Predicting Complete Cytoreduction in Ovarian Cancer Patients by RECIST 1.1 Criteria Following Neoadjuvant Chemotherapy

Abstract

Complete cytoreduction (CC) is one of the most important prognostic factors for epithelial ovarian cancer (EOC). Response to neoadjuvant chemotherapy (NACT) is potentially important to predict CC as well as counseling the patients. We aimed to study if RECIST 1.1 response predicts CC in EOC following NACT. This prospective observational study included 59 patients of EOC planned for NACT followed by interval debulking surgery (IDS). Response to NACT was assessed by RECIST 1.1 criteria. The level of cytoreduction during IDS was correlated with the radiological response. A Chi-square test was used for the group comparison. Half (50%) of patients had an objective response to NACT. CC was feasible in a total of 35 (62.5%) patients. Both response and cytoreduction levels were independent of clinical parameters. We observed 100% CC rates in CR, 95.8% in PR, 50% in SD and 12.5% in PD categories. RECIST 1.1 response was found significantly (p\u2009<\u20090.01) associated with levels of cytoreduction. The sensitivity, specificity, positive predictive value and negative predictive value of RECIST to predict CC were 77.1%, 95.2%, 96.4% and 71.4%, respectively. RECIST 1.1 predicts CC in responders (CR/PR) well. We suggest against denying surgery solely based on RECIST criteria in the SD or PD patients. Given its imprecision in these circumstances, patient characteristics such as performance status, perioperative risk and comorbidities should be taken into account. The role of newer antineoplastic agents, three-dimensional or functional imaging and diagnostic laparoscopy should be explored further for predicting CC.