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Matsukuma K, Nishio S, Tasaki S, Park J, Nasu H, Yoshimitsu T, Tasaki K, Katsuda T, Terada A, Tsuda N, Sanada S, Ushijima K. Association of Chemotherapy Response Score with Multidrug Resistance 1 and CA125 ELIMination Rate Constant K in Patients with Advanced Ovarian Cancer Treated with Neoadjuvant Chemotherapy. Kurume Med J 2024; 70:29-37. [PMID: 38556270 DOI: 10.2739/kurumemedj.ms7012004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/02/2024]
Abstract
AIM The relationship between chemotherapy response score (CRS), a widely used response predictor of neoadjuvant chemotherapy-interval debulking surgery (NAC-IDS), and multidrug resistance 1 (MDR1) and CA125 ELIMination rate constant K (KELIM), is undetermined. We evaluated CRS in advanced ovarian cancer patients undergoing NAC and looked for associations between CRS and MDR1 and CA125 KELIM. Our aim was to predict the therapeutic effect of NAC before interval debulking surgery (IDS) by examining its association with CRS. METHODS This retrospective cohort study included patients who underwent NAC-IDS (first-line treatment) at Kurume University Hospital, Japan, between 2004 and 2017. CRS association with MDR1 and CA125 KELIM was examined using Cox proportional hazard regression analyses. Survival curves used Kaplan-Meier method, and survival differences between groups used log-rank test. RESULTS Overall, 55 patients were classified into CRS1 (n=22), CRS2 (n=19), and CRS3 (n=14). The CRS3 group had a significantly better prognosis than the CRS1 or CRS2 group. CRS, age, and IDS status were clinical prognostic factors for ovarian cancer. MDR1 positivity for excision repair cross-complementing group 1, β-tubulin, and Y-box binding protein-1 occurred in 15, 17, and 11 patients, respectively, but these were not associated with CRS. CA125 KELIM was <0.5 (n=8), 0.5-1.0 (n=30), and ≥ 1.0 (n=17) but not associated with CRS. CONCLUSION CRS is reconfirmed as a treatment response predictor for NAC-IDS, but its association with drug resistance factors remains unconfirmed.
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Affiliation(s)
- Ken Matsukuma
- Department of Obstetrics and Gynecology, Kurume University School of Medicine
| | - Shin Nishio
- Department of Obstetrics and Gynecology, Kurume University School of Medicine
| | - Shingo Tasaki
- Department of Obstetrics and Gynecology, Kurume University School of Medicine
| | - Jongmyung Park
- Department of Obstetrics and Gynecology, Kurume University School of Medicine
| | - Hiroki Nasu
- Department of Obstetrics and Gynecology, Kurume University School of Medicine
| | - Teruyuki Yoshimitsu
- Department of Obstetrics and Gynecology, Kurume University School of Medicine
| | - Kazuto Tasaki
- Department of Obstetrics and Gynecology, Kurume University School of Medicine
| | - Takahiro Katsuda
- Department of Obstetrics and Gynecology, Kurume University School of Medicine
| | - Atsumu Terada
- Department of Obstetrics and Gynecology, Kurume University School of Medicine
| | - Naotake Tsuda
- Department of Obstetrics and Gynecology, Kurume University School of Medicine
| | - Sakiko Sanada
- Department of Pathology, Kurume University School of Medicine
| | - Kimio Ushijima
- Department of Obstetrics and Gynecology, Kurume University School of Medicine
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Jia Y, Jiang Y, Fan X, Zhang Y, Li K, Wang H, Ning X, Yang X. Preoperative serum level of CA153 and a new model to predict the sub-optimal primary debulking surgery in patients with advanced epithelial ovarian cancer. World J Surg Oncol 2024; 22:64. [PMID: 38395933 PMCID: PMC10885626 DOI: 10.1186/s12957-024-03336-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2023] [Accepted: 02/14/2024] [Indexed: 02/25/2024] Open
Abstract
OBJECTIVE The aim of this study was to establish a preoperative model to predict the outcome of primary debulking surgery (PDS) for advanced ovarian cancer (AOC) patients by combing Suidan predictive model with HE4, CA125, CA153 and ROMA index. METHODS 76 AOC Patients in revised 2014 International Federation of Gynecology and Obstetrics (FIGO) stage III-IV who underwent PDS between 2017 and 2019 from Yunnan Cancer Hospital were included. Clinical data including the levels of preoperative serum HE4, CA125, CA153 and mid-lower abdominal CT-enhanced scan results were collected. The logistics regression analysis was performed to find factors associated with sub-optimal debulking surgery (SDS). The receiver operating characteristic curve was used to evaluate the predictive performances of selected variables in the outcome of primary debulking surgery. The predictive index value (PIV) model was constructed to predict the outcome of SDS. RESULTS Optimal surgical cytoreduction was achieved in 61.84% (47/76) patients. The value for CA125, HE4, CA153, ROMA index and Suidan score was lower in optimal debulking surgery (ODS) group than SDS group. Based on the Youden index, which is widely used for evaluating the performance of predictive models, the best cutoff point for the preoperative serum HE4, CA125, CA153, ROMA index and Suidan score to distinguish SDS were 431.55 pmol/l, 2277 KU/L, 57.19 KU/L, 97.525% and 2.5, respectively. Patients with PIV≥5 may not be able to achieve optimal surgical cytoreduction. The diagnostic accuracy, NPV, PPV and specificity for diagnosing SDS were 73.7%, 82.9%, 62.9% and 72.3%, respectively. In the constructed model, the AUC of the SDS prediction was 0.770 (95% confidence interval: 0.654-0.887), P<0.001. CONCLUSION Preoperative serum CA153 level is an important non-invasive predictor of primary SDS in advanced AOC, which has not been reported before. The constructed PIV model based on Suidan's predictive model plus HE4, CA125, CA153 and ROMA index can noninvasively predict SDS in AOC patients, the accuracy of this prediction model still needs to be validated in future studies.
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Affiliation(s)
- Yue Jia
- Department of Gynecology, The Third Affiliated Hospital of Kunming Medical University, Yunnan Cancer Hospital, Kunming, Yunnan, P. R. China, 650118
| | - Yaping Jiang
- Department of Gynecology, The Third Affiliated Hospital of Kunming Medical University, Yunnan Cancer Hospital, Kunming, Yunnan, P. R. China, 650118
| | - Xiaoqi Fan
- Department of Gynecology, The Third Affiliated Hospital of Kunming Medical University, Yunnan Cancer Hospital, Kunming, Yunnan, P. R. China, 650118
| | - Ya Zhang
- Department of Radiology, The Third Affiliated Hospital of Kunming Medical University, Yunnan Cancer Hospital, Yunnan Cancer Center, Kunming, Yunnan, P. R. China, 650118
| | - Kun Li
- Department of Radiology, The Third Affiliated Hospital of Kunming Medical University, Yunnan Cancer Hospital, Yunnan Cancer Center, Kunming, Yunnan, P. R. China, 650118
| | - Haohan Wang
- Department of Gynecology, The Third Affiliated Hospital of Kunming Medical University, Yunnan Cancer Hospital, Kunming, Yunnan, P. R. China, 650118
| | - Xianling Ning
- Department of Gynecology, The Third Affiliated Hospital of Kunming Medical University, Yunnan Cancer Hospital, Kunming, Yunnan, P. R. China, 650118
| | - Xielan Yang
- Department of Gynecology, The Third Affiliated Hospital of Kunming Medical University, Yunnan Cancer Hospital, Kunming, Yunnan, P. R. China, 650118.
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Muhammad S, Azwan RJ, Rita RS, Susanti R, Yusrawati. The Role of Interleukin 6 (IL6), Cancer Antigen-125 (CA-125), and Human Epididymis Protein 4 (HE4) to predict tumor resectability in the advanced epithelial ovarian cancer patients. PLoS One 2023; 18:e0292282. [PMID: 37792745 PMCID: PMC10550129 DOI: 10.1371/journal.pone.0292282] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2023] [Accepted: 09/17/2023] [Indexed: 10/06/2023] Open
Abstract
INTRODUCTION A study of tumor resectability in pre-operative patients with advanced epithelial ovarian cancer is required to predict primary surgical benefits accurately. This study aims to investigate IL6, CA-125 and HE4 to predict tumor resectability in the pre-operative patients with advanced epithelial ovarian cancer. METHODS This cross-sectional study was conducted in the polyclinic, oncology and gynecology inpatient room of Dr. M. Jamil Padang Hospital from June until December 2022. Advanced epithelial ovarian cancer stage based on histology result from FIGO stages IIIB-IVA. IL6, CA-125, and HE4 were measured using ECLIA (electrochemiluminescence immunoassay). Categorical data were assessed using Chi-square and Mann-Whitney tests. Numerical variable correlations were analyzed using Pearson Correlation tests. While the correlation between numerical and nominal variables was analyzed using the Eta correlation test. A p-value of <0,05 was considered a significant correlation. The cut-off value of serum IL6, CA-125, and HE4 was determined with a ROC curve. The sensitivity and specificity of each clinical parameter were calculated. RESULTS There was a significant difference in IL-6 (1328 vs 752 pg/ml; p<0,001), CA-125 (1260,5 vs 819,5 U/ml; p<0,001), and HE4 levels (1320 vs 760 pmol/L; p<0,001) between patients with tumor resectability of > 1 cm (suboptimal) vs < 1 cm (optimal). There was a correlation between IL6 (r = 0,832), CA-125 (r = 0,716), and HE4 (r = 0,716) with tumor resectability. CONCLUSION Measuring IL6, CA-125, and HE4 levels is useful for clinicians to predict tumor resectability in pre-operative patients with advanced epithelial ovarian cancer.
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Affiliation(s)
- Syamel Muhammad
- Obstetrics and Gynecology Department, Medical Faculty of Andalas University, Padang, West Sumatera, Indonesia
| | - Reyhan Julio Azwan
- Obstetrics and Gynecology Department, Medical Faculty of Andalas University, Padang, West Sumatera, Indonesia
| | - Rauza Sukma Rita
- Biomedical Science Department, Medical Faculty of Andalas University, Padang, West Sumatera, Indonesia
| | - Restu Susanti
- Nephrology Department, Medical Faculty of Andalas University, Padang, West Sumatera, Indonesia
| | - Yusrawati
- Fetomaternal Division, Obstetrics and Gynecology Department, Medical Faculty of Andalas University, Padang, West Sumatera, Indonesia
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Lu J, Cai S, Wang F, Wu PY, Pan X, Qiang J, Li H, Zeng M. Development of a prediction model for gross residual in high-grade serous ovarian cancer by combining preoperative assessments of abdominal and pelvic metastases and multiparametric MRI. Acad Radiol 2023; 30:1823-1831. [PMID: 36587996 DOI: 10.1016/j.acra.2022.12.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2022] [Revised: 11/25/2022] [Accepted: 12/11/2022] [Indexed: 01/01/2023]
Abstract
RATIONALE AND OBJECTIVES To preoperatively predict residual tumor (RT) in patients with high-grade serous ovarian carcinoma (HGSOC) via a radiomic-clinical nomogram. METHODS A total of 128 patients with advanced HGSOC were enrolled (training cohort: n=106; validation cohort: n=22). Serum cancer antigen-125 (CA125), serum human epididymis protein 4 (HE-4) level, and neutrophil-to-lymphocyte ratio (NLR) were obtained from the medical records. Metastases in abdomen and pelvis (MAP) of HGSOC patients was evaluated and scored based on preoperative abdominal and pelvic enhanced CT, MRI and/or PET-CT. A volume of interest (VOI) of each tumor was manually contoured along the boundary slice-by-slice. Radiomic features were extracted from the T2-weighted imaging (T2WI), diffusion-weighted imaging (DWI) and apparent diffusion coefficient (ADC) images. Univariate and multivariate analyses were used to determine the independent predictors of RT status. Least absolute shrinkage and selection operator (LASSO) logistic regression was performed to select optimal features and construct radiomic models. A radiomic-clinical nomogram incorporating radiomic signature and clinical parameters was developed and evaluated in training and validation cohorts. RESULTS MAP score (p = 0.002), HE-4 level (p = 0.001) and NLR (p = 0.008) were independent predictors of RT status. The final radiomic-clinical nomogram showed satisfactory prediction performance in training (AUC = 0.936), cross validation (AUC = 0.906) and separate validation cohorts (AUC = 0.900), and fitted well in calibration curves (p > 0.05). Decision curve further confirmed the clinical application value of the nomogram. CONCLUSION The proposed MRI-based radiomic-clinical nomogram achieved excellent preoperative prediction of the RT status in HGSOC.
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Affiliation(s)
- Jingjing Lu
- Department of Radiology, Zhongshan Hospital, Fudan University, No.180 Fenglin Rd, Shanghai 200032, China; Shanghai Institute of Medical Imaging
| | - Songqi Cai
- Department of Radiology, Zhongshan Hospital, Fudan University, No.180 Fenglin Rd, Shanghai 200032, China; Shanghai Institute of Medical Imaging
| | - Fang Wang
- Department of Research and Development, Shanghai United Imaging Intelligence Co., Ltd. Shanghai, 200232, China
| | - Pu-Yeh Wu
- Department of Research and Development, GE Healthcare, Beijing 100176, China
| | - Xianpan Pan
- Department of Research and Development, Shanghai United Imaging Intelligence Co., Ltd. Shanghai, 200232, China
| | - Jinwei Qiang
- Department of Radiology, Jinshan Hospital, Fudan University, 1508 Longhang Road, Shanghai 201508, China
| | - Haiming Li
- Department of Radiology, Fudan University Shanghai Cancer Center, Shanghai 200032, China; Department of Oncology, Shanghai Medical College, Fudan University.
| | - Mengsu Zeng
- Department of Radiology, Zhongshan Hospital, Fudan University, No.180 Fenglin Rd, Shanghai 200032, China; Shanghai Institute of Medical Imaging
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Parpinel G, Laudani ME, Piovano E, Zola P, Lecuru F. The Use of Artificial Intelligence for Complete Cytoreduction Prediction in Epithelial Ovarian Cancer: A Narrative Review. Cancer Control 2023; 30:10732748231159553. [PMID: 36847148 PMCID: PMC9972055 DOI: 10.1177/10732748231159553] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/01/2023] Open
Abstract
INTRODUCTION In patients affected by epithelial ovarian cancer (EOC) complete cytoreduction (CC) has been associated with higher survival outcomes. Artificial intelligence (AI) systems have proved clinical benefice in different areas of healthcare. OBJECTIVE To systematically assemble and analyze the available literature on the use of AI in patients affected by EOC to evaluate its applicability to predict CC compared to traditional statistics. MATERIAL AND METHODS Data search was carried out through PubMed, Scopus, Ovid MEDLINE, Cochrane Library, EMBASE, international congresses and clinical trials. The main search terms were: Artificial Intelligence AND surgery/cytoreduction AND ovarian cancer. Two authors independently performed the search by October 2022 and evaluated the eligibility criteria. Studies were included when data about Artificial Intelligence and methodological data were detailed. RESULTS A total of 1899 cases were analyzed. Survival data were reported in 2 articles: 92% of 5-years overall survival (OS) and 73% of 2-years OS. The median area under the curve (AUC) resulted 0,62. The model accuracy for surgical resection reported in two articles reported was 77,7% and 65,8% respectively while the median AUC was 0,81. On average 8 variables were inserted in the algorithms. The most used parameters were age and Ca125. DISCUSSION AI revealed greater accuracy compared against the logistic regression models data. Survival predictive accuracy and AUC were lower for advanced ovarian cancers. One study analyzed the importance of factors predicting CC in recurrent epithelial ovarian cancer and disease free interval, retroperitoneal recurrence, residual disease at primary surgery and stage represented the main influencing factors. Surgical Complexity Scores resulted to be more useful in the algorithms than pre-operating imaging. CONCLUSION AI showed better prognostic accuracy if compared to conventional algorithms. However further studies are needed to compare the impact of different AI methods and variables and to provide survival informations.
