Abstract：Objective This study aimed to investigate the importance of a Suidan preoperative evaluation model in predicting the effect of tumor cell reduction in patients with advanced epithelial ovarian cancer. Methods In this study, a retrospective cohort study design was used. A total of 152 patients with advanced epithelial ovarian cancer who underwent surgical treatment in the Gynecologic Oncology Department of the First Affiliated Hospital of Bengbu Medical College from January 2019 to October 2020 were included. Patients' age ranged from 18 to 85 years, with a median age of 55 years. According to the International Union of Obstetrics and Gynecology classified,117 cases as stage Ⅲ and 35 cas es as stage Ⅳ. All patients were evaluated using a Suidan preoperative evaluation model and scored 0-9 points. All patients received ovarian cancer cell reduction, and they were divided into three groups in accordance with the surgical method and Suidan score: patients receiving primary debulking surgery (PDS) with Suidan's preoperative score of <3 were included in the PDS-A group (42 cases); patients receiving PDS with Suidan's preoperative score of ≥3 were included in the PDS-B group (46 cases); patients receiving IDS combined with NACT with Suidan's preoperative score of ≥3 were included in the NACT+IDS group (64 cases). The clinical baseline data, unsatisfactory tumor reduction rate, and gross residual lesion rate of patients in the three groups were compared, and the differences in surgical unsatisfactory tumor reduction rate and gross residual lesion rate among patients with different Suidan scores were compared. Moreover, the predictive value of the Suidan preoperative evaluation model for unsatisfactory tumor reduction and gross residual lesion after treatment in patients with advanced epithelial ovarian cancer was evaluated using the receiver operating characteristic (ROC) curve. Results No significant differences in age, pathological type, histological grade, and FIGO stage were found among the three groups (all P values >0.05). The following unsatisfactory tumor reduction rate and residual lesion rate of patients in the three groups were arranged from high to low: PDS-B group (71.7%[33/46], 78.3%[36/46]), NACT+IDS group (48.4%[31/64], 54.7%[33/64]), and PDS-A group (23.8%[10/42], 33.3%[14/42]). The differences were statistically significant (χ2=20.19, 18.05, all P values <0.001). For patients receiving PDS with different Suidan scores, the rate of surgical unsatisfactory tumor reduction and the rate of gross residual lesions gradually increased with the increase of patient scores. The ROC curve showed that the Suidan preoperative assessment model predicted an area under the tumor reduction curve (AUC) of 0.761 for patients with advanced epithelial ovarian cancer (95%[credibility interval]CI) 0.657-0.864), and the highest Youden index was 0.478. In addition, the optimal scoring threshold, sensitivity, and specificity were 3 points, 76.7%, and 71.1%, respectively. The predictive AUC of surgical residual lesions in patients with advanced epithelial ovarian cancer was 0.730 (95%CI 0.624-0.836), and the highest Yuden index was 0.457. Moreover, the optimal scoring threshold was 3, sensitivity, and specificity were 72.0% and 73.7%. Conclusion The Suidan preoperative evaluation model has good predictive value for tumor cell reduction in patients with advanced epithelial ovarian cancer, with a Suidan score of 3, indicating high sensitivity and specificity.
范艳, 杨波, 王丽华. Suidan术前评估模型在预测晚期上皮性卵巢癌肿瘤细胞减灭术效果中的应用研究[J]. 中华解剖与临床杂志, 2022, 27(7): 496-501.
Fan Yan, Yang Bo, Wang Lihua. Importance of a Suidan preoperative evaluation model in predicting the outcome of cell reduction for advanced epithelial ovarian cancer. Chinese Journal of Anatomy and Clinics, 2022, 27(7): 496-501.
Suidan RS, Ramirez PT, Sarasohn DM, et al.A multicenter assessment of the ability of preoperative computed tomography scan and CA-125 to predict gross residual disease at primary debulking for advanced epithelial ovarian cancer[J]. Gynecol Oncol, 2017,145(1):27-31. DOI: 10.1016/j.ygyno.2017.02.020.
[4]
Narasimhulu DM, Kumar A, Weaver AL, et al.Less guessing, more evidence in identifying patients least fit for cytoreductive surgery in advanced ovarian cancer: a triage algorithm to individualize surgical management[J]. Gynecol Oncol, 2020,157(3):572-577. DOI: 10.1016/j.ygyno.2020.03.024.
[5]
Straubhar AM, Wolf JL, Zhou M, et al.Advanced ovarian cancer and cytoreductive surgery: independent validation of a risk-calculator for perioperative adverse events[J]. Gynecol Oncol, 2021,160(2):438-444. DOI: 10.1016/j.ygyno.2020.11.021.
[6]
Kemppainen J, Hynninen J, Virtanen J, et al.PET/CT for evaluation of ovarian cancer[J]. Semin Nucl Med, 2019,49(6):484-492. DOI: 10.1053/j.semnuclmed.2019.06.010.
[7]
O'Dwyer J, O'Cearbhaill RE, Wylie R, et al. Enhancing delivery of small molecule and cell-based therapies for ovarian cancer using advanced delivery strategies[J]. Adv Ther (Weinh), 2020,3(11):2000144. DOI: 10.1002/adtp.202000144.
Suh-Burgmann EJ, Alavi M.Detection of early stage ovarian cancer in a large community cohort[J]. Cancer Med, 2019,8(16):7133-7140. DOI: 10.1002/cam4.2522.
