Okunade Kehinde S, Soibi-Harry Adaiah P, Osunwusi Benedetto, Ohazurike Ephraim, John-Olabode Sarah O, Okunowo Adeyemi, Rimi Garba, Salako Omolola, Adenekan Muisi, Anorlu Rose
Obstetrics and Gynaecology, Lagos University Teaching Hospital, Lagos, NGA.
Obstetrics and Gynaecology, College of Medicine, University of Lagos, Lagos, NGA.
Cureus. 2022 Jan 19;14(1):e21409. doi: 10.7759/cureus.21409. eCollection 2022 Jan.
Background Several studies have shown that whether complete tumor resection can be achieved during debulking surgery depends on various patient-related factors. However, none of these studies was conducted among patients with epithelial ovarian cancer (EOC) in sub-Saharan Africa. In this study, we aimed to determine the preoperative predictors of optimal tumor resectability (OTR) during primary debulking surgery (PDS) in patients with EOC. Methodology In this study, we reviewed all patients with histologically diagnosed EOC who underwent PDS between January 2011 and December 2020. We included 83 patients with complete clinical records for subsequent data analysis. Descriptive statistics were computed for patients' data, and binary logistic regression analysis was used to assess the strength of associations between patients' preoperative characteristics and OTR. Results The overall rate of OTR was 53.0%, while the rate in advanced EOC patients was 36.1%. In the univariate analyses, pleural effusion, ascites, tumor bilaterality, size of the largest tumor, retroperitoneal lymph nodes, omental caking, peritoneal thickening, significant extrapelvic tumor, serum cancer antigen-125 (CA-125) levels, and hemoglobin levels were recorded as the predictors of OTR. However, after adjusting for covariates in the final multivariate models, we found that the absence of moderate-to-large pleural effusion (odds ratio (OR) = 5.60; 95% confidence interval (CI) = 1.32, 23.71) and having serum CA-125 levels of ≤370 U/mL (OR = 6.80; 95% CI = 1.19, 38.79) were the overall independent predictors of OTR while not having any preexisting comorbidity (OR = 18.21; 95% CI = 2.40, 38.10), and the absence of pleural effusions (OR = 13.75; 95% CI = 1.80, 24.85) or enlarged retroperitoneal lymph nodes (OR = 11.95; 95% CI = 1.35, 16.07) were predictors of OTR in advanced EOC patients. Conclusions We demonstrated that the radiological absence of pleural effusions and enlarged retroperitoneal lymph nodes and having no preexisting medical morbidity and serum CA-125 levels of ≤370 U/mL were the independent predictors of OTR during PDS. The preliminary data generated from this study can be used to develop variables for a prediction model in a future validation study.
多项研究表明，肿瘤减瘤手术能否实现完全肿瘤切除取决于多种与患者相关的因素。然而，这些研究均未在撒哈拉以南非洲的上皮性卵巢癌（EOC）患者中进行。在本研究中，我们旨在确定EOC患者初次减瘤手术（PDS）期间最佳肿瘤可切除性（OTR）的术前预测因素。
在本研究中，我们回顾了2011年1月至2020年12月期间接受PDS且经组织学诊断为EOC的所有患者。我们纳入了83例有完整临床记录的患者用于后续数据分析。对患者数据进行描述性统计，并使用二元逻辑回归分析评估患者术前特征与OTR之间关联的强度。
OTR的总体发生率为53.0%，而晚期EOC患者的发生率为36.1%。在单因素分析中，胸腔积液、腹水、肿瘤双侧性、最大肿瘤大小、腹膜后淋巴结、网膜饼状增厚、腹膜增厚、显著的盆腔外肿瘤、血清癌抗原125（CA-125）水平和血红蛋白水平被记录为OTR的预测因素。然而，在最终的多变量模型中对协变量进行调整后，我们发现无中至大量胸腔积液（比值比（OR）=5.60；95%置信区间（CI）=1.32，23.71）以及血清CA-125水平≤370 U/mL（OR =6.80；95%CI =1.19，38.79）是OTR的总体独立预测因素，而无任何既往合并症（OR =18.21；95%CI =2.40，38.10）、无胸腔积液（OR =13.75；95%CI =1.80，24.85）或腹膜后淋巴结未肿大（OR =11.95；95%CI =1.35，16.07）是晚期EOC患者OTR的预测因素。
我们证明，影像学上无胸腔积液和腹膜后淋巴结未肿大、无既往病史以及血清CA-125水平≤370 U/mL是PDS期间OTR的独立预测因素。本研究产生的初步数据可用于在未来的验证研究中开发预测模型的变量。