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Affiliation(s)
- Giulia Parpinel
- Department of Surgical Sciences, University of Turin, Torino, Italy,Giulia Parpinel, MD, Department of Surgical
Sciences, University of Turin, Via Ventimiglia 3, Torino 10126, Italy.
| | | | - Elisa Piovano
- Department of Surgical Sciences, University of Turin, Torino, Italy
| | - Paolo Zola
- Department of Surgical Sciences, University of Turin, Torino, Italy
| | - Fabrice Lecuru
- Breast, Gynecology and
Reconstructive Surgery Unit, Curie Institute, Paris, France
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Development and Validation of 18F-FDG PET/CT-Based Models for Predicting Successful Complete Cytoreduction During Primary Cytoreductive Surgery for Advanced Ovarian cancer. Clin Nucl Med 2023; 48:e51-e59. [PMID: 36607373 DOI: 10.1097/rlu.0000000000004417] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
PURPOSE The aim of this study was to develop an 18F-FDG PET/CT-based model to predict complete cytoreduction during primary cytoreductive surgery (CRS) for ovarian cancer (OC). PATIENTS AND METHODS We retrospectively identified patients with stage III-IV OC who underwent primary CRS between June 2013 and February 2020 at 2 tertiary centers. Patients from each hospital were assigned to training and test sets. The abdominal cavity was divided into 3 sections, and data for the PET/CT-derived parameters were collected through image analysis. Various prediction models were constructed by combining clinicopathologic characteristics and PET/CT-derived parameters. The performance of the model with the highest area under the receiver operating characteristic curve (AUC) was externally validated. RESULTS The training and test sets included 159 and 166 patients, respectively. The median age of patients in the test set was 55 years; 72.3% of them had stage III tumors, and 65.4% underwent complete cytoreduction. Metabolic tumor volume, total lesion glycolysis, and the number of metastatic lesions above the upper margin of the renal vein (area A) were selected among the PET/CT parameters. The best predictive multivariable model consisted of CA-125 (<750 or ≥750 IU/mL), number of metastatic lesions (<2 or ≥2), and metabolic tumor volume of area A, predicting complete cytoreduction with an AUC of 0.768. The model was validated using a test set. Its predictive performance yielded an AUC of 0.771. CONCLUSIONS We successfully developed and validated a preoperative model to predict complete cytoreduction in advanced OC. This model can facilitate patient selection for primary CRS in clinical practice.
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Abbas-Aghababazadeh F, Sasamoto N, Townsend MK, Huang T, Terry KL, Vitonis AF, Elias KM, Poole EM, Hecht JL, Tworoger SS, Fridley BL. Predictors of residual disease after debulking surgery in advanced stage ovarian cancer. Front Oncol 2023; 13:1090092. [PMID: 36761962 PMCID: PMC9902593 DOI: 10.3389/fonc.2023.1090092] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2022] [Accepted: 01/06/2023] [Indexed: 01/25/2023] Open
Abstract
Objective Optimal debulking with no macroscopic residual disease strongly predicts ovarian cancer survival. The ability to predict likelihood of optimal debulking, which may be partially dependent on tumor biology, could inform clinical decision-making regarding use of neoadjuvant chemotherapy. Thus, we developed a prediction model including epidemiological factors and tumor markers of residual disease after primary debulking surgery. Methods Univariate analyses examined associations of 11 pre-diagnosis epidemiologic factors (n=593) and 24 tumor markers (n=204) with debulking status among incident, high-stage, epithelial ovarian cancer cases from the Nurses' Health Studies and New England Case Control study. We used Bayesian model averaging (BMA) to develop prediction models of optimal debulking with 5x5-fold cross-validation and calculated the area under the curve (AUC). Results Current aspirin use was associated with lower odds of optimal debulking compared to never use (OR=0.52, 95%CI=0.31-0.86) and two tissue markers, ADRB2 (OR=2.21, 95%CI=1.23-4.41) and FAP (OR=1.91, 95%CI=1.24-3.05) were associated with increased odds of optimal debulking. The BMA selected aspirin, parity, and menopausal status as the epidemiologic/clinical predictors with the posterior effect probability ≥20%. While the prediction model with epidemiologic/clinical predictors had low performance (average AUC=0.49), the model adding tissue biomarkers showed improved, but weak, performance (average AUC=0.62). Conclusions Addition of ovarian tumor tissue markers to our multivariable prediction models based on epidemiologic/clinical data slightly improved the model performance, suggesting debulking status may be in part driven by tumor characteristics. Larger studies are warranted to identify those at high risk of poor surgical outcomes informing personalized treatment.
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Affiliation(s)
- Farnoosh Abbas-Aghababazadeh
- Department of Biostatistics & Bioinformatics, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, United States,University Health Network, Princess Margaret Cancer Center, Toronto, ON, Canada
| | - Naoko Sasamoto
- Department of Obstetrics and Gynecology, Brigham and Women’s Hospital and Harvard Medical School, Boston, MA, United States
| | - Mary K. Townsend
- Department of Cancer Epidemiology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, United States
| | - Tianyi Huang
- Department of Medicine, Channing Division of Network Medicine, Brigham and Women’s Hospital, Boston, MA, United States
| | - Kathryn L. Terry
- Department of Obstetrics and Gynecology, Brigham and Women’s Hospital and Harvard Medical School, Boston, MA, United States
| | - Allison F. Vitonis
- Department of Obstetrics and Gynecology, Brigham and Women’s Hospital and Harvard Medical School, Boston, MA, United States
| | - Kevin M. Elias
- Department of Obstetrics and Gynecology, Brigham and Women’s Hospital and Harvard Medical School, Boston, MA, United States
| | | | - Jonathan L. Hecht
- Department of Pathology, Beth Israel Deaconess Medical Center, Boston, MA, United States
| | - Shelley S. Tworoger
- Department of Cancer Epidemiology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, United States
| | - Brooke L. Fridley
- Department of Biostatistics & Bioinformatics, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, United States,*Correspondence: Brooke L. Fridley,
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Diagnostic and Therapeutic Pathway of Advanced Ovarian Cancer with Peritoneal Metastases. Cancers (Basel) 2023; 15:cancers15020407. [PMID: 36672356 PMCID: PMC9856580 DOI: 10.3390/cancers15020407] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2022] [Revised: 12/27/2022] [Accepted: 12/30/2022] [Indexed: 01/11/2023] Open
Abstract
Over two thirds of ovarian cancer patients present with advanced stage disease at the time of diagnosis. In this scenario, standard treatment includes a combination of cytoreductive surgery and carboplatinum-paclitaxel-based chemotherapy. Despite the survival advantage of patients treated with upfront cytoreductive surgery compared to women undergoing neo-adjuvant chemotherapy (NACT) and interval debulking surgery (IDS) due to high tumor load or poor performance status has been demonstrated by multiple studies, this topic is still a matter of debate. As a consequence, selecting the adequate treatment through an appropriate diagnostic pathway represents a crucial step. Aiming to assess the likelihood of leaving no residual disease at the end of surgery, the role of the CT scan as a predictor of cytoreductive outcomes has shown controversial results. Similarly, CA 125 level as an expression of tumor load demonstrated limited applicability. On the contrary, laparoscopic assessment of disease distribution through a validated scoring system was able to identify, with the highest specificity, patients undergoing suboptimal cytoreduction and therefore best suitable for NACT-IDS. Against this background, with this article, we aim to provide a comprehensive review of available evidence on the diagnostic and treatment pathways of advanced ovarian cancer.
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Amroun K, Chaltiel R, Reyal F, Kianmanesh R, Savoye AM, Perrier M, Djerada Z, Bouché O. Dynamic Prediction of Resectability for Patients with Advanced Ovarian Cancer Undergoing Neo-Adjuvant Chemotherapy: Application of Joint Model for Longitudinal CA-125 Levels. Cancers (Basel) 2022; 15:cancers15010231. [PMID: 36612234 PMCID: PMC9818430 DOI: 10.3390/cancers15010231] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2022] [Revised: 12/23/2022] [Accepted: 12/27/2022] [Indexed: 01/04/2023] Open
Abstract
In patients with advanced ovarian cancer (AOC) receiving neoadjuvant chemotherapy (NAC), predicting the feasibility of complete interval cytoreductive surgery (ICRS) is helpful and may avoid unnecessary laparotomy. A joint model (JM) is a dynamic individual predictive model. The aim of this study was to develop a predictive JM combining CA-125 kinetics during NAC with patients' and clinical factors to predict resectability after NAC in patients with AOC. A retrospective study included 77 patients with AOC treated with NAC. A linear mixed effect (LME) sub-model was used to describe the evolution of CA-125 during NAC considering factors influencing the biomarker levels. A Cox sub-model screened the covariates associated with resectability. The JM combined the LME sub-model with the Cox sub-model. Using the LME sub-model, we observed that CA-125 levels were influenced by the number of NAC cycles and the performance of paracentesis. In the Cox sub-model, complete resectability was associated with Performance Status (HR = 0.57, [0.34-0.95], p = 0.03) and the presence of peritoneal carcinomatosis in the epigastric region (HR = 0.39, [0.19-0.80], p = 0.01). The JM accuracy to predict complete ICRS was 88% [82-100] with a predictive error of 2.24% [0-2.32]. Using a JM of a longitudinal CA-125 level during NAC could be a reliable predictor of complete ICRS.
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Affiliation(s)
- Koceila Amroun
- Department of Digestive and Endocrine Surgery, Université de Reims Champagne-Ardenne, VieFra, CHU Reims, 51100 Reims, France
- Correspondence:
| | - Raphael Chaltiel
- Department of Medical Oncology, Godinot Cancer Institute, 51100 Reims, France
| | - Fabien Reyal
- Department of Surgical Oncology, Godinot Cancer Institute, 51100 Reims, France
| | - Reza Kianmanesh
- Department of Digestive and Endocrine Surgery, Université de Reims Champagne-Ardenne, VieFra, CHU Reims, 51100 Reims, France
| | - Aude-Marie Savoye
- Department of Medical Oncology, Godinot Cancer Institute, 51100 Reims, France
| | - Marine Perrier
- Department of Gastroenterology and Digestive Oncology, Université de Reims Champagne-Ardenne, Robert Debré Hospital, CHU Reims, 51100 Reims, France
| | - Zoubir Djerada
- Department of Pharmacology and Toxicology, Université de Reims Champagne-Ardenne, HERVI, CHU Reims, 51100 Reims, France
| | - Olivier Bouché
- Department of Gastroenterology and Digestive Oncology, Université de Reims Champagne-Ardenne, Robert Debré Hospital, CHU Reims, 51100 Reims, France
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Brons PE, Nieuwenhuyzen-de Boer GM, Ramakers C, Willemsen S, Kengsakul M, van Beekhuizen HJ. Preoperative Cancer Antigen 125 Level as Predictor for Complete Cytoreduction in Ovarian Cancer: A Prospective Cohort Study and Systematic Review. Cancers (Basel) 2022; 14:cancers14235734. [PMID: 36497218 PMCID: PMC9740757 DOI: 10.3390/cancers14235734] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2022] [Revised: 11/11/2022] [Accepted: 11/19/2022] [Indexed: 11/24/2022] Open
Abstract
Background: The tumor marker ‘cancer antigen 125’ (CA-125) plays a role in the management of women with advanced stage ovarian cancer. This study aims to describe the predictive value of pre-treatment CA-125 level and the reduction after neoadjuvant chemotherapy (NACT) on surgical outcome. Methods: A systematic review and a prospective clinical study were performed. Multiple databases were searched from database inception to April 2022. The clinical study is part of a randomized controlled trial named “PlaComOv-study”. A regression analysis was performed to demonstrate correlations between preoperative CA-125 levels, CA-125 reduction after NACT, and surgical outcome. Results: Fourteen relevant articles were analyzed of which eleven reported that lower preoperative CA-125 levels were associated with a higher probability of complete cytoreduction. In the clinical study, 326 patients with FIGO stage IIIB-IV ovarian cancer who underwent CRS were enrolled from 2018 to 2020. Patients who underwent interval CRS with preoperative CA-125 levels ≤35 kU/L had higher odds of achieving complete CRS than patients with CA-125 level >35 kU/L (85% vs. 67%, OR 2.79, 95%CI 1.44−5.41, p = 0.002). In multivariable analysis with presence of ascites and peritoneal carcinomatosis, normalized preoperative CA-125 did not appear as a significant predictor for complete CRS. Conclusions: In literature, preoperative CA-125 levels ≤35 kU/L were associated with a significant higher percentage of complete CRS in univariable analysis. According to our cohort study, preoperative CA-125 level ≤35 kU/L cannot independently predict surgical outcome either for primary or interval CRS.
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Affiliation(s)
- Puck E. Brons
- Department of Gynecologic Oncology, Erasmus MC Cancer Institute, University Medical Center Rotterdam, 3000 CA Rotterdam, The Netherlands
| | - Gatske M. Nieuwenhuyzen-de Boer
- Department of Gynecologic Oncology, Erasmus MC Cancer Institute, University Medical Center Rotterdam, 3000 CA Rotterdam, The Netherlands
- Department of Obstetrics and Gynecology, Albert Schweitzer Hospital, 3318 AT Dordrecht, The Netherlands
- Correspondence: ; Tel.: +31-611151898
| | - Christian Ramakers
- Department of Clinical Chemistry, Erasmus MC, 3015 GD Rotterdam, The Netherlands
| | - Sten Willemsen
- Department of Epidemiology, Erasmus MC, 3015 GD Rotterdam, The Netherlands
- Department of Biostatistics, Erasmus MC, 3015 GD Rotterdam, The Netherlands
| | - Malika Kengsakul
- Department of Gynecologic Oncology, Erasmus MC Cancer Institute, University Medical Center Rotterdam, 3000 CA Rotterdam, The Netherlands
- Department of Obstetrics and Gynecology, Panyananthaphikkhu Chonprathan Medical Center, Srinakharinwirot University, Nonthaburi 11120, Thailand
| | - Heleen J. van Beekhuizen
- Department of Gynecologic Oncology, Erasmus MC Cancer Institute, University Medical Center Rotterdam, 3000 CA Rotterdam, The Netherlands
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11
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The role of computed tomography in the assessment of tumour extent and the risk of residual disease after upfront surgery in advanced ovarian cancer (AOC). Arch Gynecol Obstet 2022; 306:1235-1243. [PMID: 35235024 PMCID: PMC9470643 DOI: 10.1007/s00404-022-06466-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2021] [Accepted: 02/15/2022] [Indexed: 11/28/2022]
Abstract
Purpose Epithelial ovarian cancer is usually diagnosed in the advanced stages. To choose the best therapeutic approach, an accurate preoperative assessment of the tumour extent is crucial. This study aimed to determine whether the peritoneal cancer index (PCI), the amount of ascites, and the presence of cardiophrenic nodes (CPLNs) visualized by computed tomography (CT) can assess the tumour extent (S-PCI) and residual disease (RD) for advanced ovarian cancer (AOC) patients treated with upfront surgery. Methods In total, 118 AOC cases were included between January 2016 and December 2018 at Skåne University Hospital, Lund, Sweden. Linear regression and interclass correlation (ICC) analyses were used to determine the relationship between CT-PCI and S-PCI. The patients were stratified in complete cytoreductive surgery (CCS) with no RD or to non-CCS with RD of any size. The amount of ascites on CT (CT-ascites), CA-125 and the presence of radiological enlarged CPLNs (CT-CPLN) were analysed to evaluate their impact on estimating RD. Results CT-PCI correlated well with S-PCI (0.397; 95% CI 0.252–0.541; p < 0.001). The risk of RD was also related to CT-PCI (OR 1.069 (1.009–1.131), p < 0.023) with a cut-off of 21 for CT-PCI (0.715, p = 0.000). The sensitivity, specificity, positive predictive value and negative predictive value were 58.5, 70.3, 52.2 and 75.4%, respectively. CT-ascites above 1000 ml predicted RD (OR 3.510 (1.298–9.491) p < 0.013). Conclusion CT is a reliable tool to assess the extent of the disease in advanced ovarian cancer. Higher CT-PCI scores and large volumes of ascites estimated on CT predicted RD of any size.
