 147 例立即进行 PDS 的患者进行了分析。CT 分期对手术 III 期疾病（盆外腹膜疾病和/或腹膜后淋巴结转移）的阳性预测值和敏感性为 99%。然而，对于小（≤2 cm）盆外腹膜疾病的存在，阳性预测值较低；网膜的<20%。机构 CT 分期的准确性与中心审查的 CT 分期相当。
在不进行诊断性手术的情况下，新辅助化疗的卵巢癌患者的 III 期疾病术前 CT 分期可以替代手术病理诊断，但 IIIB 期疾病的诊断可靠性不足。临床试验注册：UMIN000000523（UMIN-CTR）。
