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Definition of a dynamic laparoscopic model for the prediction of incomplete cytoreduction in advanced epithelial ovarian cancer: Proof of concept
4
Abstracts / Gynecologic Oncology 137 (2015) 2–91 Toxicity (grade 3+)
CT
CTB
P
GI perforations necrosis fistula (any grade) GI perforations necrosis fistula Infections Joint pain Proteinuria Venous thrombosis Arterial thrombosis Febrile neutropenia
4% 1% 5.8% 4.6% 0% 1.2% 0.6% 2.7%
14.8% 1.8% 13.0% 15.1% 8.1% 3.9% 2.4% 6.1%
b 0.001 0.5 0.002 b 0.001 b 0.001 0.046 0.107 P = 0.056
doi:10.1016/j.ygyno.2015.01.005
4 — Scientific Plenary Definition of a dynamic laparoscopic model for the prediction of incomplete cytoreduction in advanced epithelial ovarian cancer: Proof of concept M. Petrilloa, G. Vizziellia, F. Fanfania, V. Gallottaa, F. Cosentinoa, V. Chianteraa, G. Scambiaa, A. Fagottib. aCatholic University of the Sacred Heart, Milan, Italy, bSt. Maria Hospital, University of Perugia, Terni, Italy Objectives: To develop an updated laparoscopy-based model to predict incomplete cytoreduction (RT N 0) in advanced epithelial ovarian cancer (AEOC) after the introduction of upper abdominal surgery (UAS). Methods: The presence of omental cake, peritoneal extensive carcinomatosis, diaphragmatic confluent carcinomatosis, bowel infiltration, stomach and/or spleen and/or lesser omentum infiltration, and liver superficial metastasis were evaluated by staging laparoscopy (S-LPS) in a consecutive series of 234 women with newly diagnosed AEOC undergoing laparoscopic PDS after S-LPS. Parameters showing a specificity ≥75%, positive predictive value (PPV) ≥50%, and negative predictive value (NPV) ≥50% received a 1-point score, with a point added when the accuracy was ≥60% in predicting incomplete cytoreduction. A total predictive index value was tabulated for each patient by summing positive features. The overall discriminating performance of the LPS-PI was finally estimated by receiver operating characteristic curve analysis. Results: PDS with no gross residual disease was achieved in 135 cases (57.5%). Among them, UAS was required in 72 cases (53.3%) for a total of 112 procedures, and approximately 25% of these patients received bowel resection, excluding rectosigmoid resection. We observed a very high overall agreement between S-LPS and laparoscopic findings, which ranged from 74.7% for omental cake to 94.8% for stomach infiltration. At an LPS-PIV ≥10, the chance of achieving complete PDS was 0, and the risk of unnecessary laparotomy was 33.2%. Discriminating performance of LPS-PI was very high (AUC = 0.885). Conclusions: S-LPS is an accurate tool in predicting complete PDS in women with AEOC. The updated LPS-PI showed improved discriminating performance, with a lower rate of inappropriate laparoscopic explorations at the established cut-off value of 10.
doi:10.1016/j.ygyno.2015.01.006
5 — Scientific Plenary Correlation between surgeon's assessment of residual disease and findings on postoperative pre-treatment computed tomography scan in women with advanced stage ovarian cancer reported to have undergone optimal cytoreduction: An NRG Oncology/GOG study R.N. Eskandera, J. Kaudererb, K.S. Tewaria, R.E. Bristowc, R.A. Burgerd. a UC Irvine Medical Center, Orange, CA, USA, bGynecologic Oncology Group Statistical and Data Center, Buffalo, NY, USA, cUniversity of California, Irvine, Irvine, CA, USA, dUniversity of Pennsylvania, Philadelphia, PA, USA
Objectives: We sought to determine the level of concordance between surgeons' operative assessment of residual disease (RD) and pretreatment computed tomography (CT) findings among women who had undergone optimal surgical cytoreduction for advanced ovarian cancer. Methods: This is a post-trial ad hoc analysis of Gynecologic Oncology Group protocol 218, a phase III randomized clinical trial that evaluated the impact of bevacizumab in primary and maintenance therapy for patients with newly diagnosed advanced-stage ovarian cancer. All patients underwent imaging of the chest/abdomen/pelvis to establish a postsurgical baseline prior to the initiation of chemotherapy. Information collected on the surgical status form, pretreatment summary form, and surgical reporting form was used to compare surgeon's operative assessment of RD to pretreatment imaging. Descriptive statistics were reported and proportional hazards regression (HR) was used to determine the impact of RD on progression free and overall survival. Results: A total of 1718 patients were randomized and enrolled. Surgical outcome was described as optimal (RD ≤1 cm) in 639 patients. Twelve patients were excluded because they did not have a baseline CT scan, leaving 627 participants for analysis. The average interval from surgery to baseline scan was 26 days (range: 1–109 days). In 251 cases (40%), the postoperative scan was discordant with surgeon assessment, demonstrating RD N1 cm in size, with 