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Okunade KS, Soibi-Harry AP, Osunwusi B, Ohazurike E, John-olabode SO, Okunowo A, Rimi G, Salako O, Adenekan M, Anorlu R. Preoperative Predictors of Optimal Tumor Resectability in Patients With Epithelial Ovarian Cancer. Cureus 2022; 14:e21409. [PMID: 35198316 PMCID: PMC8855641 DOI: 10.7759/cureus.21409] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/19/2022] [Indexed: 12/01/2022] Open
Abstract
Background Several studies have shown that whether complete tumor resection can be achieved during debulking surgery depends on various patient-related factors. However, none of these studies was conducted among patients with epithelial ovarian cancer (EOC) in sub-Saharan Africa. In this study, we aimed to determine the preoperative predictors of optimal tumor resectability (OTR) during primary debulking surgery (PDS) in patients with EOC. Methodology In this study, we reviewed all patients with histologically diagnosed EOC who underwent PDS between January 2011 and December 2020. We included 83 patients with complete clinical records for subsequent data analysis. Descriptive statistics were computed for patients’ data, and binary logistic regression analysis was used to assess the strength of associations between patients’ preoperative characteristics and OTR. Results The overall rate of OTR was 53.0%, while the rate in advanced EOC patients was 36.1%. In the univariate analyses, pleural effusion, ascites, tumor bilaterality, size of the largest tumor, retroperitoneal lymph nodes, omental caking, peritoneal thickening, significant extrapelvic tumor, serum cancer antigen-125 (CA-125) levels, and hemoglobin levels were recorded as the predictors of OTR. However, after adjusting for covariates in the final multivariate models, we found that the absence of moderate-to-large pleural effusion (odds ratio (OR) = 5.60; 95% confidence interval (CI) = 1.32, 23.71) and having serum CA-125 levels of ≤370 U/mL (OR = 6.80; 95% CI = 1.19, 38.79) were the overall independent predictors of OTR while not having any preexisting comorbidity (OR = 18.21; 95% CI = 2.40, 38.10), and the absence of pleural effusions (OR = 13.75; 95% CI = 1.80, 24.85) or enlarged retroperitoneal lymph nodes (OR = 11.95; 95% CI = 1.35, 16.07) were predictors of OTR in advanced EOC patients. Conclusions We demonstrated that the radiological absence of pleural effusions and enlarged retroperitoneal lymph nodes and having no preexisting medical morbidity and serum CA-125 levels of ≤370 U/mL were the independent predictors of OTR during PDS. The preliminary data generated from this study can be used to develop variables for a prediction model in a future validation study.
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13
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Albright BB, Monuszko KA, Kaplan SJ, Davidson BA, Moss HA, Huang AB, Melamed A, Wright JD, Havrilesky LJ, Previs RA. Primary cytoreductive surgery for advanced stage endometrial cancer: a systematic review and meta-analysis. Am J Obstet Gynecol 2021; 225:237.e1-237.e24. [PMID: 33957111 DOI: 10.1016/j.ajog.2021.04.254] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2020] [Revised: 04/12/2021] [Accepted: 04/20/2021] [Indexed: 01/08/2023]
Abstract
OBJECTIVE Endometrial cancer uncommonly presents at an advanced stage and little prospective evidence exists to guide the management thereof. We aimed to summarize the evidence about primary cytoreductive surgery in the treatment of advanced stage endometrial cancer. DATA SOURCES MEDLINE, Embase, and Scopus databases were searched from inception to September 11, 2020, using search terms representing the themes "endometrial cancer," "advanced stage," and "primary cytoreductive surgery." STUDY ELIGIBILITY CRITERIA We included full-text, English reports that included ≥10 patients undergoing primary cytoreductive surgery for advanced stage endometrial cancer and that reported on the outcomes of primary cytoreductive surgery and survival rates based on the residual disease burden. METHODS Two reviewers independently screened the studies and with disagreements between the reviewers resolved by a third reviewer. Data were extracted using a standardized form. The percentage of cases reaching maximal (no gross residual disease) and optimal (<1 cm or <2 cm residual disease) cytoreduction were assessed by summing binomials proportions, and the association with survival was assessed using an inverse variance-weighted meta-analysis of logarithmic hazard ratios. RESULTS From 1219 unique records identified, 34 studies were selected for inclusion. Studies consisted of single or multi-institutional cohorts of patients collected over a period of 6 to 24 years and included various mixes of histologies (endometrioid, serous, clear cell, and carcinosarcoma) and disease stages (III or IV). In a meta-analysis of the extent of residual disease after primary cytoreductive surgery, we found that 52.1% of cases reached no gross residual disease status (n=18 studies; 1329 patients) and 75% reached <1 cm residual disease status (n=27 studies; 2343 patients). The proportion of cytoreduction for both thresholds was lower for studies of stage IV vs stage III to IV disease (41.4% vs 69.8% for no gross residual disease; 63.2% vs 82.2% for <1 cm residual disease) but did not vary notably by histology. In a meta-analysis of the reported hazard ratios, submaximal (any gross residual disease vs no gross residual disease) and suboptimal (≥1 cm vs <1 cm) cytoreduction thresholds were associated with worse progression-free survival (submaximal hazard ratio, 2.16; 95% confidence interval, 1.45-3.21; I2=68%; suboptimal hazard ratio, 2.55; 95% confidence interval, 1.93-3.37; I2=63%) and overall survival rates (submaximal hazard ratio, 2.57; 95% confidence interval, 2.13-3.10; I2=1%; suboptimal hazard ratio, 2.62; 95% confidence interval, 2.20-3.11; I2=15%). Sensitivity analyses limited to high-quality studies demonstrated consistent results. CONCLUSION Among cases of advanced stage endometrial cancer undergoing primary cytoreductive surgery, a significant proportion of patients are left with residual disease, which is associated with worse survival outcomes. Further investigations about the roles of neoadjuvant chemotherapy and primary cytoreductive surgery in prospective trials is warranted in this population.
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14
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Preoperative serum CA-125 level as a predictor for the extent of cytoreduction in patients with advanced stage epithelial ovarian cancer. Radiol Oncol 2021; 55:341-346. [PMID: 33675192 PMCID: PMC8366730 DOI: 10.2478/raon-2021-0013] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2020] [Accepted: 02/09/2021] [Indexed: 01/17/2023] Open
Abstract
BACKGROUND Ovarian cancer is the seventh most common cancer in women worldwide and the eighth most common cause of cancer death. Due to the lack of effective early detection strategies and the unspecific onset of symptoms, it is diagnosed at an advanced stage in 75% of cases. The cancer antigen (CA) 125 is used as a prognostic marker and its level is elevated in more than 85% of women with advanced stages of epithelial ovarian cancer (EOC). The standard treatment is primary debulking surgery (PDS) followed by adjuvant chemotherapy (ACT), but the later approach is neoadjuvant chemotherapy (NACT) followed by interval debulking surgery (IDS). Several studies have been conducted to find out whether preoperative CA-125 serum levels influence treatment choice, surgical resection and survival outcome. The aim of our study was to analyse experience of single institution as Cancer comprehensive center with preoperative usefulness of CA-125. PATIENTS AND METHODS At the Institute of Oncology Ljubljana a retrospective analysis of 253 women with stage FIGO IIIC and IV ovarian cancer was conducted. Women were divided into two groups based on their primary treatment. The first group was the NACT group (215 women) and the second the PDS group (38 women). The differences in patient characteristics were compared using the Chi-square test and ANOVA and the Kaplan-Meier method was used for calculating progression-free survival (PFS) and overall survival (OS). RESULTS The median serum CA-125 level was higher in the NACT group than in the PDS group, 972 IU/ml and 499 IU/ ml, respectively. The PFS in the NACT group was 8 months (95% CI 6.4-9.5) and 18 months (95% CI 12.5-23.4) in the PDS group. The median OS was lower in the NACT group than in the PDS group, 25 months (95% CI 20.6-29.5) and 46 months (95% CI 32.9-62.1), respectively. CONCLUSIONS Preoperative CA-125 cut off value of 500 IU/ml is a promising threshold to predict a successful PDS.
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15
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Abstract
The mainstay management of advanced ovarian cancer is maximal cytoreductive surgery followed by chemotherapy. Neoadjuvant chemotherapy (NACT) and interval debulking surgery (IDS) are alternative treatments for patients with comorbidity, poor performance status, and predicted for suboptimal debulking surgery. It is the invariable principle in any situation that no residual disease after the completion of surgery is useful for patients with ovarian cancer. Therefore, the prediction of optimal debulking before the treatment of ovarian cancer is of utmost importance. Many studies have reported on the use of serum biomarkers, such as cancer antigen 125 (CA125) or human epididymis 4 (HE4), and imaging studies, such as computed tomography (CT), diffusion-weighted magnetic resonance imaging (DW-MRI), and positron emission tomography (PET)/CT, to identify adequate surgical candidates for primary debulking surgery (PDS). Laparoscopy has also been studied as a reliable tool for the prediction of optimal debulking. Here, we summarize a review of the related literature.
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Affiliation(s)
- Yong Jung Song
- Department of Obstetrics and Gynecology, Pusan National University Yangsan Hospital, Yangsan, South Korea.,Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Pusan National University School of Medicine, Yangsan, South Korea
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16
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Salminen L, Gidwani K, Grènman S, Carpén O, Hietanen S, Pettersson K, Huhtinen K, Hynninen J. HE4 in the evaluation of tumor load and prognostic stratification of high grade serous ovarian carcinoma. Acta Oncol 2020; 59:1461-1468. [PMID: 33030975 DOI: 10.1080/0284186x.2020.1827157] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
OBJECTIVE Human epididymis protein 4 (HE4) is a validated, complementary biomarker to cancer antigen 125 (CA125) for high grade serous ovarian carcinoma (HGSC). Currently, there are insufficient data on the utility of longitudinal HE4 measurement during HGSC treatment and follow up. We set to provide a comprehensive analysis on the kinetics and prognostic performance of HE4 with serial measurements during HGSC treatment and follow up. METHODS This prospective study included 143 patients with advanced HGSC (ClinicalTrials.gov identifier: NCT01276574). Serum CA125 and HE4 were measured at baseline, before each cycle of chemotherapy and during follow up until first progression. Baseline biomarker values were compared to the tumor load assessed during surgery and to residual disease. Biomarker nadir values and concentrations at progression were correlated to survival. RESULTS The baseline HE4 concentration distinguished patients with a high tumor load from patients with a low tumor load assessed during surgery (p<.0001). The baseline CA125 level was not associated with tumor load to a similar extent (p=.067). At progression, the HE4 level was an independent predictor of worse survival in the multivariate analysis (p=.002). All patients that were alive 3 years post-progression had a serum HE4 concentration below 199.20 pmol/l at the 1st recurrence. CONCLUSION HE4 is a feasible biomarker in the treatment monitoring and prognostic stratification of patients with HGSC. Specifically, the serum level of HE4 at first relapse was associated with the survival of patients and it may be a useful complementary tool in the selection of second line treatments. This is to the best of our knowledge the first time this finding has been reported.
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Affiliation(s)
- Liina Salminen
- Department of Obstetrics and Gynecology, Turku University Hospital and University of Turku, Turku, Finland
| | - Kamlesh Gidwani
- Department of Biochemistry/Biotechnology, University of Turku, Turku, Finland
| | - Seija Grènman
- Department of Obstetrics and Gynecology, Turku University Hospital and University of Turku, Turku, Finland
| | - Olli Carpén
- Institute of Biomedicine and Western Finland Cancer Centre (FICAN), University of Turku, Turku, Finland
- Medicum, Research Program in Systems Oncology and HUSLAB, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Sakari Hietanen
- Department of Obstetrics and Gynecology, Turku University Hospital and University of Turku, Turku, Finland
| | - Kim Pettersson
- Department of Biochemistry/Biotechnology, University of Turku, Turku, Finland
| | - Kaisa Huhtinen
- Institute of Biomedicine and Western Finland Cancer Centre (FICAN), University of Turku, Turku, Finland
| | - Johanna Hynninen
- Department of Obstetrics and Gynecology, Turku University Hospital and University of Turku, Turku, Finland
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Hidayat YM, Munizar, Harsono AB, Winarno GNA, Hasanuddin, Salima S. Chemokine Ligand 5 to Predict Optimal Cytoreduction in Ovarian Cancer. Int J Gen Med 2020; 13:1201-1206. [PMID: 33244258 PMCID: PMC7685389 DOI: 10.2147/ijgm.s280858] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2020] [Accepted: 11/02/2020] [Indexed: 12/25/2022] Open
Abstract
Purpose The ultimate goal of cytoreduction surgery is the complete removal of all visible tumors (complete cytoreductive surgery) or tumor residues <1 cm (optimal cytoreduction surgery). Following cytoreduction surgery in ovarian cancer, tumor residue is one of the most important prognostic factors. Oncologists strive to be able to predict the outcome of cytoreduction surgery during the presurgical period. The purpose of this study was to assess CCL5 as a modality for determining whether a patient could perform optimal cytoreduction surgery or not. Materials and Methods This was an observational, analytic, and cross-sectional study of patients with ovarian cancer who underwent surgery at the Dr. Hasan Sadikin Bandung from 2019 to 2020. All of the patients had stage I–IV disease based on the International Federation of Gynecology and Obstetrics (FIGO) score. Results In total, 72 patients were enrolled in this study, 31 of whom underwent suboptimal cytoreduction surgery and 41 underwent optimal cytoreduction surgery. The mean serum CCL5 level at suboptimal cytoreduction was 70,920.87 ± 36,362.966, while that at optimal cytoreduction was 43,244.95 ± 21,983.887. CCL5, as a predictor of suboptimal cytoreduction surgery, had a sensitivity of 61.3%, a specificity of 68.3%, and an accuracy of 65.7% (p = 0.012). Conclusion Preoperative CCL5 serum levels can predict suboptimal cytoreduction surgery outcomes in patients with ovarian cancer.
