Nomogram to predict postoperative complications after cytoreductive
surgery for advanced epithelial ovarian cancer: a multicenter
retrospective cohort study
Abstract
Objective: To establish and externally validate nomograms to predict the
risk of postoperative complications after cytoreductive surgery for
advanced epithelial ovarian cancer (AEOC) patients. Design: A
retrospective cohort study. Setting: Multicenter Population or Sample:
Patients with FIGO stage IIIC-IV epithelial ovarian cancer who underwent
cytoreductive surgery. Methods: Patient preoperative characteristics
were used to predict the risk of postoperative complications by
univariate and multivariate analyses. Nomograms were developed based on
multivariate modeling. Main Outcome Measures: Postoperative overall and
severe complications. Results: Overall, 585 AEOC patients were included
for analysis (training cohort = 426, validation cohort = 159). Among the
clinical variables assessed, modified frailty index (mFI) (OR 1.96 and
2.18), FIGO stage (OR 2.31 and 3.22), and Surgical Complexity Score
(SCS) (OR 1.16 and 1.23) were most strongly associated with the risk of
overall and severe complications, respectively. The final nomograms had
superior internal discrimination with the C-index were 0.74 and 0.78 for
predicting overall and severe complications, respectively, as well as
good consistency and stable calibration. Additionally, the validation
cohort suggested a good external discrimination with the C-index were
0.92 and 0.91 to predict overall and severe complications, respectively.
Conclusions: These two nomograms can help clinicians to predict the risk
of postoperative complications, and instruct clinical decision-making,
as well as perioperative care to prevent adverse outcomes for AEOC
patients. Funding: The Department of Science and Technology of Sichuan
Province (grant number 21PJ050). Keywords: Advanced epithelial ovarian
cancer, Postoperative complications, Cytoreductive surgery, Nomogram