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Fagotti Score

Prospective validation of a laparoscopic predictive model for optimal cytoreduction in advanced ovarian carcinoma
Date of Publication:

December 1, 2008

Pubmed Link:
https://www.ncbi.nlm.nih.gov/pubmed/18801470
Hypothesis:

The predictive model can improve the possibility of correctly identifying the optimally cytoreducible patients from 85% as assessed by CT scan, to the clinically relevant alternative of 100% as assessed by laparoscopy.

Control Arm(s):
Experimental Arm(s):

Laparoscopy followed by laparotomy with scores calculated from assessments made during each surgical approach.

9 parameters used to forecast optimal cytoreduction surgery: ovarian masses, omental cake or nodules, peritoneal carcinomatosis, diaphragmatic carcinomatosis, mesenteric retraction, bowel infiltration, stomach infiltration, liver metastases and lymph nodes

Unresectable Score = 2

Resectable Score = 0

Primary End Point:

Total predictive index (PIV), followed by sensitivity, specificity, PPV, NPV and accuracy with respect to residual disease after laparotomy

Inclusion Criteria:

At least 2 of the following:

ECOG>2

Ascites >500 mL

Elevated CA 125 >500 UI/mL

CT evidences of metastatic disease equivalent to stage III/IV


Exclusion Criteria:

Clinically early stage

Very large abdominal mass

Disease progression during NACT or achieved an optimal response during NACT

Results:

With PIV >8, the probability of optimally resecting disease at laparotomy is 0 and the rate of unnecessary laparotomy is 40.5% (PPV= 100%; NPV 59.5%).

Mean PIV 5.

Overall accuracy of laparoscopic procedure 77.3%-100%

Metric: Assessable / NPV / PPV / Accurancy

Peritoneal carcinosis: 100% / 100% / 100% / 100%

Omental cake: 96.5 / 91.4 / 98.6 / 96.3

Diaphragmatic carcinosis: 91.1 / 86.8 / 100 / 95.1

Mesenteral retraction: 75.2 / 93.7 / 100 / 95.3

Bowel infiltration: 85.8 / 71.6 / 86.4 / 77.3

Stomach infiltration: 84.9 / 97.8 / 60.0 / 95.8

Superficial liver metastasis: 93.8 / 88.5 / 89.4 / 88.7

Conclusions:

The proposed laparoscopic model appears to be a reliable and flexible tool to predict optimal cytoreduction in advanced ovarian cancer

Reviewer:
Heather Williams