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Affiliation(s)
- Yudi Mulyana Hidayat
- Department of Obstetrics and Gynecology, Faculty of Medicine, Universitas Padjadjaran, Bandung, Indonesia
| | - Munizar
- Department of Obstetrics and Gynecology, Faculty of Medicine, Universitas Padjadjaran, Bandung, Indonesia
| | - Ali Budi Harsono
- Department of Obstetrics and Gynecology, Faculty of Medicine, Universitas Padjadjaran, Bandung, Indonesia
| | | | - Hasanuddin
- Department of Obstetrics and Gynecology, Faculty of Medicine, Universitas Syiah Kuala, Aceh, Indonesia
| | - Siti Salima
- Department of Obstetrics and Gynecology, Faculty of Medicine, Universitas Padjadjaran, Bandung, Indonesia
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Bachmann R, Brucker S, Stäbler A, Krämer B, Ladurner R, Königsrainer A, Wallwiener D, Bachmann C. Prognostic relevance of high pretreatment CA125 levels in primary serous ovarian cancer. Mol Clin Oncol 2020; 14:8. [PMID: 33262888 PMCID: PMC7690236 DOI: 10.3892/mco.2020.2170] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2019] [Accepted: 08/12/2020] [Indexed: 02/01/2023] Open
Abstract
The objective of the present study was to analyze the prognostic relevance of pretreatment serum CA125 ≥500 U/ml and its role as a non-invasive factor for estimating optimal cytoreduction (≤1 cm) in primary serous ovarian cancer. Clinicopathological parameters and CA125 levels prior to primary cytoreductive surgery were retrospectively evaluated in all 261 consecutive patients with primary epithelial ovarian cancer from a single centre. Inclusion criteria were existing preoperative CA125 level, serous ovarian cancer and performed full primary treatment (surgery/platinum-based chemotherapy). A total of 136 patients met the criteria. Among them, 74 patients had CA125 ≥500 U/ml. The other 62 patients that met the aforementioned criteria and had CA125 <500 U/ml were defined as controls. The present study tested cut-off CA125 values to detect subgroups affecting prognosis. The goal was to evaluate patients with optimal cytoreduction (R≤1 cm). Univariate analyses were performed with PASW to identify clinicopathological parameters associated with the pretreatment CA125 level. For survival analyses, a cut-off-value of CA125 ≥500 U/ml was used to identify the association between preoperative CA125 levels, resection status and prognosis. To test significant differences between examined groups, Student's t-test and the Mann-Whitney test were used. P<0.05 was considered to indicate a statistically significant difference. Significantly worse prognosis in terms of overall survival (P=0.023) and progression-free survival (P=0.011) was detected in the CA125 ≥500 U/ml group of optimally cytoreduced patients compared with in the CA125 <500 U/ml group. The complete cytoreduction rate was higher in CA125 <500 U/ml (33.9%) vs. CA125 ≥500 U/ml (21.6%). A CA125 level >1,404 U/ml had a higher rate of suboptimal cytoreduction (32.4%) compared with lower CA125 levels. A pretreatment CA125 level ≥500 U/ml had significantly worse prognostic impact after optimal cytoreduction compared with CA125 <500 U/ml. The higher the CA125 level the higher the suboptimal cytoreduction rate. Patients with CA125 ≥500 U/ml may be candidates for an initial laparoscopic approach to specify resectability and to determine how to proceed. Overall, CA125 levels appear to be helpful in predicting suboptimal cytoreductive surgery for patients with primary ovarian cancer, but should be interpreted together with clinical and radiologic findings. This may improve defining the optimal treatment strategy in these patients.
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Affiliation(s)
- Robert Bachmann
- Department of General, Visceral and Transplant Surgery, University Hospital Tübingen, D-72076 Tübingen, Germany
| | - Sara Brucker
- Department of Obstetrics and Gynecology, University of Tuebingen, D-72076 Tübingen, Germany
| | - Annette Stäbler
- Institute of Pathology and Neuropathology and Comprehensive Cancer Center Tübingen, University Hospital Tübingen, Eberhard-Karls-University, D-72076 Tübingen, Germany
| | - Bernhard Krämer
- Department of Obstetrics and Gynecology, University of Tuebingen, D-72076 Tübingen, Germany
| | - Ruth Ladurner
- Department of General, Visceral and Transplant Surgery, University Hospital Tübingen, D-72076 Tübingen, Germany
| | - Alfred Königsrainer
- Department of General, Visceral and Transplant Surgery, University Hospital Tübingen, D-72076 Tübingen, Germany
| | - Diethelm Wallwiener
- Department of Obstetrics and Gynecology, University of Tuebingen, D-72076 Tübingen, Germany
| | - Cornelia Bachmann
- Department of Obstetrics and Gynecology, University of Tuebingen, D-72076 Tübingen, Germany
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19
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Winarno GNA, Hidayat Y, Soetopo S, Krisnadi SR, Tobing MDL, Rauf S. Higher Level of Fatty Acid Synthase Enzyme Predicts Lower Rate of Completing Debulking Surgery in Epithelial Ovarian Cancer. Asian Pac J Cancer Prev 2020; 21:2859-2863. [PMID: 33112541 PMCID: PMC7798157 DOI: 10.31557/apjcp.2020.21.10.2859] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2019] [Indexed: 11/25/2022] Open
Abstract
Background: The most dominant histopathologic type of ovarian cancer is epithelial ovarian cancer (EOC). Primary debulking surgery determines the treatment success and prognosis of advanced stage EOC. To maintain survival and progression, cancer cells need fatty acid synthase enzyme (FASN). The aim of this study was to evaluate preoperative serum FASN and CA 125 as predictors of primary debulking surgery results in patients with EOC. Methods: An observational cross-sectional study was performed on consecutive patients who underwent debulking surgery for suspected ovarian cancer at Dr. Hasan Sadikin Hospital Bandung from 2017 to 2019. Before debulking surgery, blood samples were examined for the serum levels of FASN and CA 125 using ELISA. Results: There were 53 patients enrolled in this study. Compared with the optimal debulking surgery group, the significant suboptimal debulking surgery group had significantly lower mean serum levels of FASN (0.46 ± 0.144 vs. 0.36 ± 0.128, p = 0.012) and CA 125 (964.22 ± 1722.5 vs. 264.98 ± 251.8, p = 0.002). The cutoff value was highest for the combination of FASN and CA 125 [410.06, area under the curve (AUC) = 77.5% (95% CI 65.5% to 81.9%, p = 0.001)] than for FASN alone [0.375, AUC = 71.3% (95% CI 56.8% to 85.8%, p = 0.009)] and CA 125 alone [222.5, AUC = 75.3% (95% CI 62.5% to 88.1%, p =0.002)]. Conclusion: The serum levelof FASN was correlated with suboptimal debulking surgery.
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Affiliation(s)
| | - Yudi Hidayat
- Department of Obstetrics and Gynecology, Faculty of Medicine, Padjadjaran University, Bandung, Indonesia
| | - Setiawan Soetopo
- Department of Radiology, Faculty of Medicine, Padjadjaran University, Bandung, Indonesia
| | - Sofie Rifayani Krisnadi
- Department of Obstetrics and Gynecology, Faculty of Medicine, Padjadjaran University, Bandung, Indonesia
| | | | - Syahrul Rauf
- Department of Obstetrics and Gynecology, Faculty of Medicine, Hasanuddin University, Makasar, Indonesia
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20
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Winarno GNA, Hidayat YM, Soetopo S, Krisnadi SR, Tobing MDL, Rauf S. The role of CA-125, GLS and FASN in predicting cytoreduction for epithelial ovarian cancers. BMC Res Notes 2020; 13:346. [PMID: 32698888 PMCID: PMC7376706 DOI: 10.1186/s13104-020-05188-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2020] [Accepted: 07/15/2020] [Indexed: 11/10/2022] Open
Abstract
OBJECTIVE Cytoreduction has an important role in improving the survival rate of epithelial ovarian cancer (EOC) patients. This study aimed to assess the ability of preoperative serum CA125, FASN and GLS as predictors of cytoreductive surgery for epithelial ovarian cancer (EOC). RESULTS The average values of serum CA-125, FASN, and GLS in the suboptimal cytoreduction group were higher than those in optimal cytoreduction group. The cut off point (COP) was 248.55 (p = 0.0001) with 73.2% sensitivity and 73.6% specificity for CA-125, 0.445 (p = 0.017) with 62.5% sensitivity and 60.4% specificity for FASN, and 22.895 (p = 0.0001) with 73.2% sensitivity and 75.5% specificity for GLS. The COP of CA-125 and GLS combined was 29.16 (p = 0.0001) with sensitivity 82.1% and specificity 73.6%, while the COP of CA-125, GLS, and FASN combined was 0.83 (p = 0.0001) with 87.5% sensitivity and 73.6% specificity.
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Affiliation(s)
- G N A Winarno
- Department of Obstetrics and Gynecology, Faculty of Medicine, Padjadjaran University, Jl Pasteur No.38, Bandung, Indonesia.
| | - Y M Hidayat
- Department of Obstetrics and Gynecology, Faculty of Medicine, Padjadjaran University, Jl Pasteur No.38, Bandung, Indonesia
| | - S Soetopo
- Department of Radiology, Faculty of Medicine, Padjadjaran University, Jl Pasteur No.38, Bandung, Indonesia
| | - S R Krisnadi
- Department of Obstetrics and Gynecology, Faculty of Medicine, Padjadjaran University, Jl Pasteur No.38, Bandung, Indonesia
| | - M D L Tobing
- Department of Obstetrics and Gynecology, Faculty of Medicine, Padjadjaran University, Jl Pasteur No.38, Bandung, Indonesia
| | - S Rauf
- Department of Obstetrics and Gynecology, Faculty of Medicine, Hasanuddin University, Jl. Perintis Kemerdekaan KM. 10, Makasar, Indonesia
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Feng LY, Liao SB, Li L. Preoperative serum levels of HE4 and CA125 predict primary optimal cytoreduction in advanced epithelial ovarian cancer: a preliminary model study. J Ovarian Res 2020; 13:17. [PMID: 32050995 PMCID: PMC7014747 DOI: 10.1186/s13048-020-0614-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2019] [Accepted: 01/22/2020] [Indexed: 12/18/2022] Open
Abstract
Objective The aim of this study is to establish a noninvasive preoperative model for predicting primary optimal cytoreduction in advanced epithelial ovarian cancer by HE4 and CA125 combined with clinicopathological parameters. Methods Clinical data including preoperative serum HE4 and CA125 level of 83 patients with advanced epithelial ovarian cancer were collected. The sensitivity, specificity, positive predictive value, negative predictive value and overall accuracy of each clinical parameter were calculated. The Predictive Index score model and the logistic model were constructed to predict the primary optimal cytoreduction. Results Optimal surgical cytoreduction was achieved in 62.65% (52/83) patients. Cutoff values of preoperative serum HE4 and CA125 were 777.10 pmol/L and 313.60 U/ml. (1) Patients with PIV ≥ 6 may not be able to achieve optimal surgical cytoreduction. The diagnostic accuracy, NPV, PPV and specificity for diagnosing suboptimal cytoreduction were 71, 100, 68, and 100%, respectively. (2) The logistic model was: logit p = 0.12 age − 2.38 preoperative serum CA125 level − 1.86 preoperative serum HE4 level-2.74 histological type-3.37. AUC of the logistic model in the validation group was 0.71(95%CI 0.54–0.88, P = 0.025). Sensitivity and specificity were 1.00 and 0.44, respectively. Conclusion Age, preoperative serum CA125 level and preoperative serum HE4 level are important non-invasive predictors of primary optimal surgical cytoreduction in advanced epithelial ovarian cancer. Our PIV and logistic model can be used for assessment before expensive and complex predictive methods including laparoscopy and diagnostic imaging. Further future clinical validation is needed.
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Affiliation(s)
- Li-Yuan Feng
- Department of Gynecologic oncology, Guangxi Medical University Cancer Hospital, 71 Hedi Road, Nanning, Guangxi, 530021, People's Republic of China
| | - Sheng-Bin Liao
- Department of Gynecologic oncology, Guangxi Medical University Cancer Hospital, 71 Hedi Road, Nanning, Guangxi, 530021, People's Republic of China
| | - Li Li
- Department of Gynecologic oncology, Guangxi Medical University Cancer Hospital, 71 Hedi Road, Nanning, Guangxi, 530021, People's Republic of China.
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Salminen L, Nadeem N, Jain S, Grènman S, Carpén O, Hietanen S, Oksa S, Lamminmäki U, Pettersson K, Gidwani K, Huhtinen K, Hynninen J. A longitudinal analysis of CA125 glycoforms in the monitoring and follow up of high grade serous ovarian cancer. Gynecol Oncol 2019; 156:689-694. [PMID: 31889528 DOI: 10.1016/j.ygyno.2019.12.025] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2019] [Revised: 12/17/2019] [Accepted: 12/18/2019] [Indexed: 12/31/2022]
Abstract
OBJECTIVE Cancer antigen 125 (CA125) is generally considered the gold standard of biomarkers in the diagnosis and monitoring of high grade serous ovarian carcinoma (HGSC). We recently reported, that two CA125 glycoforms (CA125-STn and CA125-MGL) have a high specificity to HGSC and further hypothesized, that these cancer specific glycoforms are feasible candidates as biomarkers in HGSC treatment and follow up. METHODS Our cohort consisted of 122 patients diagnosed with HGSC. Serum samples were collected longitudinally at the time of diagnosis, during treatment and follow up. Serum levels of CA125, CA125-STn and CA125-MGL were determined and compared or correlated with different end points (tumor load assessed intraoperatively, residual disease, treatment response, progression free survival). RESULTS Serum CA125-STn levels at diagnosis differentiated patients with low tumor load and high tumor load (p = 0,030), indicating a favorable detection of tumor volume. Similarly, the CA125-STn levels at diagnosis were significantly lower in patients with subsequent complete cytoreduction than in patients with suboptimal cytoreduction (p = 0,025). Conventional CA125 did not differentiate these patients (p = 0,363 and p = 0,154). The CA125-STn nadir value predicted the progression free survival of patients. The detection of disease relapse was improved with CA125-STn, which presented higher fold increase in 80,0% of patients and earlier increase in 37,0% of patients. CONCLUSIONS CA125-STn showed promise as a useful biomarker in the monitoring and follow up of patients with HGSC utilizing a robust and affordable technique. Our findings are topical as a suitable indicator of tumor load facilitates patient selection in an era of new targeted therapies.
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Affiliation(s)
- Liina Salminen
- Department of Obstetrics and Gynecology, Turku University Hospital and University of Turku, Turku, Finland
| | - Nimrah Nadeem
- Department of Biochemistry/Biotechnology, University of Turku, Turku, Finland
| | - Shruti Jain
- Department of Biochemistry/Biotechnology, University of Turku, Turku, Finland
| | - Seija Grènman
- Department of Obstetrics and Gynecology, Turku University Hospital and University of Turku, Turku, Finland
| | - Olli Carpén
- Institute of Biomedicine, Research Center for Cancer, Infections and Immunity, Department of Pathology, University of Turku, Finland; Department of Pathology and Genome Scale Biology Research Program, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Sakari Hietanen
- Department of Obstetrics and Gynecology, Turku University Hospital and University of Turku, Turku, Finland
| | - Sinikka Oksa
- Department of Obstetrics and Gynecology, Satakunta Central Hospital, Finland
| | - Urpo Lamminmäki
- Department of Biochemistry/Biotechnology, University of Turku, Turku, Finland
| | - Kim Pettersson
- Department of Biochemistry/Biotechnology, University of Turku, Turku, Finland
| | - Kamlesh Gidwani
- Department of Biochemistry/Biotechnology, University of Turku, Turku, Finland
| | - Kaisa Huhtinen
- Institute of Biomedicine, Research Center for Cancer, Infections and Immunity, Department of Pathology, University of Turku, Finland
| | - Johanna Hynninen
- Department of Obstetrics and Gynecology, Turku University Hospital and University of Turku, Turku, Finland.
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Kadhel P, Revaux A, Carbonnel M, Naoura I, Asmar J, Ayoubi JM. An update on preoperative assessment of the resectability of advanced ovarian cancer. Horm Mol Biol Clin Investig 2019; 41:hmbci-2019-0032. [PMID: 31398144 DOI: 10.1515/hmbci-2019-0032] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2019] [Accepted: 07/12/2019] [Indexed: 12/24/2022]
Abstract
The best prognosis for advanced ovarian cancer is provided by no residual disease after primary cytoreductive surgery. It is thus important to be able to predict resectability that will result in complete cytoreduction, while avoiding unnecessary surgery that may leave residual disease. No single procedure appears to be sufficiently accurate and reliable to predict resectability. The process should include a preoperative workup based on clinical examination, biomarkers, especially tumor markers, and imaging, for which computed tomography, as well as sonography, magnetic resonance imaging and positron-emission tomography, can be used. This workup should provide sufficient information to determine whether complete cytoreduction is possible or if not, to propose neoadjuvant chemotherapy which is preferable in this case. For the remaining patients, laparoscopy is broadly recommended as an ultimate triage step. However, its modalities are still debated, and several scores have been proposed for standardization and improving accuracy. The risk of false negatives requires a final assessment of resectability as the first stage of cytoreductive surgery by laparotomy. Composite models, consisting of several criteria of workup and, sometimes, laparoscopy have been proposed to improve the accuracy of the predictive process. Regardless of the modality, the process appears to be accurate and reliable for predicting residual disease but less so for predicting complete cytoreduction and thus avoiding unnecessary surgery and an inappropriate treatment strategy. Overall, the proposed procedures are heterogeneous, sometimes unvalidated, or do not consider advances in surgery. Future techniques and/or models are still needed to improve the prediction of complete resectability.
