Objective. To evaluate the utility of combined positron emission tomography/computed tomography (PET/CT) for detecting recurrent epithelial ovarian cancer limited to retroperitoneal adenopathy. Methods. Fourteen patie...Objective. To evaluate the utility of combined positron emission tomography/computed tomography (PET/CT) for detecting recurrent epithelial ovarian cancer limited to retroperitoneal adenopathy. Methods. Fourteen patients (median age = 53 years) with rising serum CA125 levels, and negative or equivocal conventional CT imaging ≥6 months after primary therapy were retrospectively identified as having recurrent disease limited to retroperitoneal lymph nodes by combined PET/CT and underwent surgical reassessment of targeted nodal basins. Fisher’s Exact Test was used to measure the ability of PET/CT to predict isolated retroperitoneal nodal disease. Results. The median increase in serum CA125 from baseline nadir was 14 U/ml (range = 2-76 U/ml). There were 29 target nodes in 15 nodal basins identified with increased metabolic uptake on combined PET/CT.Eleven patients (78.6%) had recurrent ovarian cancer in retroperitoneal lymph nodes targeted by PET/CT. Of 143 nodes retrieved, 59 contained recurrent ovarian cancer (median nodal diameter = 2.5 cm, range = 0.8-5.2 cm). For all target nodal basins, the sensitivity, specificity, positive and negative predictive values, and accuracy for recurrent ovarian cancer in dissected lymph nodes were: 40.7%(24/59), 94.0%(79/84), 82.8%(24/29), 69.3%(79/114), and 72.0%(103/143)(P < 0.001). PET/CT failed to identify microscopic disease in 59.3%of pathologically positive nodes. Conclusion. Combined PET/CT demonstrates high positive predictive value in identifying recurrent ovarian cancer in retroperitoneal lymph nodes when conventional CT findings are negative or equivocal. The high incidence of occult disease within the target nodal basins suggests that regional lymphadenectomy may be necessary for complete secondary cytoreduction of recurrent disease.展开更多
Objective. To characterize the primary surgical care and shortterm outcomes for ovarian cancer in women aged 80 years and older compared to women younger than 80 years. Methods. A statewide hospital discharge database...Objective. To characterize the primary surgical care and shortterm outcomes for ovarian cancer in women aged 80 years and older compared to women younger than 80 years. Methods. A statewide hospital discharge database was used to identify women undergoing primary surgery for ovarian cancer from 1990 to 2000. Logistic regression models were used to evaluate for significant differences in demographic characteristics and short-term outcomes comparing women aged ≥80 years with those aged < 80 years. Results. A total of 2417 women were identified; women aged ≥80 years comprised 7.0%(n = 168) of cases. Compared to younger women, those aged ≥80 years were significantly more likely to be admitted under emergent conditions (25.6%vs 14.9%, P < 0.0003) and less likely to undergo surgery at a university hospital (6.6%vs 18.6%, P = 0.001). Ovarian cancer patients aged ≥80 years were significantly more likely to have a longer hospital stay (median 10 days vs 7 days, P < 0.0001) and a higher adjusted cost of hospital related care (median ＄76,760 vs ＄52,649, P < 0.0001). The 30-day mortality rate was 2.3-fold higher for women aged ≥80 years (5.4%vs 2.4%, P = 0.036). For women aged ≥80 years, there was a trend toward a higher risk of peri-operative death among low-volume hospitals (8.8%) compared to high-volume hospitals (3.0%, P = 0.16). Conclusion. Primary surgical care for ovarian cancer in women aged ≥80 years is associated with utilization of significant health care resources and worse short-term outcomes compared to younger women. Additional research is needed to identify opportunities for improving the cost-effectiveness of care in this population.展开更多
文摘Objective. To evaluate the utility of combined positron emission tomography/computed tomography (PET/CT) for detecting recurrent epithelial ovarian cancer limited to retroperitoneal adenopathy. Methods. Fourteen patients (median age = 53 years) with rising serum CA125 levels, and negative or equivocal conventional CT imaging ≥6 months after primary therapy were retrospectively identified as having recurrent disease limited to retroperitoneal lymph nodes by combined PET/CT and underwent surgical reassessment of targeted nodal basins. Fisher’s Exact Test was used to measure the ability of PET/CT to predict isolated retroperitoneal nodal disease. Results. The median increase in serum CA125 from baseline nadir was 14 U/ml (range = 2-76 U/ml). There were 29 target nodes in 15 nodal basins identified with increased metabolic uptake on combined PET/CT.Eleven patients (78.6%) had recurrent ovarian cancer in retroperitoneal lymph nodes targeted by PET/CT. Of 143 nodes retrieved, 59 contained recurrent ovarian cancer (median nodal diameter = 2.5 cm, range = 0.8-5.2 cm). For all target nodal basins, the sensitivity, specificity, positive and negative predictive values, and accuracy for recurrent ovarian cancer in dissected lymph nodes were: 40.7%(24/59), 94.0%(79/84), 82.8%(24/29), 69.3%(79/114), and 72.0%(103/143)(P < 0.001). PET/CT failed to identify microscopic disease in 59.3%of pathologically positive nodes. Conclusion. Combined PET/CT demonstrates high positive predictive value in identifying recurrent ovarian cancer in retroperitoneal lymph nodes when conventional CT findings are negative or equivocal. The high incidence of occult disease within the target nodal basins suggests that regional lymphadenectomy may be necessary for complete secondary cytoreduction of recurrent disease.
文摘Objective. To characterize the primary surgical care and shortterm outcomes for ovarian cancer in women aged 80 years and older compared to women younger than 80 years. Methods. A statewide hospital discharge database was used to identify women undergoing primary surgery for ovarian cancer from 1990 to 2000. Logistic regression models were used to evaluate for significant differences in demographic characteristics and short-term outcomes comparing women aged ≥80 years with those aged < 80 years. Results. A total of 2417 women were identified; women aged ≥80 years comprised 7.0%(n = 168) of cases. Compared to younger women, those aged ≥80 years were significantly more likely to be admitted under emergent conditions (25.6%vs 14.9%, P < 0.0003) and less likely to undergo surgery at a university hospital (6.6%vs 18.6%, P = 0.001). Ovarian cancer patients aged ≥80 years were significantly more likely to have a longer hospital stay (median 10 days vs 7 days, P < 0.0001) and a higher adjusted cost of hospital related care (median ＄76,760 vs ＄52,649, P < 0.0001). The 30-day mortality rate was 2.3-fold higher for women aged ≥80 years (5.4%vs 2.4%, P = 0.036). For women aged ≥80 years, there was a trend toward a higher risk of peri-operative death among low-volume hospitals (8.8%) compared to high-volume hospitals (3.0%, P = 0.16). Conclusion. Primary surgical care for ovarian cancer in women aged ≥80 years is associated with utilization of significant health care resources and worse short-term outcomes compared to younger women. Additional research is needed to identify opportunities for improving the cost-effectiveness of care in this population.