69.2% of patients having ≥2 target lesions (total of 719 target lesions reported). RD N1 cm was most commonly identified in the right upper quadrant (28.4%), retroperitoneal paraaortic lymph nodes (28.2%), and the left upper quadrant (10.7%). Patients with RD N1 cm on pretreatment CT (discordant) exhibited a significantly greater risk of progression (HR 1.30; 95% CI 1.08–1.56; P = 0.0059). No difference in overall survival was noted (HR 0.99; 95% CI 0.80–1.23; P = ns). Conclusions: Among patients reported to have undergone optimal cytoreduction, 40% were found to have lesions N1 cm on postoperative CT imaging. Although postoperative inflammatory changes and/or rapid tumor regrowth could account for the observed discordance, the distribution of RD favoring the upper abdomen and retroperitoneum may indicate underestimation by the operating surgeon. doi:10.1016/j.ygyno.2015.01.007
Scientific Plenary II Saturday, March 28, 2015 Moderator: Noriaki Sakuragi, MD, Hokkaido University School of Medicine, Sapporo, Japan Laura Jean Havrilesky, MD, Duke University Medical Center, Durham, NC, USA 6 — Scientific Plenary Clinical implications for MSI, MLH1 methylation analysis and IHC in Lynch screening for endometrial cancer patients: An analysis of 940 endometrioid endometrial cancer cases from the GOG 0210 study C.C. Billingsleya, D.E. Cohna, D.G. Mutchb, R. Broaddusc, N. Ramirezd, H. Lankese, S. Alif, F.J. Backesg, L.M. Landrumh, P.J. Goodfellowa. aThe Ohio State University, Columbus, OH, USA, bWashington University School of Medicine, St. Louis, MO, USA, cThe University of Texas MD Anderson Cancer Center, Houston, TX, USA, dGynecologic Oncology Group Tissue Bank, Biopathology Center, Research Institute at Nationwide Children's Hospital, Columbus, OH, USA, eGynecologic Oncology Group Statistical and Data Center, Buffalo, NY, USA, fRoswell Park Cancer Institute, Buffalo, NY, USA, gThe Ohio State University, James Cancer Hospital, Columbus, OH, USA, hThe University of Oklahoma, Oklahoma City, OK, USA Objectives: To assess the effectiveness of tumor microsatellite instability (MSI) and methylation analysis combined with immunohistochemistry (IHC) in predicting germline mutations in DNA mismatch repair (MMR) (Lynch syndrome [LS]) in endometrial
Abstracts / Gynecologic Oncology 137 (2015) 2–91 Toxicity (grade 3+)
CT
CTB
P
GI perforations necrosis fistula (any grade) GI perforations necrosis fistula Infections Joint pain Proteinuria Venous thrombosis Arterial thrombosis Febrile neutropenia
4% 1% 5.8% 4.6% 0% 1.2% 0.6% 2.7%
14.8% 1.8% 13.0% 15.1% 8.1% 3.9% 2.4% 6.1%
b 0.001 0.5 0.002 b 0.001 b 0.001 0.046 0.107 P = 0.056
doi:10.1016/j.ygyno.2015.01.005
4 — Scientific Plenary Definition of a dynamic laparoscopic model for the prediction of incomplete cytoreduction in advanced epithelial ovarian cancer: Proof of concept M. Petrilloa, G. Vizziellia, F. Fanfania, V. Gallottaa, F. Cosentinoa, V. Chianteraa, G. Scambiaa, A. Fagottib. aCatholic University of the Sacred Heart, Milan, Italy, bSt. Maria Hospital, University of Perugia, Terni, Italy Objectives: To develop an updated laparoscopy-based model to predict incomplete cytoreduction (RT N 0) in advanced epithelial ovarian cancer (AEOC) after the introduction of upper abdominal surgery (UAS). Methods: The presence of omental cake, peritoneal extensive carcinomatosis, diaphragmatic confluent carcinomatosis, bowel infiltration, stomach and/or spleen and/or lesser omentum infiltration, and liver superficial metastasis were evaluated by staging laparoscopy (S-LPS) in a consecutive series of 234 women with newly diagnosed AEOC undergoing laparoscopic PDS after S-LPS. Parameters showing a specificity ≥75%, positive predictive value (PPV) ≥50%, and negative predictive value (NPV) ≥50% received a 1-point score, with a point added when the accuracy was ≥60% in predicting incomplete cytoreduction. A total predictive index value was tabulated for each patient by summing positive features. The overall discriminating performance of the LPS-PI was finally estimated by receiver operating characteristic curve analysis. Results: PDS with no gross residual disease was achieved in 135 cases (57.5%). Among them, UAS was required in 72 cases (53.3%) for a total of 112 procedures, and approximately 25% of these patients received bowel resection, excluding rectosigmoid resection. We observed a very high overall agreement between S-LPS and laparoscopic findings, which ranged from 74.7% for omental cake to 94.8% for stomach infiltration. At an LPS-PIV ≥10, the chance of achieving complete PDS was 0, and the risk of unnecessary laparotomy was 33.2%. Discriminating performance of LPS-PI was very high (AUC = 0.885). Conclusions: S-LPS is an accurate tool in predicting complete PDS in women with AEOC. The updated LPS-PI showed improved discriminating performance, with a lower rate of inappropriate laparoscopic explorations at the established cut-off value of 10.