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Affiliation(s)
- Philippe Kadhel
- Department of Gynecology and Obstetrics, Foch Hospital, 40 Rue Worth, 92150 Suresnes, France.,CHU de Pointe-à-Pitre, Univ Antilles, Univ Rennes, Inserm, EHESP, Irset (Institut de recherche en santé, environnement et travail) - UMR_S 1085, Pointe-à-Pitre, France, Phone: +33 1 45 26 35 19
| | - Aurélie Revaux
- Department of Gynecology and Obstetrics, Foch Hospital, Suresnes, France
| | - Marie Carbonnel
- Department of Gynecology and Obstetrics, Foch Hospital, Suresnes, France
| | - Iptissem Naoura
- Department of Gynecology and Obstetrics, Foch Hospital, Suresnes, France
| | - Jennifer Asmar
- Department of Gynecology and Obstetrics, Foch Hospital, Suresnes, France.,Université de Versailles Saint-Quentin-en-Yvelines, Versailles, France
| | - Jean Marc Ayoubi
- Department of Gynecology and Obstetrics, Foch Hospital, Suresnes, France.,Université de Versailles Saint-Quentin-en-Yvelines, Versailles, France
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24
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Bendifallah S, Body G, Daraï E, Ouldamer L. [Diagnostic and prognostic value of tumor markers, scores (clinical and biological) algorithms, in front of an ovarian mass suspected of an epithelial ovarian cancer: Article drafted from the French Guidelines in oncology entitled "Initial management of patients with epithelial ovarian cancer" developed by FRANCOGYN, CNGOF, SFOG, GINECO-ARCAGY under the aegis of CNGOF and endorsed by INCa]. ACTA ACUST UNITED AC 2019; 47:134-154. [PMID: 30733191 DOI: 10.1016/j.gofs.2018.12.013] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2018] [Indexed: 11/26/2022]
Abstract
OBJECTIVES To evaluate the diagnostic value of serum/urinary biomarkers and the operability diagnosis strategy to make management recommendations. METHODS Bibliographical search in French and English languages by consultation of Pubmed, Cochrane and Embase databases. RESULTS For the diagnosis of a suspicious adnexal mass on imaging: Serum CA125 antigen is recommended (grade A). Serum CAE is not recommended (grade C). The low evidence in literature concerning diagnostic value of CA19.9 does not allow any recommendation concerning its use. Serum Human epididymis protein 4 (HE4) is recommended (grade A). Comparison of data concerning diagnosis value of CA125 and HE4 show similar results for the prediction of malignancy in case of a suspicious adnexal mass on imaging (NP1). Urinary HE4 is not recommended (grade A). The use of circulating tumor DNA is not recommended (grade A). Tumor associated antigen-antibodies (AAbs) is not recommended (grade B). The use of ROMA score (Risk of Ovarian Malignancy Algorithm) is recommended (grade A). The use of Copenhagen index (CPH-I), R-OPS score, OVA500 is not recommended (grade C). For the prediction of resectability of an ovarian cancer with peritoneal carcinomatosis in the context of a primary debulking surgery: It is not recommendend to use serum CA125 (grade A). The low evidence in literature concerning diagnostic value of HE4 does not allow any recommendation concerning its use in this context. No recommendation can be given concerning CA19.9 and CAE. For the prediction of resectability of an ovarian cancer with peritoneal carcinomatosis in the context of surgery after neoadjuvant chemotherapy: the low evidence in literature concerning diagnostic value of serum markers in this context does not allow any recommendation concerning their use in this context. Place of laparoscopy for the prediction of resectability in case of upfront surgery of an ovarian cancer with peritoneal carcinomatosis robust data shows that the use of laparoscopy significantly reduce futile laparotomies (LE1). Laparoscopy is recommended in this context (grade A). Fagotti score is a reproducible tool (LE1) permitting the evaluation of feasibility of an optimal upfront debulking (NP4), its use is recommended (grade C). A Fagotti score≥8 is correlated to a low probability of complete or optimal debulking surgery (LE4) (grade C). There is no sufficient evidence to recommend the use of the modified Fagotti score or any other laparoscopic score (LE4). In case of laparotomy for an ovarian cancer with peritoneal carcinomatosis, the use of Peritoneal Cancer Index (PCI) is recommended (grade C). For the prediction of overall survival, disease free survival and the prediction of postoperative complications, the clinical and statistical of actually available tools do not allow any recommendation.
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Affiliation(s)
- S Bendifallah
- Département de gynécologie-obstétrique, hôpital Tenon, Assistance publique des Hôpitaux de Paris (AP-HP), 4, rue de la Chine, 75020 Paris, France; UMR_S938, université de Sorbonne, 75000 Paris, France
| | - G Body
- Département de gynécologie, centre hospitalier universitaire de Tours, 2, boulevard Tonnellé, 37044 Tours, France; Inserm U1069, université François-Rabelais, 37044 Tours, France
| | - E Daraï
- Département de gynécologie-obstétrique, hôpital Tenon, Assistance publique des Hôpitaux de Paris (AP-HP), 4, rue de la Chine, 75020 Paris, France; Inserm UMR S 938, université Pierre-et-Marie-Curie, 75000 Paris, France
| | - L Ouldamer
- Département de gynécologie, centre hospitalier universitaire de Tours, 2, boulevard Tonnellé, 37044 Tours, France; Inserm U1069, université François-Rabelais, 37044 Tours, France.
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25
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Zhang D, Jiang YX, Luo SJ, Zhou R, Jiang QX, Linghu H. Serum CA125 levels predict outcome of interval debulking surgery after neoadjuvant chemotherapy in patients with advanced ovarian cancer. Clin Chim Acta 2018; 484:32-35. [DOI: 10.1016/j.cca.2018.04.030] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2018] [Revised: 04/23/2018] [Accepted: 04/23/2018] [Indexed: 10/17/2022]
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26
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Hu TWY, Nie D, Gou JH, Li ZY. Predictive significance of preoperative CT findings for suboptimal cytoreduction in advanced ovarian cancer: a meta-analysis. Cancer Manag Res 2018; 10:2019-2030. [PMID: 30038518 PMCID: PMC6053262 DOI: 10.2147/cmar.s166658] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
Background Computed tomography (CT) has been extensively used in predicting suboptimal cytoreduction (SCR) in advanced ovarian cancer (OC). However, disagreements remain in literatures on the predictive value of CT findings for SCR. This meta-analysis was designed to determine the ability of eight preoperative CT findings to predict SCR in advanced OC. Materials and methods A comprehensive literature search was conducted for eligible studies to identify the association between the eight preoperative CT findings and SCR in advanced OC. The predictive performances of preoperative CT findings were expressed in terms of sensitivity, specificity, positive likelihood ratio (PLR), negative likelihood ratio (NLR) and diagnostic odds ratio (DOR) with pooled proportion. Results A total of 10 studies and 1,614 patients were included in this meta-analysis. Large volume ascites had the highest sensitivity (64%, CI 56–71%), with a PLR of 1.3 (CI 1.1–1.5) and an NLR of 0.73 (0.59–0.90), while lymph node involvement had the highest specificity (89%, CI 79–94%). The highest DOR of 3 (CI 2–4) was achieved in peritoneal involvement and large bowel mesentery involvement. The other CT findings had poorer predictive performance. Conclusion Preoperative CT findings have a poor discriminative capacity to predict SCR in advanced OC. Preoperative CT predictors should be used with caution amid clinical decision-making.
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Affiliation(s)
- Ting Wen Yi Hu
- Department of Gynecology and Obstetrics, West China Second University Hospital, Sichuan University, Chengdu, People's Republic of China,
| | - Dan Nie
- Department of Gynecology and Obstetrics, West China Second University Hospital, Sichuan University, Chengdu, People's Republic of China, .,Key Laboratory of Obstetrics and Gynecologic and Pediatric Diseases and Birth Defects of Ministry of Education, West China Second Hospital, Sichuan University, Chengdu, People's Republic of China
| | - Jin Hai Gou
- Department of Gynecology and Obstetrics, West China Second University Hospital, Sichuan University, Chengdu, People's Republic of China, .,The State Key Laboratory of Biotherapy, West China Hospital, Sichuan University, Chengdu, People's Republic of China,
| | - Zheng Yu Li
- Department of Gynecology and Obstetrics, West China Second University Hospital, Sichuan University, Chengdu, People's Republic of China, .,The State Key Laboratory of Biotherapy, West China Hospital, Sichuan University, Chengdu, People's Republic of China,
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27
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Arab M, Jamdar F, Sadat Hosseini M, Ghodssi- Ghasemabadi R, Farzaneh F, Ashrafganjoei T. Model for Prediction of Optimal Debulking of Epithelial Ovarian Cancer. Asian Pac J Cancer Prev 2018; 19:1319-1324. [PMID: 29802693 PMCID: PMC6031811 DOI: 10.22034/apjcp.2018.19.5.1319] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2017] [Accepted: 01/16/2018] [Indexed: 12/01/2022] Open
Abstract
Background: Primary cytoreduction surgery followed by chemotherapy is the cornerstone treatment for epithelial ovarian cancer (EOC). In patients with a low probability of optimal primary surgical debulking, neoadjuvant chemotherapy (NACT) followed by interval debulking increases the chance of optimal surgery. The aim of this study was to develop a model to identify preoperative predictors for suboptimal cytoreduction. Methods: Medical records of patients with EOC who underwent primary cytoreductive surgery in a referral tertiary gyneco-oncology center were reviewed from 2007 to 2017. Data were collected on a range of characteristics including demographic features, comorbidities, serum tumor markers, hematologic markers, preoperative imaging, surgical procedures, and pathologic reports. Univariate and multivariate analyses were performed to clarify the ability of preoperative factors to predict suboptimal primary surgery. Results: The majority of patients (71.3%) who underwent primary cytoreductive surgery were optimally debulked. Based on the Youden index, the best cut-off point for the serum CA125 level to distinguish suboptimal debulking was 420U/ml with 0.730 (95%CI:0.559 to 0.862) sensitivity and 0.783 (0.684 to 0.862) specificity. Multiple logistic regression results showed that serum CA125 level >420 U/ ml (p value <0.001), the presence of liver metastasis on preoperative imaging (p value: 0.041) and ascites (p value: 0.032) or massive ascites (p value:0.010) significantly increased the risk of suboptimal debulking (logit p = 2.36 CA125 level +1.85 Liverinvolvement +1.68 presence of Ascites+ 2.28 Massive Ascites). Conclusion:The present study suggests that a serum CA125 level >420 U/ml, the presence of ascites or massive ascites and liver metastasis are strong predictors of suboptimal primary surgery in cases of EOC. Based on the constructed model, with any of these 4 factors, the probability of suboptimal debulking in EOC is more than 80%.
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Affiliation(s)
- Maliheh Arab
- Cancer Research Center, ShahidBeheshti University of Medical Science, Tehran, Iran.
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28
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Zeff N. Role of laparoscopy in initial tumour staging in advanced epithelial ovarian cancer: A systematic review. Pleura Peritoneum 2018; 3:20180106. [PMID: 30911654 PMCID: PMC6405008 DOI: 10.1515/pp-2018-0106] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2018] [Accepted: 03/13/2018] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND The aim of this systematic review was to investigate the accuracy of additional staging laparoscopy (SL) in advanced epithelial ovarian cancer (AEOC) to predict futile laparotomy (FL). METHODS Systematic review according to preferred reporting items for systematic reviews and meta-analyses statement (PRISMA) criteria. Clinical studies investigating the role of SL in selecting women with AEOC for primary debulking surgery (PDS) were included. Index test: SL. Reference test: laparotomy. Target condition: incomplete cytoreduction (CR) with remaining disease<1 cm. RESULTS Nine prospective and retrospective studies reporting on eight cohorts totalizing 778 LS were included. Reference test was completed in 76 % cases. PPV for FL was between 0.69 and 1.0. In three studies examining the value of a predictive index value (PIV) for predicting FL, sensitivity of the index test (LS with PIV ≥8) was between 46% and 70 %, and specificity between 89 % and 100 %. The proportion of patients that received CR during PDS differed widely between studies (from 50 to 91). Using a PIV did not increase the sensitivity and might result in more patients receiving FL. In the only randomized trial, FL occurred in 10 (10 %) of 102 patients in the LS group versus 39 (39 %) of 99 patients in the primary PDS group (relative risk, 0.25; 95 % CI, 0.13-0.47; p<0.001). Port-site recurrences occurred in 2%-6 % patients. Overall costs of with or without SL were comparable. CONCLUSIONS The evidence available from this systematic review supports the inclusion of an additional LS to the conventional initial diagnostic workup in women with AEOC.
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Affiliation(s)
- Natalia Zeff
- Gynecology Oncology, Institute of Oncology “Angel H. Roffo”– CEMI, University of Buenos Aires, Buenos Aires, Argentina
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29
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Batista TP, Carneiro VCG, Tancredi R, Teles ALB, Badiglian-Filho L, Leão CS. Neoadjuvant chemotherapy followed by fast-track cytoreductive surgery plus short-course hyperthermic intraperitoneal chemotherapy (HIPEC) in advanced ovarian cancer: preliminary results of a promising all-in-one approach. Cancer Manag Res 2017; 9:869-878. [PMID: 29263704 PMCID: PMC5732565 DOI: 10.2147/cmar.s153327] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Purpose Hyperthermic intraperitoneal chemotherapy (HIPEC) has been considered a promising treatment option for advanced or recurrent ovarian cancer, but there is no clear evidence based on randomized controlled trials to advocate this approach as a standard therapy. In this study, we aim to present the early outcomes and insights after an interim analysis of a pioneering clinical trial in Brazil. Methods This study was a cross-sectional analysis of early data from our ongoing clinical trial – an open-label, double-center, single-arm trial on the safety and efficacy of using HIPEC for advanced ovarian cancer (ClinicalTrials.gov: NCT02249013). A fast-track recovery strategy was also applied to improve patient outcomes. Results Nine patients with stage IIIB (n=1) or IIIC (n=8) epithelial malignancies were enrolled until February 2017. The median (range) serum CA125 level at diagnosis was 692 (223.7–6550) U/mL. The median number of preoperative cycles of intravenous (i.v.) chemotherapy was 3 (2–4), resulting in peritoneal cancer index scores of 9 (3–18) at the time of HIPEC. Time of restarting i.v. chemotherapy was 37 (33–50) days with all patients completing 6 cycles as planned. The median operation time was 395 (235–760) minutes, the length of hospital stay was 4 (3–10) days, and all the patients left the ICU on the morning after the procedure. Two patients experienced no postoperative complications, whereas 91% of the complications were minor G1/G2 events. Preliminary assessment also suggested no impairment of the patient’s quality of life. Conclusion Our comprehensive protocol might represent a promising all-in-one approach for advanced ovarian cancer. The patient recruitment for this trial is ongoing.
