Investigator
University Of Toronto
Treatment Strategy and Residual Disease as Determinants of Survival in Stage IVB High‐Grade Serous Ovarian Cancer: A Retrospective Cohort Study
ABSTRACT Background and Objective Stage IVB high‐grade serous ovarian cancer (HGSOC) carries a poor prognosis. We aimed to: (1) describe the characteristics and survival of patients treated with primary cytoreductive surgery (PCS), interval cytoreductive surgery (ICS) or chemotherapy alone, (2) investigate the correlation between disease distribution and treatment type, and (3) evaluate the impact of cytoreductive surgery (CS) “aggressiveness” and outcome on survival. Methods A single‐center retrospective cohort study of Stage IVB HGSOC patients. Demographics, tumor characteristics, treatment including “aggressive” CS (upper abdominal and extraperitoneal procedures), and outcomes were analyzed using descriptive statistics and survival analysis, with nonparametric tests and Cox‐proportional hazard models. Results Of 110 patients, 24 (22%) underwent PCS, 73 (66%) ICS, and 13 (12%) chemotherapy alone. Median overall survival (OS) was 76.2 (PCS), 36.9 (ICS), and 20.1 months (chemotherapy alone) ( p = 0.014). Supradiaphragmatic lymph‐node metastasis differed across groups ( p = 0.042). “Aggressive” CS was performed in 53.6% of the surgical cohort, with 54.86% no‐gross‐residual (NGR), 34% optimal ≤ 1 cm ≤ and 11.3% suboptimal/aborted surgical outcome. Median OS post CS for NGR, optimal ≤ 1 cm, and suboptimal was 67.55, 35.26, and 20.97 months, respectively ( p = 0.006). Conclusions OS for Stage IVB HGSOC follows a hierarchical pattern: PCS, ICS, and chemotherapy. Disease distribution guides treatment and residual tumor after CS correlates with survival.
Implementation of O-RADS Ultrasound Reporting System: A Quality Improvement Initiative
Objectives: To determine the feasibility of implementing Ovarian-Adnexal Reporting & Data System (O-RADS) ultrasound (US) for reporting of adnexal masses at our institution, with a specific goal of increasing the use of O-RADS from a baseline of <5% to at least 75% over a 16-month period. Methods: A prospective interrupted time series quality improvement study was undertaken over a 16-month period. Plan, do, study, act cycles included: (1) Engagement of interested parties, (2) Targeted educational sessions, (3) Development of reporting templates, (4) Weekly audit-feedback. Inter-reader variability assessment was performed on 70% of O-RADS risk-category 2 to 5. The primary outcome was the reporting of an O-RADS risk category. Results: A total of 635 female pelvic US were performed at our centre between July 2022 and April 2023. An O-RADS risk category was provided on the final radiology report by the radiologist for 489/635 (77%) US. From November 2022 to April 2023, the weekly rate of O-RADS risk category reporting reached 88%. The O-RADS score was concordant between readers for 83/103 (81%) of US reports with kappa score of 0.69 corresponding to good agreement. Conclusions: The reporting of O-RADS risk category increased from <5% to 88% over a 16-month period with a high level of agreement among readers in assigning O-RADS risk category. Implementation of a standardizing reporting ultrasound system at a tertiary cancer centre is feasible with rapid learning and uptake curves.
The impact of perioperative transfusions on the oncologic outcomes of patients with ovarian cancer: A population‐based study
AbstractPerioperative blood transfusion in ovarian cancer patients was associated with a 28% increase in all‐cause mortality. The negative impact of perioperative blood transfusion extends beyond the immediate postoperative period.ObjectivesThe effect of perioperative blood transfusions on long‐term oncologic outcomes of patients with advanced ovarian cancer undergoing cytoreductive surgery remains uncertain. Our study aims to determine the association between perioperative blood transfusion and all‐cause mortality in this population.MethodsUsing province‐wide administrative databases, patients with advanced ovarian cancer who underwent surgery between 2007 and 2021 as part of first‐line treatment were identified. Perioperative transfusion was defined as any transfusion from date of surgery to discharge from hospital. Multivariable Cox proportional hazards regression models were used to determine if there was an independent association of transfusion with all‐cause mortality, accounting significant confounders.ResultsA total of 5891 patients had cytoreductive surgery for advanced ovarian cancer between 2007 and 2021, of which 2898 (49.2%) had interval cytoreductive surgery (ICS) and 2993 (50.8%) had primary cytoreductive surgery (PCS). Perioperative blood transfusion was given to 37.3% of patients (40.5% ICS and 34.2% PCS). On multivariable analysis, there was an increased hazard of all‐cause mortality for patients receiving perioperative transfusion compared to those who did not (hazard ratio: 1.28; 95% CI: 1.20–1.37). The association of increased all‐cause mortality was observed starting 1 year after surgery, was sustained thereafter, and seen in both ICS and PCS groups.ConclusionPerioperative blood transfusion after cytoreductive surgery for ovarian cancer is common in Ontario, Canada and was significantly associated with an increase in all‐cause mortality. Blood transfusion is a poor prognostic factor, and the negative impact of blood transfusion persists beyond the immediate postoperative period.
Ultrasound Ovarian-Adnexal Reporting and Data System (O-RADS) and modified ultrasound simple rules comparison in evaluation of surgically proven adnexal masses
The aim of this study was validating Ovarian-Adnexal Reporting and Data System (O-RADS) 2022 risk estimates in surgically treated ovarian/adnexal masses comparing accuracy of O-RADS with modified ultrasound simple rules (mUSR) differentiating malignant from benign lesions. The mUSR was a simplified version of the International Ovarian Tumor Analysis (IOTA) using a binary classification of adnexal masses into benign/suspicious for malignancy. multisite retrospective study was conducted including patients with pathology-proven adnexal masses between January 2008 and December 2018. All ultrasound (US) video clips reviewed by an experienced radiologist with randomly selected subset were reviewed by two additional radiologists. Areas under receiver operator characteristic curves (AUCs) were compared without and with CA-125. 791 ovarian masses in 765 patients (26 bilateral) (mean age: 44 ± 15 years) (628 benign, 49 borderline, and 114 malignancies) demonstrated malignancy rates of 0.3%, 3.0%, 24.9%, and 82.4% for O-RADS 2, 3, 4, and 5, respectively. O-RADS and mUSR had a sensitivity of 0.96 (confidence interval [CI]: 0.92-0.99) and 0.96 (CI: 0.91-0.98), negative predictive values (NPVs) of 0.99 (CI: 0.97-1.00) and 0.99 (CI: 0.98-1.00) (P>0.05), specificities 0.75 [CI: 0.71-0.78] and 0.88 [CI: 0.85-0.91], and positive predictive values (PPVs) 0.50 (CI: 0.44-0.55) and 0.68 (CI: 0.61-0.74) (P 0.86). CA 125 improved performance of mUSR (P=0.002) and O-RADS (P=0.005) only in perimenopausal/postmenopausal patients. O-RADS and mUSR both with high sensitivity and NPV for detection of ovarian malignancy but mUSR with significantly higher specificity and PPV than O-RADS. This finding endorses the American College of Radiology (ACR) recommendation for expert sonologist consultation for O-RADS 3 and 4.
Accuracy of Large Language Model–based Automatic Calculation of Ovarian-Adnexal Reporting and Data System MRI Scores from Pelvic MRI Reports
A hybrid large language model (LLM)–based application, optimized by combining LLM feature classification with deterministic elements, accurately assigned Ovarian-Adnexal Reporting and Data System MRI scores from adnexal lesion descriptions and outperformed originally reporting radiologists.
