Neoadjuvant chemotherapy and cytoreductive surgery in epithelial ovarian cancer

Table 1 Studies of cancer antigen 125 for predicting the result of surgery in epithelial ovarian cancer

First author, year	n	Preoperative CA 125 (U/mL)		Optimal surgery3	Sensitivity	Specificity	PPV	NPV
		Median	Cut-off
Not clinically useful1
Gemer et al[30], 2001	40	341	500	60%	62%	83%	71%	77%
Cooper et al[31], 2002	112	893	500	58%	49%	77%	74%	52%
Memarzadeh et al[32], 2003	99	-	912	73%	58%	54%	78%	31%
Rossi et al[33], 2004	822	1351	500	40%	40%	64%	-	-
Alcázar et al[34], 2004	67	730	620	48%	60%	-	-	-
Gemer et al[35], 2005	424	495	400	57%	69%	57%	55%	71%
Everett et al[36], 2005	56	NA	500	52%	-	-	-	-
Barlow et al[37], 2006	164	364	500	47%	66%	59%	64%	36%
Gilani et al[38], 2007	90	500	500	47%	68%	62%	64%	35%
Arits et al[39], 2008	96	625	330	43%	80%	42%	-	-
Chi et al[40], 2009	277	731	500	80%	-	-	-	-
Probably clinically useful1
Chi et al[41], 2000	100	819	500	45%	78%	73%	78%	73%
Saygili et al[42], 2002	92	494	500	52%	73%	77%	75%	75%
Obeidat et al[43], 2004	40	467	500	55%	72%	73%	68%	76%
Eltabbakh et al[44], 2004	72	680	500	81%	73%	74%	-	-
Brockbank et al[45], 2004	77	397	586	68%	80%	89%	86%	80%
Vorgias et al[46], 2009	426	650	500	42%	79%	90%	85%	85%

¹Studies of not clinical useful and probably useful were arranged according to the comments of the authors in each study;

²Diagnostic functions of cancer antigen (CA) 125 in the study were of the whole group (22% early stages and 78% advanced stages) while the numbers of patients (n) in other studies were of stage III or stage III-IV disease;

³All studies defined residual disease ≤ 1 cm as optimal surgery. NPV: Negative predictive value; PPV: Positive predictive value; NA: Not available.

Table 2 Studies of computed tomography scan with or without clinical features to predict surgical outcome in epithelial ovarian cancer

First author, year	n	OS	CT criteria ± clinical feature	Sensitivity	Specificity	PPV	NPV	Accuracy
Using 2 cm as criteria for OS
Nelson et al[52], 1993	421	69%	1 of 8 disease site	92%	79%	67%	96%	86%
Meyer et al[55], 1995	281	57%	5 disease sites	58%	100%	100%	55%	79%
Byrom et al[57], 2002	51	51%	Full/reduced models (same values)	88%	98%	95%	94%	-
			CT with age and CA 125 (not useful)	88%	92%	85%	94%	-
Qayyum et al[62], 2005	137	15%	Either CT (n = 91) or MRI (n = 46)	76%	99%	94%	96%	95% (CT), 96% (MRI)
Using 1 cm as criteria for OS
Dowdy et al[54], 2004	87	71%	3 disease sites (CA 125 not useful)	44%	95%	79%	81%	-
Fujwara et al[56], 2011	98	86%	4 or 6 disease sites (similar values)	-	-	50%	97% or 99%	91% or 94%
Bristow et al[58], 2000	41	49%	13 disease site (predictive index ≥ 4) (age and CA 125 not useful)	100%	85%	88%	100%	93%
Axtell et al[59], 2007	(3 cohorts)		2 disease sites
	65	78%	Cohort A	79%	75%	-	-	77%
	48	41%	Cohort B	15%	32%	-	-	34%
	71	87%	Cohort C	72%	56%	-	-	64%
Gemer et al[60], 2009	123	73%	Nelson’s criteria	64%	64%	-	-	64%
			Qayyum’s criteria	67%	57%	-	-	60%
			Bristow’s criteria	70%	64%	-	-	66%
			Dowdy’s criteria	79%	60%	-	-	65%
Ferrandina et al[61], 2009	195	44%	9 disease sites ± age, CA 125, PS	AUC 0.78 for CT only and 0.81 when added with PS

¹19% of the patients in the study of Nelson et al[52] and 36% in the study of Meyer et al[55] had stage I-II diseases while all other studies included only advanced stage disease. OS: Optimal surgery; CT: Computed tomography; PPV: Positive predictive value; NPV: Negative predictive value; PS: Performance status; CA: Cancer antigen; MRI: Magnetic resonance imaging; AUC: Area under the curve.

Table 3 Studies using laparoscopy to predict surgical outcome

Study	n	PDS (n)	Optimal surgery1	Criteria of residual diseases (cm)	Sensitivity	Specificity	PPV	NPV	Accuracy
Angioli et al[71], 2006	87	53	96%	0	-	-	-	-	-
Deffieux et al[72], 2006	15	11	91%	0	-	-	-	-	-
Fagotti et al[73], 20062	64	61	67%	1	30%	100%	100%	70%	74%
Fagotti et al[74], 20082	113	91	50%	1	30%	100%	100%	60%	75%
Brun et al[75], 20082	55	26	69%	1	46%	89%	89%	44%	60%

¹Percentage of optimal surgery was obtained only in the patients who had primary debulking surgery;

²Diagnostic performance predictions in these studies used score ≥ 8 as cut-off value from the model of the study. PDS: Primary debulking surgery; NPV: Negative predictive value; PPV: Positive predictive value.

Table 4 Laparoscopic parameters assigned a predictive index score

Predictive index parameter	Point value	Sensitivity	Specificity	PPV	NPV	Accuracy
Omental cake	0	72.7%	68.3%	55.8%	82.0%	69.9%
Diaphragmatic carcinosis	0	77.1%	71.2%	61.4%	84.0%	73.4%
Mesenteral retraction	2	64.3%	98.2%	94.7%	85.0%	87.2%
Bowel infiltration	2	69.7%	86.0%	74.2%	84.1%	80.8%
Stomach infiltration	2	17.6%	100%	100%	67.4%	69.6%
Superficial liver metastasis	2	22.8%	100%	100%	68.9%	71.6%

NPV: Negative predictive value; PPV: Positive predictive value.