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Affiliation(s)
- Thales Paulo Batista
- Department of Surgery/Oncology, IMIP - Instituto de Medicina Integral Professor Fernando Figueira.,Department of Surgery, UFPE - Universidade Federal de Pernambuco
| | - Vandré Cabral G Carneiro
- Department of Surgery/Oncology, IMIP - Instituto de Medicina Integral Professor Fernando Figueira.,Department of Gynecology, HCP - Hospital de Câncer de Pernambuco
| | - Rodrigo Tancredi
- Department of Clinical Oncology, IMIP - Instituto de Medicina Integral Professor Fernando Figueira.,Department of Clinical Oncology, HCP - Hospital de Câncer de Pernambuco
| | - Ana Ligia Bezerra Teles
- Department of Anaesthesiology, IMIP - Instituto de Medicina Integral Professor Fernando Figueira, Recife
| | | | - Cristiano Souza Leão
- Department of Surgery, IMIP - Instituto de Medicina Integral Professor Fernando Figueira, Recife, Brazil
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30
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Bagul K, Vijaykumar DK, Rajanbabu A, Antony MA, Ranganathan V. Advanced Primary Epithelial Ovarian and Peritoneal Carcinoma-Does Diagnostic Accuracy of Preoperative CT Scan for Detection of Peritoneal Metastatic Sites Reflect into Prediction of Suboptimal Debulking? A Prospective Study. Indian J Surg Oncol 2017; 8:98-104. [PMID: 28546700 DOI: 10.1007/s13193-016-0601-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2015] [Accepted: 12/01/2016] [Indexed: 11/29/2022] Open
Abstract
Ovarian cancer is the seventh most common cancer in females worldwide. Optimal debulking is the standard treatment but possible only in 30-85% of advanced stages. Knowing exactly the disease extent preoperatively may predict suboptimal debulking. We analyzed diagnostic accuracy of preoperative CT scan in disease mapping and prediction of suboptimal debulking in a prospective observational study from March 2013 to May 2015 in a tertiary hospital. Adults below the age of 75 years with ECOG PS-0, 1, 2, clinically/radiologically newly diagnosed stage IIIc epithelial ovarian (EOC), and primary peritoneal carcinoma (PPC) were included. Neoadjuvant chemotherapy recipients were excluded. Preoperative multidetector CT (MDCT) scan showing deposits at 19 predetermined abdominopelvic sites were compared with the same sites seen at laparotomy and corresponding accuracies of CT scan calculated. Primary debulking surgery was done to achieve debulking to nil or less than 1-cm residual disease. Stepwise logistic regression models were used to determine the frequent suboptimal debulking sites and the predictive performance of the clinical and CT scan findings. A total of 36 patients were enrolled. The optimal debulking rate was 50%. The CT scan could detect the disease-bearing sites with overall sensitivity of 68.29%, specificity of 89%, accuracy of 78.07%, and positive and negative predictive values of 99 and 50.1%, respectively. Upon multivariate analysis, bowel mesentery (p 0.011) and omental extension (p 0.025) were associated with suboptimal debulking. CT scan accuracy at these sites (predictive performance) was 86.1%. We identified small bowel mesentery and omental extension (to spleen/stomach/colon) as sites associated with suboptimal debulking. MDCT accurately depicts peritoneal metastases, although sensitivity is reduced in certain areas of significance for optimal debulking. Further validation with more number of patients is warranted.
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Affiliation(s)
- Kiran Bagul
- Department of Surgical Oncology, Amrita Institute of Medical Sciences, Ponekkara PO, Kochi, Kerala 682 041 India
| | - D K Vijaykumar
- Department of Surgical Oncology, Amrita Institute of Medical Sciences, Ponekkara PO, Kochi, Kerala 682 041 India
| | - Anupama Rajanbabu
- Department of Surgical Oncology, Amrita Institute of Medical Sciences, Ponekkara PO, Kochi, Kerala 682 041 India
| | - Mitchelle Aline Antony
- Department of Surgical Oncology, Amrita Institute of Medical Sciences, Ponekkara PO, Kochi, Kerala 682 041 India
| | - Venkatesan Ranganathan
- Department of Surgical Oncology, Amrita Institute of Medical Sciences, Ponekkara PO, Kochi, Kerala 682 041 India
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31
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Zeng J, Yin J, Song X, Jin Y, Li Y, Pan L. Reduction of CA125 Levels During Neoadjuvant Chemotherapy Can Predict Cytoreduction to No Visible Residual Disease in Patients with Advanced Epithelial Ovarian Cancer, Primary Carcinoma of Fallopian tube and Peritoneal Carcinoma. J Cancer 2016; 7:2327-2332. [PMID: 27994671 PMCID: PMC5166544 DOI: 10.7150/jca.16761] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2016] [Accepted: 09/30/2016] [Indexed: 02/06/2023] Open
Abstract
Background and aims. To determine whether reduction of CA125 levels is a predictive factor for cytoreduction to no visible residual disease (NVRD) and chemotherapeutic sensitivity in advanced epithelial ovarian carcinoma (EOC), primary carcinoma of fallopian tube and peritoneal carcinoma patients who received neoadjuvant chemotherapy followed by interval debulking surgery (NAC-IDS). Methods. This was a single-team-based study of advanced EOC, primary carcinoma of fallopian tube and peritoneal carcinoma patients diagnosed between 1996 and 2015 at Peking Union Medical College Hospital. Patients were treated with NAC-IDS by one gynecologic oncologist. Demographic data, CA125 levels, radiographic data, and chemotherapy and surgical-pathologic information were obtained. Univariate and multivariate analyses were performed to evaluate variables associated with optimal cytoreduction to NVRD and chemotherapy-sensitivity. Results. One hundred and eighteen patients met the study inclusion criteria. Thirty-seven (31.4%) patients underwent resection to NVRD. The median serum CA125 level at presentation and before IDS was 1814.5 U/ml and 205.9 U/ml, respectively. In the univariate analysis, histology, a preoperative CA125 of ≤200 U/ml and a >80% reduction of CA125 between presentation and IDS were significantly associated with the likelihood of NVRD (P=0.014, 0.000, 0.000, respectively). Multivariate analysis revealed that, of the various CA125 parameters tested, preoperative CA125 ≤200 U/ml was the only independent predictor of NVRD (odds ratio 3.667, 95% confidence interval 1.337-10.057; P=0.012). Preoperative CA125 ≤200 U/ml was also significantly associated with chemotherapy-sensitive disease in the univariate analysis (P=0.037). Conclusions. EOC patients who received NAC-IDS and had a preoperative CA125 level of ≤200 U/ml were highly likely to be cytoreduced to NVRD and to exhibit chemotherapeutic sensitivity.
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Affiliation(s)
- Jing Zeng
- Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Jie Yin
- Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Xiao Song
- Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Ying Jin
- Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Yan Li
- Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Lingya Pan
- Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
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Chern JY, Curtin JP. Appropriate Recommendations for Surgical Debulking in Stage IV Ovarian Cancer. Curr Treat Options Oncol 2016; 17:1. [PMID: 26714493 DOI: 10.1007/s11864-015-0380-2] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
OPINION STATEMENT Epithelial ovarian cancer continues to be the leading cause of death due to gynecologic malignancy, and it is the fifth leading cause of cancer death in women in the USA and seventh worldwide. In most women with ovarian cancer, the disease is diagnosed at an advanced stage and primary cytoreductive surgery is considered standard of care. Traditionally, the gynecologic oncology literature supports the dictum that aggressive radical debulking to reduce intra-abdominal tumor burden to minimal or less than 1 cm of disease has significant impact on overall survival. However, the European Organization for Research and Treatment of Cancer (EORTC) trial found that survival after neoadjuvant followed by interval debulking surgery was similar to survival with the standard approach of primary surgery followed by chemotherapy. Many gynecologic oncologists have now adopted neoadjuvant chemotherapy for the treatment of stage IV ovarian cancer given the complex nature of this disease. Currently, there are conflicting results in the literature with regards to neoadjuvant chemotherapy versus primary debulking for stage IV ovarian cancer. While there is evidence that neoadjuvant treatment is not inferior to primary debulking, the literature also supports that maximizing debulking efforts with radical surgery can provide a survival benefit in patients with stage IV ovarian carcinoma.
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Affiliation(s)
- Jing-Yi Chern
- Department of Obstetrics and Gynecology, NYU Langone Medical Center, NYU School of Medicine, 550 First Ave, NBV 9E2, New York, NY, 10016, USA.
| | - John P Curtin
- Department of Obstetrics and Gynecology, NYU Langone Medical Center, NYU School of Medicine, 550 First Ave, NBV 9E2, New York, NY, 10016, USA.
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Hacker NF, Rao A. Surgery for advanced epithelial ovarian cancer. Best Pract Res Clin Obstet Gynaecol 2016; 41:71-87. [PMID: 27884789 DOI: 10.1016/j.bpobgyn.2016.10.007] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2016] [Accepted: 10/12/2016] [Indexed: 10/20/2022]
Abstract
Cytoreductive surgery for patients with advanced epithelial ovarian cancer has been practised since the pioneering work of Tom Griffiths in 1975. Further research has demonstrated the prognostic significance of the extent of metastatic disease pre-operatively, and of complete cytoreduction post-operatively. Patients with advanced epithelial ovarian cancer should be referred to high volume cancer units, and managed by multidisciplinary teams. The role of thoracoscopy and resection of intrathoracic disease is presently investigational. In recent years, there has been increasing use of neoadjuvant chemotherapy and interval cytoreductive surgery in patients with poor performance status, which is usually due to large volume ascites and/or large pleural effusions. Neoadjuvant chemotherapy reduces the post-operative morbidity, but if the tumour responds well to the chemotherapy, the inflammatory response makes the surgery more difficult. Post-operative morbidity is generally tolerable, but increases in older patients, and in those having multiple, aggressive surgical procedures, such as bowel resection or diaphragmatic stripping. Primary cytoreductive surgery should be regarded as the gold standard for most patients until a test is developed which would allow the prediction of platinum resistance pre-operatively.
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Affiliation(s)
- Neville F Hacker
- Gynaecological Cancer Centre, Royal Hospital for Women, Randwick NSW 2031, Australia; School of Women's and Children's Health, University of New South Wales, Kensington NSW 2031, Australia.
| | - Archana Rao
- Gynaecological Cancer Centre, Royal Hospital for Women, Randwick NSW 2031, Australia.
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Wright AA, Bohlke K, Armstrong DK, Bookman MA, Cliby WA, Coleman RL, Dizon DS, Kash JJ, Meyer LA, Moore KN, Olawaiye AB, Oldham J, Salani R, Sparacio D, Tew WP, Vergote I, Edelson MI. Neoadjuvant chemotherapy for newly diagnosed, advanced ovarian cancer: Society of Gynecologic Oncology and American Society of Clinical Oncology Clinical Practice Guideline. Gynecol Oncol 2016; 143:3-15. [PMID: 27650684 PMCID: PMC5413203 DOI: 10.1016/j.ygyno.2016.05.022] [Citation(s) in RCA: 178] [Impact Index Per Article: 22.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2016] [Revised: 05/18/2016] [Accepted: 05/18/2016] [Indexed: 11/24/2022]
Abstract
PURPOSE To provide guidance to clinicians regarding the use of neoadjuvant chemotherapy and interval cytoreduction among women with stage IIIC or IV epithelial ovarian cancer. METHODS The Society of Gynecologic Oncology and the American Society of Clinical Oncology convened an Expert Panel and conducted a systematic review of the literature. RESULTS Four phase III clinical trials form the primary evidence base for the recommendations. The published studies suggest that for selected women with stage IIIC or IV epithelial ovarian cancer, neoadjuvant chemotherapy and interval cytoreduction are non-inferior to primary cytoreduction and adjuvant chemotherapy with respect to overall and progression-free survival and are associated with less perioperative morbidity and mortality. RECOMMENDATIONS All women with suspected stage IIIC or IV invasive epithelial ovarian cancer should be evaluated by a gynecologic oncologist prior to initiation of therapy. The primary clinical evaluation should include a CT of the abdomen and pelvis, and chest imaging (CT preferred). Women with a high perioperative risk profile or a low likelihood of achieving cytoreduction to <1cm of residual disease (ideally to no visible disease) should receive neoadjuvant chemotherapy. Women who are fit for primary cytoreductive surgery, and with potentially resectable disease, may receive either neoadjuvant chemotherapy or primary cytoreductive surgery. However, primary cytoreductive surgery is preferred if there is a high likelihood of achieving cytoreduction to <1cm (ideally to no visible disease) with acceptable morbidity. Before neoadjuvant chemotherapy is delivered, all patients should have confirmation of an invasive ovarian, fallopian tube, or peritoneal cancer. Additional information is available at www.asco.org/NACT-ovarian-guideline and www.asco.org/guidelineswiki.
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Affiliation(s)
- Alexi A Wright
- Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA, United States
| | - Kari Bohlke
- American Society of Clinical Oncology, Alexandria, VA, United States
| | - Deborah K Armstrong
- Johns Hopkins Sidney Kimmel Comprehensive Cancer Center, Baltimore, MD, United States
| | - Michael A Bookman
- US Oncology Research and Arizona Oncology, Tucson, AZ, United States
| | | | - Robert L Coleman
- University of Texas, M.D. Anderson Cancer Center, Houston, TX, United States
| | - Don S Dizon
- Massachusetts General Hospital Cancer Center, Harvard Medical School, Boston, MA, United States
| | | | - Larissa A Meyer
- The University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Kathleen N Moore
- Stephenson Oklahoma Cancer Center at the University of Oklahoma, Oklahoma City, OK, United States
| | | | - Jessica Oldham
- Society of Gynecologic Oncology, Chicago, IL, United States
| | - Ritu Salani
- The Ohio State University, Columbus, OH, United States
| | | | - William P Tew
- Memorial Sloan Kettering Cancer Center, New York, NY, United States
| | - Ignace Vergote
- Leuven Cancer Institute, Leuven, European Union, Belgium
| | - Mitchell I Edelson
- Hanjani Institute for Gynecologic Oncology, Abington Hospital, Jefferson Health, Abington, PA, United States.
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35
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Wright AA, Bohlke K, Armstrong DK, Bookman MA, Cliby WA, Coleman RL, Dizon DS, Kash JJ, Meyer LA, Moore KN, Olawaiye AB, Oldham J, Salani R, Sparacio D, Tew WP, Vergote I, Edelson MI. Neoadjuvant Chemotherapy for Newly Diagnosed, Advanced Ovarian Cancer: Society of Gynecologic Oncology and American Society of Clinical Oncology Clinical Practice Guideline. J Clin Oncol 2016; 34:3460-73. [PMID: 27502591 PMCID: PMC5512594 DOI: 10.1200/jco.2016.68.6907] [Citation(s) in RCA: 267] [Impact Index Per Article: 33.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE To provide guidance to clinicians regarding the use of neoadjuvant chemotherapy and interval cytoreduction among women with stage IIIC or IV epithelial ovarian cancer. METHODS The Society of Gynecologic Oncology and the American Society of Clinical Oncology convened an Expert Panel and conducted a systematic review of the literature. RESULTS Four phase III clinical trials form the primary evidence base for the recommendations. The published studies suggest that for selected women with stage IIIC or IV epithelial ovarian cancer, neoadjuvant chemotherapy and interval cytoreduction are noninferior to primary cytoreduction and adjuvant chemotherapy with respect to overall and progression-free survival and are associated with less perioperative morbidity and mortality. RECOMMENDATIONS All women with suspected stage IIIC or IV invasive epithelial ovarian cancer should be evaluated by a gynecologic oncologist prior to initiation of therapy. The primary clinical evaluation should include a CT of the abdomen and pelvis, and chest imaging (CT preferred). Women with a high perioperative risk profile or a low likelihood of achieving cytoreduction to < 1 cm of residual disease (ideally to no visible disease) should receive neoadjuvant chemotherapy. Women who are fit for primary cytoreductive surgery, and with potentially resectable disease, may receive either neoadjuvant chemotherapy or primary cytoreductive surgery. However, primary cytoreductive surgery is preferred if there is a high likelihood of achieving cytoreduction to < 1 cm (ideally to no visible disease) with acceptable morbidity. Before neoadjuvant chemotherapy is delivered, all patients should have confirmation of an invasive ovarian, fallopian tube, or peritoneal cancer. Additional information is available at www.asco.org/NACT-ovarian-guideline and www.asco.org/guidelineswiki.