[10]
Zhang L, He Q, Zhou T, et al.Incidental detection of ovarian thecoma by 99mTc-MDP whole-body bone scan: contribution of hybrid SPECT/CT[J]. Clin Nucl Med, 2019,44(10): e577-e578. DOI: 10.1097/RLU.0000000000002673.
[11]
Braicu EI, Fotopoulou C, Van Gorp T, et al.Preoperative HE4 expression in plasma predicts surgical outcome in primary ovarian cancer patients: results from the OVCAD study[J]. Gynecol Oncol, 2013,128(2):245-251. DOI: 10.1016/j.ygyno.2012.11.023.
[12]
Kang S, Kim TJ, Nam BH, et al.Preoperative serum CA-125 levels and risk of suboptimal cytoreduction in ovarian cancer: a meta-analysis[J]. J Surg Oncol, 2010, 101(1): 13-17. DOI: 10.1002/jso.21398.
[13]
Tang Z, Chang X, Ye X, et al.Usefulness of human epididymis protein 4 in predicting cytoreductive surgical outcomes for advanced ovarian tubal and peritoneal carcinoma[J]. Chin J Cancer Res, 2015, 27(3): 309-317. DOI: 10.3978/j.issn.1000-9604.2015.06.01.
[14]
Chi DS, Venkatraman ES, Masson V, et al.The ability of preoperative serum CA-125 to predict optimal primary tumor cytoreduction in stage Ⅲ epithelial ovarian carcinoma[J]. Gynecol Oncol, 2000,77(2):227-231. DOI: 10.1006/gyno.2000.5749.
MacKintosh ML, Rahim R, Rajashanker B, et al. CT scan does not predict optimal debulking in stage Ⅲ-Ⅳ epithelial ovarian cancer: a multicentre validation study[J]. J Obstet Gynaecol, 2014,34(5):424-428. DOI: 10.3109/01443615.2014.899330.
[17]
Fagotti A, Vizzielli G, Costantini B, et al.Learning curve and pitfalls of a laparoscopic score to describe peritoneal carcinosis in advanced ovarian cancer[J]. Acta Obstet Gynecol Scand, 2011,90(10):1126-1131. DOI: 10.1111/j.1600-0412.2011.01227.x.
[18]
吴科, 王亚, 唐郢, 等. 腹腔镜预测指数与晚期卵巢癌患者一期切除结果的一致性及预测价值[J]. 腹腔镜外科杂志, 2020, 25(2):150-153. DOI: 10.13499/j.cnki.fqjwkzz.2020.02.150.Wu K, Wang Y, Tang Y, et al.Consistency of laparoscopic predictive index and outcome of primary resection and its predictive value in patients with advanced ovarian cancer[J]. Journal of Lap Aroscopic Surgery, 2020, 25(2): 150-153. DOI: 10.13499/j.cnki.fqjwkzz.2020.02.150.
[19]
Ataseven B, Grimm C, Harter P, et al.Prognostic impact of port-site metastasis after diagnostic laparoscopy for epithelial ovarian cancer[J]. Ann Surg Oncol, 2016, 23(Suppl 5): 834-840. DOI: 10.1245/s10434-016-5415-9.
[20]
徐丽萍, 毛竹青, 陈爱平, 等. CT联合血清CA125水平评估卵巢癌行初次理想肿瘤细胞减灭术的临床价值[J]. 现代生物医学进展, 2018,18(3):537-540. DOI: 10.13241/j.cnki.pmb.2018.03.030.Xu LP, Mao ZQ, Chen AP, et al.Clinical value of preoperative computed tomography scan and serum CA-125 level in the prediction of ovarian cancer patients underwent ideal primary cytoreductive surgery[J]. Progress in Modern Biomedicine,2018,18(3):537-540. DOI: 10.13241/j.cnki.pmb.2018.03.030.
[21]
Suidan RS, Ramirez PT, Sarasohn DM, et al.A multicenter prospective trial evaluating the ability of preoperative computed tomography scan and serum CA-125 to predict suboptimal cytoreduction at primary debulking surgery for advanced ovarian, fallopian tube, and peritoneal cancer[J]. Gynecol Oncol, 2014,134(3):455-461. DOI: 10.1016/j.ygyno.2014.07.002.
[22]
Kehoe S, Hook J, Nankivell M, et al.Primary chemotherapy versus primary surgery for newly diagnosed advanced ovarian cancer (CHORUS): an open-label, randomised, controlled, non-inferiority trial[J]. Lancet, 2015, 386(9990):249-257. DOI: 10.1016/S0140-6736(14)62223-6.
[23]
Nishio S, Ushijima K.Clinical significance of primary debulking surgery and neoadjuvant chemotherapy-interval debulking surgery in advanced ovarian cancer[J]. Jpn J Clin Oncol, 2020,50(4):379-386. DOI: 10.1093/jjco/hyaa015.
[24]
Vergote I, Coens C, Nankivell M, et al.Neoadjuvant chemotherapy versus debulking surgery in advanced tubo-ovarian cancers: pooled analysis of individual patient data from the EORTC 55971 and CHORUS trials[J]. Lancet Oncol, 2018,19(12):1680-1687. DOI: 10.1016/S1470-2045(18)30566-7.
[25]
Becker DA, Thomas ED, Gilbert AL, et al.Improved outcomes with dose-dense paclitaxel-based neoadjuvant chemotherapy in advanced epithelial ovarian carcinoma[J]. Gynecol Oncol, 2016,142(1):25-29. DOI: 10.1016/j.ygyno.2016.04.539.
2022, Vol. 27 