doi:10.1016/j.ygyno.2015.01.006
5 — Scientific Plenary Correlation between surgeon's assessment of residual disease and findings on postoperative pre-treatment computed tomography scan in women with advanced stage ovarian cancer reported to have undergone optimal cytoreduction: An NRG Oncology/GOG study R.N. Eskandera, J. Kaudererb, K.S. Tewaria, R.E. Bristowc, R.A. Burgerd. a UC Irvine Medical Center, Orange, CA, USA, bGynecologic Oncology Group Statistical and Data Center, Buffalo, NY, USA, cUniversity of California, Irvine, Irvine, CA, USA, dUniversity of Pennsylvania, Philadelphia, PA, USA
Objectives: We sought to determine the level of concordance between surgeons' operative assessment of residual disease (RD) and pretreatment computed tomography (CT) findings among women who had undergone optimal surgical cytoreduction for advanced ovarian cancer. Methods: This is a post-trial ad hoc analysis of Gynecologic Oncology Group protocol 218, a phase III randomized clinical trial that evaluated the impact of bevacizumab in primary and maintenance therapy for patients with newly diagnosed advanced-stage ovarian cancer. All patients underwent imaging of the chest/abdomen/pelvis to establish a postsurgical baseline prior to the initiation of chemotherapy. Information collected on the surgical status form, pretreatment summary form, and surgical reporting form was used to compare surgeon's operative assessment of RD to pretreatment imaging. Descriptive statistics were reported and proportional hazards regression (HR) was used to determine the impact of RD on progression free and overall survival. Results: A total of 1718 patients were randomized and enrolled. Surgical outcome was described as optimal (RD ≤1 cm) in 639 patients. Twelve patients were excluded because they did not have a baseline CT scan, leaving 627 participants for analysis. The average interval from surgery to baseline scan was 26 days (range: 1–109 days). In 251 cases (40%), the postoperative scan was discordant with surgeon assessment, demonstrating RD N1 cm in size, with 69.2% of patients having ≥2 target lesions (total of 719 target lesions reported). RD N1 cm was most commonly identified in the right upper quadrant (28.4%), retroperitoneal paraaortic lymph nodes (28.2%), and the left upper quadrant (10.7%). Patients with RD N1 cm on pretreatment CT (discordant) exhibited a significantly greater risk of progression (HR 1.30; 95% CI 1.08–1.56; P = 0.0059). No difference in overall survival was noted (HR 0.99; 95% CI 0.80–1.23; P = ns). Conclusions: Among patients reported to have undergone optimal cytoreduction, 40% were found to have lesions N1 cm on postoperative CT imaging. Although postoperative inflammatory changes and/or rapid tumor regrowth could account for the observed discordance, the distribution of RD favoring the upper abdomen and retroperitoneum may indicate underestimation by the operating surgeon. doi:10.1016/j.ygyno.2015.01.007
Scientific Plenary II Saturday, March 28, 2015 Moderator: Noriaki Sakuragi, MD, Hokkaido University School of Medicine, Sapporo, Japan Laura Jean Havrilesky, MD, Duke University Medical Center, Durham, NC, USA 6 — Scientific Plenary Clinical implications for MSI, MLH1 methylation analysis and IHC in Lynch screening for endometrial cancer patients: An analysis of 940 endometrioid endometrial cancer cases from the GOG 0210 study C.C. Billingsleya, D.E. Cohna, D.G. Mutchb, R. Broaddusc, N. Ramirezd, H. Lankese, S. Alif, F.J. Backesg, L.M. Landrumh, P.J. Goodfellowa. aThe Ohio State University, Columbus, OH, USA, bWashington University School of Medicine, St. Louis, MO, USA, cThe University of Texas MD Anderson Cancer Center, Houston, TX, USA, dGynecologic Oncology Group Tissue Bank, Biopathology Center, Research Institute at Nationwide Children's Hospital, Columbus, OH, USA, eGynecologic Oncology Group Statistical and Data Center, Buffalo, NY, USA, fRoswell Park Cancer Institute, Buffalo, NY, USA, gThe Ohio State University, James Cancer Hospital, Columbus, OH, USA, hThe University of Oklahoma, Oklahoma City, OK, USA Objectives: To assess the effectiveness of tumor microsatellite instability (MSI) and methylation analysis combined with immunohistochemistry (IHC) in predicting germline mutations in DNA mismatch repair (MMR) (Lynch syndrome [LS]) in endometrial