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Affiliation(s)
- Alexi A Wright
- Alexi A. Wright, Dana-Farber Cancer Institute, Harvard Medical School; Don S. Dizon, Massachusetts General Hospital Cancer Center, Harvard Medical School, Boston, MA; Kari Bohlke, American Society of Clinical Oncology, Alexandria, VA; Deborah K. Armstrong, Johns Hopkins Sidney Kimmel Comprehensive Cancer Center, Baltimore, MD; Michael A. Bookman, US Oncology Research and Arizona Oncology, Tucson, AZ; William A. Cliby, Mayo Clinic, Rochester, MN; Robert L. Coleman and Larissa A. Meyer, The University of Texas MD Anderson Cancer Center, Houston, TX; Joseph J. Kash, Edward Cancer Center, Naperville; Jessica Oldham, Society of Gynecologic Oncology, Chicago, IL; Kathleen N. Moore, Stephenson Oklahoma Cancer Center at the University of Oklahoma, Oklahoma City, OK; Alexander B. Olawaiye, University of Pittsburgh Medical Center, Pittsburgh; Mitchell I. Edelson, Hanjani Institute for Gynecologic Oncology, Abington Hospital, Jefferson Health, Abington, PA; Ritu Salani, The Ohio State University, Columbus, OH; Dee Sparacio, Hightstown, New Jersey; William P. Tew, Memorial Sloan-Kettering Cancer Center, New York, NY; and Ignace Vergote, Leuven Cancer Institute, Leuven, Belgium
| | - Kari Bohlke
- Alexi A. Wright, Dana-Farber Cancer Institute, Harvard Medical School; Don S. Dizon, Massachusetts General Hospital Cancer Center, Harvard Medical School, Boston, MA; Kari Bohlke, American Society of Clinical Oncology, Alexandria, VA; Deborah K. Armstrong, Johns Hopkins Sidney Kimmel Comprehensive Cancer Center, Baltimore, MD; Michael A. Bookman, US Oncology Research and Arizona Oncology, Tucson, AZ; William A. Cliby, Mayo Clinic, Rochester, MN; Robert L. Coleman and Larissa A. Meyer, The University of Texas MD Anderson Cancer Center, Houston, TX; Joseph J. Kash, Edward Cancer Center, Naperville; Jessica Oldham, Society of Gynecologic Oncology, Chicago, IL; Kathleen N. Moore, Stephenson Oklahoma Cancer Center at the University of Oklahoma, Oklahoma City, OK; Alexander B. Olawaiye, University of Pittsburgh Medical Center, Pittsburgh; Mitchell I. Edelson, Hanjani Institute for Gynecologic Oncology, Abington Hospital, Jefferson Health, Abington, PA; Ritu Salani, The Ohio State University, Columbus, OH; Dee Sparacio, Hightstown, New Jersey; William P. Tew, Memorial Sloan-Kettering Cancer Center, New York, NY; and Ignace Vergote, Leuven Cancer Institute, Leuven, Belgium
| | - Deborah K Armstrong
- Alexi A. Wright, Dana-Farber Cancer Institute, Harvard Medical School; Don S. Dizon, Massachusetts General Hospital Cancer Center, Harvard Medical School, Boston, MA; Kari Bohlke, American Society of Clinical Oncology, Alexandria, VA; Deborah K. Armstrong, Johns Hopkins Sidney Kimmel Comprehensive Cancer Center, Baltimore, MD; Michael A. Bookman, US Oncology Research and Arizona Oncology, Tucson, AZ; William A. Cliby, Mayo Clinic, Rochester, MN; Robert L. Coleman and Larissa A. Meyer, The University of Texas MD Anderson Cancer Center, Houston, TX; Joseph J. Kash, Edward Cancer Center, Naperville; Jessica Oldham, Society of Gynecologic Oncology, Chicago, IL; Kathleen N. Moore, Stephenson Oklahoma Cancer Center at the University of Oklahoma, Oklahoma City, OK; Alexander B. Olawaiye, University of Pittsburgh Medical Center, Pittsburgh; Mitchell I. Edelson, Hanjani Institute for Gynecologic Oncology, Abington Hospital, Jefferson Health, Abington, PA; Ritu Salani, The Ohio State University, Columbus, OH; Dee Sparacio, Hightstown, New Jersey; William P. Tew, Memorial Sloan-Kettering Cancer Center, New York, NY; and Ignace Vergote, Leuven Cancer Institute, Leuven, Belgium
| | - Michael A Bookman
- Alexi A. Wright, Dana-Farber Cancer Institute, Harvard Medical School; Don S. Dizon, Massachusetts General Hospital Cancer Center, Harvard Medical School, Boston, MA; Kari Bohlke, American Society of Clinical Oncology, Alexandria, VA; Deborah K. Armstrong, Johns Hopkins Sidney Kimmel Comprehensive Cancer Center, Baltimore, MD; Michael A. Bookman, US Oncology Research and Arizona Oncology, Tucson, AZ; William A. Cliby, Mayo Clinic, Rochester, MN; Robert L. Coleman and Larissa A. Meyer, The University of Texas MD Anderson Cancer Center, Houston, TX; Joseph J. Kash, Edward Cancer Center, Naperville; Jessica Oldham, Society of Gynecologic Oncology, Chicago, IL; Kathleen N. Moore, Stephenson Oklahoma Cancer Center at the University of Oklahoma, Oklahoma City, OK; Alexander B. Olawaiye, University of Pittsburgh Medical Center, Pittsburgh; Mitchell I. Edelson, Hanjani Institute for Gynecologic Oncology, Abington Hospital, Jefferson Health, Abington, PA; Ritu Salani, The Ohio State University, Columbus, OH; Dee Sparacio, Hightstown, New Jersey; William P. Tew, Memorial Sloan-Kettering Cancer Center, New York, NY; and Ignace Vergote, Leuven Cancer Institute, Leuven, Belgium
| | - William A Cliby
- Alexi A. Wright, Dana-Farber Cancer Institute, Harvard Medical School; Don S. Dizon, Massachusetts General Hospital Cancer Center, Harvard Medical School, Boston, MA; Kari Bohlke, American Society of Clinical Oncology, Alexandria, VA; Deborah K. Armstrong, Johns Hopkins Sidney Kimmel Comprehensive Cancer Center, Baltimore, MD; Michael A. Bookman, US Oncology Research and Arizona Oncology, Tucson, AZ; William A. Cliby, Mayo Clinic, Rochester, MN; Robert L. Coleman and Larissa A. Meyer, The University of Texas MD Anderson Cancer Center, Houston, TX; Joseph J. Kash, Edward Cancer Center, Naperville; Jessica Oldham, Society of Gynecologic Oncology, Chicago, IL; Kathleen N. Moore, Stephenson Oklahoma Cancer Center at the University of Oklahoma, Oklahoma City, OK; Alexander B. Olawaiye, University of Pittsburgh Medical Center, Pittsburgh; Mitchell I. Edelson, Hanjani Institute for Gynecologic Oncology, Abington Hospital, Jefferson Health, Abington, PA; Ritu Salani, The Ohio State University, Columbus, OH; Dee Sparacio, Hightstown, New Jersey; William P. Tew, Memorial Sloan-Kettering Cancer Center, New York, NY; and Ignace Vergote, Leuven Cancer Institute, Leuven, Belgium
| | - Robert L Coleman
- Alexi A. Wright, Dana-Farber Cancer Institute, Harvard Medical School; Don S. Dizon, Massachusetts General Hospital Cancer Center, Harvard Medical School, Boston, MA; Kari Bohlke, American Society of Clinical Oncology, Alexandria, VA; Deborah K. Armstrong, Johns Hopkins Sidney Kimmel Comprehensive Cancer Center, Baltimore, MD; Michael A. Bookman, US Oncology Research and Arizona Oncology, Tucson, AZ; William A. Cliby, Mayo Clinic, Rochester, MN; Robert L. Coleman and Larissa A. Meyer, The University of Texas MD Anderson Cancer Center, Houston, TX; Joseph J. Kash, Edward Cancer Center, Naperville; Jessica Oldham, Society of Gynecologic Oncology, Chicago, IL; Kathleen N. Moore, Stephenson Oklahoma Cancer Center at the University of Oklahoma, Oklahoma City, OK; Alexander B. Olawaiye, University of Pittsburgh Medical Center, Pittsburgh; Mitchell I. Edelson, Hanjani Institute for Gynecologic Oncology, Abington Hospital, Jefferson Health, Abington, PA; Ritu Salani, The Ohio State University, Columbus, OH; Dee Sparacio, Hightstown, New Jersey; William P. Tew, Memorial Sloan-Kettering Cancer Center, New York, NY; and Ignace Vergote, Leuven Cancer Institute, Leuven, Belgium
| | - Don S Dizon
- Alexi A. Wright, Dana-Farber Cancer Institute, Harvard Medical School; Don S. Dizon, Massachusetts General Hospital Cancer Center, Harvard Medical School, Boston, MA; Kari Bohlke, American Society of Clinical Oncology, Alexandria, VA; Deborah K. Armstrong, Johns Hopkins Sidney Kimmel Comprehensive Cancer Center, Baltimore, MD; Michael A. Bookman, US Oncology Research and Arizona Oncology, Tucson, AZ; William A. Cliby, Mayo Clinic, Rochester, MN; Robert L. Coleman and Larissa A. Meyer, The University of Texas MD Anderson Cancer Center, Houston, TX; Joseph J. Kash, Edward Cancer Center, Naperville; Jessica Oldham, Society of Gynecologic Oncology, Chicago, IL; Kathleen N. Moore, Stephenson Oklahoma Cancer Center at the University of Oklahoma, Oklahoma City, OK; Alexander B. Olawaiye, University of Pittsburgh Medical Center, Pittsburgh; Mitchell I. Edelson, Hanjani Institute for Gynecologic Oncology, Abington Hospital, Jefferson Health, Abington, PA; Ritu Salani, The Ohio State University, Columbus, OH; Dee Sparacio, Hightstown, New Jersey; William P. Tew, Memorial Sloan-Kettering Cancer Center, New York, NY; and Ignace Vergote, Leuven Cancer Institute, Leuven, Belgium
| | - Joseph J Kash
- Alexi A. Wright, Dana-Farber Cancer Institute, Harvard Medical School; Don S. Dizon, Massachusetts General Hospital Cancer Center, Harvard Medical School, Boston, MA; Kari Bohlke, American Society of Clinical Oncology, Alexandria, VA; Deborah K. Armstrong, Johns Hopkins Sidney Kimmel Comprehensive Cancer Center, Baltimore, MD; Michael A. Bookman, US Oncology Research and Arizona Oncology, Tucson, AZ; William A. Cliby, Mayo Clinic, Rochester, MN; Robert L. Coleman and Larissa A. Meyer, The University of Texas MD Anderson Cancer Center, Houston, TX; Joseph J. Kash, Edward Cancer Center, Naperville; Jessica Oldham, Society of Gynecologic Oncology, Chicago, IL; Kathleen N. Moore, Stephenson Oklahoma Cancer Center at the University of Oklahoma, Oklahoma City, OK; Alexander B. Olawaiye, University of Pittsburgh Medical Center, Pittsburgh; Mitchell I. Edelson, Hanjani Institute for Gynecologic Oncology, Abington Hospital, Jefferson Health, Abington, PA; Ritu Salani, The Ohio State University, Columbus, OH; Dee Sparacio, Hightstown, New Jersey; William P. Tew, Memorial Sloan-Kettering Cancer Center, New York, NY; and Ignace Vergote, Leuven Cancer Institute, Leuven, Belgium
| | - Larissa A Meyer
- Alexi A. Wright, Dana-Farber Cancer Institute, Harvard Medical School; Don S. Dizon, Massachusetts General Hospital Cancer Center, Harvard Medical School, Boston, MA; Kari Bohlke, American Society of Clinical Oncology, Alexandria, VA; Deborah K. Armstrong, Johns Hopkins Sidney Kimmel Comprehensive Cancer Center, Baltimore, MD; Michael A. Bookman, US Oncology Research and Arizona Oncology, Tucson, AZ; William A. Cliby, Mayo Clinic, Rochester, MN; Robert L. Coleman and Larissa A. Meyer, The University of Texas MD Anderson Cancer Center, Houston, TX; Joseph J. Kash, Edward Cancer Center, Naperville; Jessica Oldham, Society of Gynecologic Oncology, Chicago, IL; Kathleen N. Moore, Stephenson Oklahoma Cancer Center at the University of Oklahoma, Oklahoma City, OK; Alexander B. Olawaiye, University of Pittsburgh Medical Center, Pittsburgh; Mitchell I. Edelson, Hanjani Institute for Gynecologic Oncology, Abington Hospital, Jefferson Health, Abington, PA; Ritu Salani, The Ohio State University, Columbus, OH; Dee Sparacio, Hightstown, New Jersey; William P. Tew, Memorial Sloan-Kettering Cancer Center, New York, NY; and Ignace Vergote, Leuven Cancer Institute, Leuven, Belgium
| | - Kathleen N Moore
- Alexi A. Wright, Dana-Farber Cancer Institute, Harvard Medical School; Don S. Dizon, Massachusetts General Hospital Cancer Center, Harvard Medical School, Boston, MA; Kari Bohlke, American Society of Clinical Oncology, Alexandria, VA; Deborah K. Armstrong, Johns Hopkins Sidney Kimmel Comprehensive Cancer Center, Baltimore, MD; Michael A. Bookman, US Oncology Research and Arizona Oncology, Tucson, AZ; William A. Cliby, Mayo Clinic, Rochester, MN; Robert L. Coleman and Larissa A. Meyer, The University of Texas MD Anderson Cancer Center, Houston, TX; Joseph J. Kash, Edward Cancer Center, Naperville; Jessica Oldham, Society of Gynecologic Oncology, Chicago, IL; Kathleen N. Moore, Stephenson Oklahoma Cancer Center at the University of Oklahoma, Oklahoma City, OK; Alexander B. Olawaiye, University of Pittsburgh Medical Center, Pittsburgh; Mitchell I. Edelson, Hanjani Institute for Gynecologic Oncology, Abington Hospital, Jefferson Health, Abington, PA; Ritu Salani, The Ohio State University, Columbus, OH; Dee Sparacio, Hightstown, New Jersey; William P. Tew, Memorial Sloan-Kettering Cancer Center, New York, NY; and Ignace Vergote, Leuven Cancer Institute, Leuven, Belgium
| | - Alexander B Olawaiye
- Alexi A. Wright, Dana-Farber Cancer Institute, Harvard Medical School; Don S. Dizon, Massachusetts General Hospital Cancer Center, Harvard Medical School, Boston, MA; Kari Bohlke, American Society of Clinical Oncology, Alexandria, VA; Deborah K. Armstrong, Johns Hopkins Sidney Kimmel Comprehensive Cancer Center, Baltimore, MD; Michael A. Bookman, US Oncology Research and Arizona Oncology, Tucson, AZ; William A. Cliby, Mayo Clinic, Rochester, MN; Robert L. Coleman and Larissa A. Meyer, The University of Texas MD Anderson Cancer Center, Houston, TX; Joseph J. Kash, Edward Cancer Center, Naperville; Jessica Oldham, Society of Gynecologic Oncology, Chicago, IL; Kathleen N. Moore, Stephenson Oklahoma Cancer Center at the University of Oklahoma, Oklahoma City, OK; Alexander B. Olawaiye, University of Pittsburgh Medical Center, Pittsburgh; Mitchell I. Edelson, Hanjani Institute for Gynecologic Oncology, Abington Hospital, Jefferson Health, Abington, PA; Ritu Salani, The Ohio State University, Columbus, OH; Dee Sparacio, Hightstown, New Jersey; William P. Tew, Memorial Sloan-Kettering Cancer Center, New York, NY; and Ignace Vergote, Leuven Cancer Institute, Leuven, Belgium
| | - Jessica Oldham
- Alexi A. Wright, Dana-Farber Cancer Institute, Harvard Medical School; Don S. Dizon, Massachusetts General Hospital Cancer Center, Harvard Medical School, Boston, MA; Kari Bohlke, American Society of Clinical Oncology, Alexandria, VA; Deborah K. Armstrong, Johns Hopkins Sidney Kimmel Comprehensive Cancer Center, Baltimore, MD; Michael A. Bookman, US Oncology Research and Arizona Oncology, Tucson, AZ; William A. Cliby, Mayo Clinic, Rochester, MN; Robert L. Coleman and Larissa A. Meyer, The University of Texas MD Anderson Cancer Center, Houston, TX; Joseph J. Kash, Edward Cancer Center, Naperville; Jessica Oldham, Society of Gynecologic Oncology, Chicago, IL; Kathleen N. Moore, Stephenson Oklahoma Cancer Center at the University of Oklahoma, Oklahoma City, OK; Alexander B. Olawaiye, University of Pittsburgh Medical Center, Pittsburgh; Mitchell I. Edelson, Hanjani Institute for Gynecologic Oncology, Abington Hospital, Jefferson Health, Abington, PA; Ritu Salani, The Ohio State University, Columbus, OH; Dee Sparacio, Hightstown, New Jersey; William P. Tew, Memorial Sloan-Kettering Cancer Center, New York, NY; and Ignace Vergote, Leuven Cancer Institute, Leuven, Belgium
