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DOI: 10.1055/a-1334-2575
Stellenwert der präoperativen Computertomografie für die Prädiktion einer optimalen Zytoreduktion beim fortgeschrittenen Ovarialkarzinom
The Significance of Preoperative Computed Tomography for Predicting Optimal Cytoreduction in Advanced Ovarian Cancer![](https://www.thieme-connect.de/media/tumor/202101/lookinside/thumbnails/td-13342575_10-1055-a-1334-2575-1.jpg)
Zusammenfassung
Einleitung Eine optimale Zytoreduktion ist der wichtigste Prognosefaktor beim fortgeschrittenen Ovarialkarzinom. Obwohl Stadieneinteilung und Einschätzung der Operabilität durch Explorativ-Operation erfolgen, gilt die präoperative Computertomografie (CT) des Abdomens als Standard. Ziel dieser Studie ist die Überprüfung verschiedener CT-Parameter hinsichtlich der Prädiktion einer optimalen Zytoreduktion.
Patienten und Methoden In die retrospektive Studie wurden 131 Patientinnen mit zwischen 2010 bis 2014 neu diagnostiziertem Ovarialkarzinom aufgenommen. Davon wurden n = 36 im FIGO-Stadium I bis IIB aus der Studie ausgeschlossen. Von den 95 Patientinnen mit FIGO-Stadium IIC bis IV lagen bei n = 75 präoperative CT-Abdomen vor. Die CT-Scans wurden einem verblindeten Review unterzogen. Die evaluierten 11 CT-Parameter wurden mittels χ2-Test und logistischer Regressionsanalyse hinsichtlich der Endpunkte makroskopischer Tumorrest sowie Tumorrest > 1 cm überprüft. Überlebensanalysen erfolgten mittels Kaplan-Meier-Methode und Log-Rank-Test.
Ergebnisse Von 75 Patientinnen hatten 28 (37,3 %) eine vollständige Tumorresektion und 26 (34,7 %) Tumorreste ≤ 1 cm. Tumorreste > 1 cm fanden sich bei 21 Patientinnen (28 %), davon waren 5 nicht resektabel. Das Gesamtüberleben bei Tumorrest > 1 cm unterschied sich signifikant von der Gruppe mit makroskopischer Tumorfreiheit (p = 0,003) bzw. Tumorrest ≤ 1 cm (p = 0,04). Die CT-Parameter Tumorherde am Diaphragma, Mesokolon, Omentum majus, Peritoneum sowie Aszites korrelierten mit makroskopischem Tumorrest. In der multivariaten logistischen Regressionsanalyse war lediglich hinsichtlich der Prädiktion einer suboptimalen Tumorresektion (> 1 cm) der CT-Parameter intraparenchymatöse Lebermetastase statistisch signifikant (OR 8,04; 95 %-KI 1,57–42,4; p = 0,0134). Sensitivität, Spezifität, PPV und NPV betragen 37,5, 89,7, 66,7 und 72,2 %.
Schlussfolgerung Obwohl mittels CT Abdomen Risikoparameter für suboptimale Tumorreduktion identifizierbar sind, ist wegen der geringen diagnostischen Genauigkeit die chirurgische Exploration mit histologischer Diagnosesicherung unverzichtbar.
Abstract
Introduction Optimal cytoreduction is the most important prognostic factor in advanced ovarian cancer. Although staging and assessment of operability are made by exploratory surgery, preoperative computed tomography (CT) of the abdomen is regarded as standard. The aim of this study was to examine various CT parameters with regard to prediction of optimal cytoreduction.
Patients and Methods The retrospective study included 131 patients with ovarian cancer newly diagnosed between 2010 and 2014. Of these, n = 36 with FIGO stage I to IIB were excluded from the study. A preoperative abdominal CT was available for n = 75 of the 95 patients with FIGO stage IIC to IV. The CT scans underwent blinded review. The 11 evaluated CT parameters were examined by means of χ2 test and logistic regression analysis with regard to the endpoints of macroscopic residual tumour and residual tumour > 1 cm. Survival analyses used the Kaplan-Meier method and log rank test.
Results Of 75 patients, 28 (37.3 %) had complete tumour resection and 26 (34.7 %) had residual tumour ≤ 1 cm. Residual tumours > 1 cm were found in 21 (28 %) patients, five of which were not resectable. Overall survival with residual tumour > 1 cm differed significantly from the group with no macroscopic residual tumour (p = 0.003) and with residual tumour ≤ 1 cm (p = 0.04). The CT parameters tumour foci in the diaphragm, mesocolon, greater omentum and peritoneum as well as ascites correlated with macroscopic residual tumour. In the multivariate logistic regression analysis only the CT parameter intraparenchymal liver metastasis was statistically significant with regard to prediction of suboptimal tumour resection (> 1 cm) (OR 8.04; 95 % CI 1.57–42.4; p = 0.0134). The sensitivity, specificity, PPV and NPV were 37.5, 89.7, 66.7 and 72.2 %.
Conclusion Although risk parameters for suboptimal tumour reduction can be identified by CT of the abdomen, surgical exploration with histological confirmation of the diagnosis is essential because of the poor diagnostic accuracy.
Publication History
Article published online:
28 January 2021
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