COMMENTARY

Study: Surgeons Report Optimal Residual Disease Incorrectly in 40% of Cases

Maurie Markman, MD

Disclosures

August 21, 2018

Hello. I am Dr Maurie Markman from Cancer Treatment Centers of America in Philadelphia. I wanted to briefly discuss a very interesting and somewhat concerning report that appeared in the journal Gynecologic Oncology, entitled, "Correlation Between Surgeon's Assessment and Radiographic Evaluation of Residual Disease in Women With Advanced Stage Ovarian Cancer Reported to Have Undergone Optimal Surgical Cytoreduction: An NRG Oncology/Gynecologic Oncology Group Study."[1]

This was a very interesting post-hoc analysis that included a total of 1873 patients who enrolled in a phase 3 Gynecologic Oncology Group trial. Of these patients, 639 were reported by the surgeons to have optimal residual disease, meaning that at the end of surgery, the largest mass was less than 1 cm in maximal diameter.

As required in the trial, a baseline CT scan was obtained an average of 26 days following surgery. In 40% of these cases of so-called optimal residual disease, the radiologist saw a mass larger than 1 cm in diameter, and in half of those 40%, there were at least three masses.

To [illustrate] that these were not simply inflammatory changes, those patients with discordant CT versus surgical assessment findings had a worse outcome.

There are several concerning implications of this observation that need to be considered. First, was there optimal surgical assessment in these cases? Was the entire abdomen explored [or did the surgeons miss] certain parts of the abdominal cavity?

As noted by the authors, surgeons very understandably would want to give the best possible prognostic information to patients and their families, saying that, "Yes, it was optimal residual," when in fact they knew, could have known, or should have known that that was not the case.

[There is] no clear answer here. However, with 40% discordance, one must be concerned and ask specifically, "What is the impact of this type of discordance on results of clinical trials?" I think the ovarian cancer research community needs to consider this in detail, as do others who are responsible for designing and interpreting the results of clinical trials.

[This is] an important paper. I would encourage those who are interested in ovarian cancer research, or clinical cancer research in general, to review this important analysis. Thank you for your attention.

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