Development and Validation of a Predictive Score for Preoperative Diagnosis of Early Stage Epithelial Ovarian Cancer

Document Type : Research Articles


1 Department of Obstetrics and Gynecology, Phrapokklao Hospital, Chanthaburi, Thailand.

2 Department of Obstetrics and Gynecology, Faculty of Medicine, Thammasat University, Pathum Thani, Thailand.

3 Research Division, Maesai District Hospital, Maesai, Chiang Rai Thailand.

4 Center for Clinical Epidemiology and Clinical Statistics, Faculty of Medicine, Ching Mai University, Chiang Mai, Thailand.

5 Department of Obstetrics and Gynecology Faculty of Medicine, Chiang Mai University Chiang Mai,Thailand.


Objective: To develop and validate a simplified multi-parameter risk-based scoring system for preoperative diagnosis
of early stage epithelial ovarian cancer. Methods: All women presented with adnexal mass and were scheduled for
operation at Phrapokklao hospital during September 2013 – December 2017 were included and categorized according
to their histopathologic reports into early stage ovarian cancer groups and benign ovarian tumor groups. Multivariable
logistic regression was used to explore for potential predictors. The selected logistic coefficients were transformed
into risk-based scoring system. Internal validation was done with bootstrapping procedure. Results: A total of 270
participants were included in analysis and predictive model development, 54 in early stage ovarian cancer group and
216 in benign ovarian tumor group. Menopausal status, two abnormal ultrasound findings (presence of solid component
or ascites), tumor size and serum CA-125 level were used for derivation of the scoring system. The score-based model
showed area under ROC of 0.88 (95%CI 0.82-0.93). The developed scoring system ranged from 0 to 51 was classified
into 3 subcategories for clinical practicability. The positive predictive values for the presence of early stage ovarian
cancer were 2.07 (95%CI 0.43-6.05) for low risk patient, 29.13(95%CI 19.65-41.58) for moderate risk patient, and
95.45(95%CI 77.16-99.88) for high risk patient. Conclusion: This simplified risk-based scoring system for preoperative
diagnosis of early stage ovarian cancer could aid general physicians or general gynecologists in evaluation of patients
presenting with ovarian tumors and help gynecologic oncologists in management planning and prioritization of patients
for operation.


Main Subjects