OviR0: A novel application for assessing the feasibility of complete cytoreduction and hyperthermic intraperitoneal chemotherapy in epithelial ovarian cancer following neoadjuvant chemotherapy
Shouptik BasuObjectives:
High-grade serous ovarian neoplasms, a subtype of Epithelial ovarian carcinoma, are a significant health burden, particularly in advanced stages. The presentation of the disease may be extensive and suboptimal. Cytoreduction may preclude Hyperthermic intraperitoneal chemotherapy (HIPEC), which may, in turn, jeopardize the surgical outcomes in these patients. This study addresses the challenge of unsatisfactory surgical outcomes due to inadequate cytoreduction in these patients. Despite the availability of predictive models in the literature, there is a lack of research from the Indian Subcontinent on this topic. This study aimed to develop a predictive model to determine whether Complete Cytoreduction (CC-0/CC-1) was possible after Neoadjuvant Chemotherapy (NACT) based on perioperative factors.
Material and Methods:
This retrospective study, conducted at a tertiary-level care center, included 61 female patients diagnosed with serous ovarian neoplasms, treated between January 2022 and January 2024. NACT with subsequent Cytoreductive Surgery (CRS) and HIPEC were the primary interventions. Demographic, preoperative factors, Peritoneal Carcinomatosis Index (PCI), and Completeness of Cytoreduction were noted. A Logistic regression analysis was performed to develop a predictive model, and a Nomogram was created. A website-based application was developed for external validation.
Results:
The study cohort had a mean age of 55 years, with 65.6% diagnosed at International Federation of Gynecology and Obstetrics (FIGO) Stage III. Univariate analysis revealed age, number of co-morbidities, post-chemotherapy CA-125 levels, and PCI index as significant predictors of the outcome of CC-0/CC-1 . A multivariate predictive model was developed, and it demonstrated an overall accuracy of 97.17% area under curve (AUC) as per the receiver operating characteristic (ROC) Curve. A nomogram was created from the results of the multivariate analysis, and an HTML and CSS ® application was created for external validation.
Conclusion:
This study addresses the critical issue of inadequate cytoreduction in high-grade Serous Ovarian neoplasms and provides a comprehensive predictive model that may be used during the preoperative setting prior to embarking on an Interval Cytoreductive Surgery. The study emphasizes the need for accessible and robust decision-making tools for personalized and optimized care for ovarian cancer patients.