| | - Ritu Salani
- Alexi A. Wright, Dana-Farber Cancer Institute, Harvard Medical School; Don S. Dizon, Massachusetts General Hospital Cancer Center, Harvard Medical School, Boston, MA; Kari Bohlke, American Society of Clinical Oncology, Alexandria, VA; Deborah K. Armstrong, Johns Hopkins Sidney Kimmel Comprehensive Cancer Center, Baltimore, MD; Michael A. Bookman, US Oncology Research and Arizona Oncology, Tucson, AZ; William A. Cliby, Mayo Clinic, Rochester, MN; Robert L. Coleman and Larissa A. Meyer, The University of Texas MD Anderson Cancer Center, Houston, TX; Joseph J. Kash, Edward Cancer Center, Naperville; Jessica Oldham, Society of Gynecologic Oncology, Chicago, IL; Kathleen N. Moore, Stephenson Oklahoma Cancer Center at the University of Oklahoma, Oklahoma City, OK; Alexander B. Olawaiye, University of Pittsburgh Medical Center, Pittsburgh; Mitchell I. Edelson, Hanjani Institute for Gynecologic Oncology, Abington Hospital, Jefferson Health, Abington, PA; Ritu Salani, The Ohio State University, Columbus, OH; Dee Sparacio, Hightstown, New Jersey; William P. Tew, Memorial Sloan-Kettering Cancer Center, New York, NY; and Ignace Vergote, Leuven Cancer Institute, Leuven, Belgium
| | - Dee Sparacio
- Alexi A. Wright, Dana-Farber Cancer Institute, Harvard Medical School; Don S. Dizon, Massachusetts General Hospital Cancer Center, Harvard Medical School, Boston, MA; Kari Bohlke, American Society of Clinical Oncology, Alexandria, VA; Deborah K. Armstrong, Johns Hopkins Sidney Kimmel Comprehensive Cancer Center, Baltimore, MD; Michael A. Bookman, US Oncology Research and Arizona Oncology, Tucson, AZ; William A. Cliby, Mayo Clinic, Rochester, MN; Robert L. Coleman and Larissa A. Meyer, The University of Texas MD Anderson Cancer Center, Houston, TX; Joseph J. Kash, Edward Cancer Center, Naperville; Jessica Oldham, Society of Gynecologic Oncology, Chicago, IL; Kathleen N. Moore, Stephenson Oklahoma Cancer Center at the University of Oklahoma, Oklahoma City, OK; Alexander B. Olawaiye, University of Pittsburgh Medical Center, Pittsburgh; Mitchell I. Edelson, Hanjani Institute for Gynecologic Oncology, Abington Hospital, Jefferson Health, Abington, PA; Ritu Salani, The Ohio State University, Columbus, OH; Dee Sparacio, Hightstown, New Jersey; William P. Tew, Memorial Sloan-Kettering Cancer Center, New York, NY; and Ignace Vergote, Leuven Cancer Institute, Leuven, Belgium
| | - William P Tew
- Alexi A. Wright, Dana-Farber Cancer Institute, Harvard Medical School; Don S. Dizon, Massachusetts General Hospital Cancer Center, Harvard Medical School, Boston, MA; Kari Bohlke, American Society of Clinical Oncology, Alexandria, VA; Deborah K. Armstrong, Johns Hopkins Sidney Kimmel Comprehensive Cancer Center, Baltimore, MD; Michael A. Bookman, US Oncology Research and Arizona Oncology, Tucson, AZ; William A. Cliby, Mayo Clinic, Rochester, MN; Robert L. Coleman and Larissa A. Meyer, The University of Texas MD Anderson Cancer Center, Houston, TX; Joseph J. Kash, Edward Cancer Center, Naperville; Jessica Oldham, Society of Gynecologic Oncology, Chicago, IL; Kathleen N. Moore, Stephenson Oklahoma Cancer Center at the University of Oklahoma, Oklahoma City, OK; Alexander B. Olawaiye, University of Pittsburgh Medical Center, Pittsburgh; Mitchell I. Edelson, Hanjani Institute for Gynecologic Oncology, Abington Hospital, Jefferson Health, Abington, PA; Ritu Salani, The Ohio State University, Columbus, OH; Dee Sparacio, Hightstown, New Jersey; William P. Tew, Memorial Sloan-Kettering Cancer Center, New York, NY; and Ignace Vergote, Leuven Cancer Institute, Leuven, Belgium
| | - Ignace Vergote
- Alexi A. Wright, Dana-Farber Cancer Institute, Harvard Medical School; Don S. Dizon, Massachusetts General Hospital Cancer Center, Harvard Medical School, Boston, MA; Kari Bohlke, American Society of Clinical Oncology, Alexandria, VA; Deborah K. Armstrong, Johns Hopkins Sidney Kimmel Comprehensive Cancer Center, Baltimore, MD; Michael A. Bookman, US Oncology Research and Arizona Oncology, Tucson, AZ; William A. Cliby, Mayo Clinic, Rochester, MN; Robert L. Coleman and Larissa A. Meyer, The University of Texas MD Anderson Cancer Center, Houston, TX; Joseph J. Kash, Edward Cancer Center, Naperville; Jessica Oldham, Society of Gynecologic Oncology, Chicago, IL; Kathleen N. Moore, Stephenson Oklahoma Cancer Center at the University of Oklahoma, Oklahoma City, OK; Alexander B. Olawaiye, University of Pittsburgh Medical Center, Pittsburgh; Mitchell I. Edelson, Hanjani Institute for Gynecologic Oncology, Abington Hospital, Jefferson Health, Abington, PA; Ritu Salani, The Ohio State University, Columbus, OH; Dee Sparacio, Hightstown, New Jersey; William P. Tew, Memorial Sloan-Kettering Cancer Center, New York, NY; and Ignace Vergote, Leuven Cancer Institute, Leuven, Belgium
| | - Mitchell I Edelson
- Alexi A. Wright, Dana-Farber Cancer Institute, Harvard Medical School; Don S. Dizon, Massachusetts General Hospital Cancer Center, Harvard Medical School, Boston, MA; Kari Bohlke, American Society of Clinical Oncology, Alexandria, VA; Deborah K. Armstrong, Johns Hopkins Sidney Kimmel Comprehensive Cancer Center, Baltimore, MD; Michael A. Bookman, US Oncology Research and Arizona Oncology, Tucson, AZ; William A. Cliby, Mayo Clinic, Rochester, MN; Robert L. Coleman and Larissa A. Meyer, The University of Texas MD Anderson Cancer Center, Houston, TX; Joseph J. Kash, Edward Cancer Center, Naperville; Jessica Oldham, Society of Gynecologic Oncology, Chicago, IL; Kathleen N. Moore, Stephenson Oklahoma Cancer Center at the University of Oklahoma, Oklahoma City, OK; Alexander B. Olawaiye, University of Pittsburgh Medical Center, Pittsburgh; Mitchell I. Edelson, Hanjani Institute for Gynecologic Oncology, Abington Hospital, Jefferson Health, Abington, PA; Ritu Salani, The Ohio State University, Columbus, OH; Dee Sparacio, Hightstown, New Jersey; William P. Tew, Memorial Sloan-Kettering Cancer Center, New York, NY; and Ignace Vergote, Leuven Cancer Institute, Leuven, Belgium.
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Serum CA125 and HE4 levels as predictors for optimal interval surgery and platinum sensitivity after neoadjuvant platinum-based chemotherapy in patients with advanced epithelial ovarian cancer. J Ovarian Res 2016; 9:61. [PMID: 27677313 PMCID: PMC5039904 DOI: 10.1186/s13048-016-0270-7] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2016] [Accepted: 09/19/2016] [Indexed: 01/30/2023] Open
Abstract
BACKGROUND The aim of this study is to evaluate a new tumour marker, HE4, and to compare it with CA125 in predicting optimal cytoreduction and response to chemotherapy. Thirty patients with advanced epithelial ovarian cancer and multiple sera harvested during neoadjuvant chemotherapy (NAC) were included. RESULTS Based on ROC curves analysis, CA125 ≤ 75 UI/ml and HE4 ≤ 252 pmol/L after the 3rd cycles of NAC, with a sensitivity of 93.7 % and a specificity of 92.3 % (PPV = 93.7 % and NPV = 92.3 %), offered the best combination for predicting optimal cytoreduction. In addition, the HE4 value of 115 pmol/L is the best cut-off level for identifying platinum-sensitive patients. CONCLUSIONS The introduction of HE4 as a new tool for predicting platinum-sensitivity and interval optimal cytoreduction is promising.
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Serum HE4 superior to CA125 in predicting poorer surgical outcome of epithelial ovarian cancer. Tumour Biol 2016; 37:14765-14772. [PMID: 27629144 DOI: 10.1007/s13277-016-5335-0] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2016] [Accepted: 09/06/2016] [Indexed: 01/10/2023] Open
Abstract
Epithelial ovarian cancer (EOC) remains the deadliest form of gynecological cancers. Optimal tumor debulking, no matter the primary or the interval, is the most important prognostic factor for EOC, so there is an urgent demand for biomarkers to predict surgical outcome. The aim of this study was to investigate whether serum human epididymis protein 4 (HE4) and cancer antigen 125 (CA125) could predict surgical outcome of EOC. The levels of preoperative serum HE4 and CA125 were determined by electrochemiluminescence (ECLIA) in 82 EOC patients, comprising 39 subjected to primary debulking surgery (PDS) and 43 with extensive stage III or IV disease to neoadjuvant chemotherapy followed by interval debulking surgery (NACT-IDS). Among 39 patients subjected to primary debulking surgery, HE4 was superior to CA125 in predicting surgical outcome (area under curve [AUC] 0.758 vs. 0.633). At a cutoff of 353.22 pmol/L, HE4 reached 77.4 % in sensitivity and 75 % in specificity. The prediction of surgical outcome of interval debulking surgery based on preoperative HE4 and CA125 values was performed in 43 patients who received NACT-IDS. The difference of AUC between HE4 and CA125 (0.793 vs. 0.663) indicating that HE4 was the better biomarker to predict surgical outcome of IDS. A pre-IDS HE4 value of 154.3 pmol/L is the optimal cutoff to identify patients who would not benefit from IDS with a sensitivity of 92.9 % and a specificity of 69 %. The change (>70 %) of HE4 before and after neoadjuvant chemotherapy could predict optimal interval debulking surgery. Serum HE4 was superior to CA125 in predicting surgical outcome of primary debulking surgery and interval debulking surgery. The change (absolute value or percentage) of HE4 in neoadjuvant chemotherapy could predict the outcome of interval debulking surgery.
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Eo W, Kim HB, Lee YJ, Suh DS, Kim KH, Kim H. Preoperative Lymphocyte-Monocyte Ratio Is a Predictor of Suboptimal Cytoreduction in Stage III-IV Epithelial Ovarian Cancer. J Cancer 2016; 7:1772-1779. [PMID: 27698915 PMCID: PMC5039359 DOI: 10.7150/jca.15724] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2016] [Accepted: 06/29/2016] [Indexed: 12/29/2022] Open
Abstract
Objective: To determine whether the preoperative lymphocyte-monocyte ratio (LMR) is a predictor of suboptimal cytoreduction in advanced-stage epithelial ovarian cancer (EOC). Methods: Preoperative clinico-pathologic and hematologic parameters were reviewed in a total of 154 patients with EOC submitted to primary cytoreductive surgery. Patients were categorized into two different groups according to the results of cytoreductive surgery: optimal and suboptimal cytoreduction. Continuous variables were categorized into two groups using the best cutoff points selected on the receiver operating characteristic (ROC) curve for suboptimal cytoreduction. Results: Based on data collected from the 154 patients, 133 (86.4%) and 21 (13.6%) patients presented with stage III and IV disease, respectively. One hundred seventeen (76.0%) patients had serous adenocarcinoma, and 92 (59.7%) had histologic tumor grade 3. The optimal and suboptimal cytoreduction groups included 96 (62.3%) and 58 patients (37.7%), respectively. The best LMR cutoff point for suboptimal cytoreduction was 3.75. On multivariate logistic regression analysis, age, cancer antigen 125, white blood cell count, and LMR were found to be the strongest predictors for suboptimal cytoreduction (P=0.0037, 0.0249, 0.0062, and 0.0015, respectively). Conclusion: Preoperative LMR is an independent predictor of suboptimal cytoreduction. It provides additional prognostic information beyond the biological parameters of the tumor.
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Affiliation(s)
- Wankyu Eo
- Department of Internal Medicine, College of Medicine, Kyung Hee University, Seoul, Korea
| | - Hong-Bae Kim
- Department of Obstetrics and Gynecology, Kangnam Sacred Heart Hospital, Hallym University Medical Center, Hallym University College of Medicine, Seoul, Korea
| | - Yong Joo Lee
- Department of Medicine, Pusan National University Graduate School
| | - Dong Soo Suh
- Department of Obstetrics and Gynecology, Pusan National University School of Medicine; Biomedical Research Institute, Pusan National University Hospital, Busan, Korea
| | - Ki Hyung Kim
- Department of Obstetrics and Gynecology, Pusan National University School of Medicine; Biomedical Research Institute, Pusan National University Hospital, Busan, Korea
| | - Heungyeol Kim
- Department of Obstetrics and Gynecology, College of Medicine, Kosin University, Busan, Korea
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Ramirez PT. Upping the ante in assessing the feasibility of surgical cytoreduction for advanced ovarian cancer: A modified laparoscopic Predictive Index score. Gynecol Oncol 2015; 139:1-2. [DOI: 10.1016/j.ygyno.2015.09.014] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2015] [Accepted: 09/14/2015] [Indexed: 10/22/2022]
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Differences in regional diagnostic strategies and in intended versus actual first-line treatment of patients with advanced ovarian cancer in Denmark. Int J Gynecol Cancer 2015; 24:1195-205. [PMID: 25101855 DOI: 10.1097/igc.0000000000000200] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Triage of patients with ovarian cancer to primary debulking surgery (PDS) or neoadjuvant chemotherapy (NACT) is challenging. In Denmark, the use of NACT has increased, but substantial differences in the use of NACT or PDS exist among centers. We aimed to characterize the differences between intended and actual first-line treatments in addition to the differences in the triage process among the centers and to evaluate the different diagnostic modalities and the clinical aspects' influence in the triage process. MATERIALS AND METHODS From 4 centers, forms containing data about the diagnostic process and intended treatment were prospectively collected and merged with data from the Danish Gynecological Cancer Database and medical records. RESULTS Of the 671 completed forms, 540 patients had stage IIIC or IV epithelial ovarian cancer. Of the 238 (44%) referred to PDS, 91% received PDS and 4% never had debulking surgery. Of the 288 patients (53%) referred to NACT, 44% were never debulked. Fourteen patients (3%) were referred to palliative treatment. The use of different imaging modalities, diagnostic laparoscopy, and laparotomy varied significantly among the centers. Diagnostic surgical procedures were considered to be most influential in the triage process. Regardless of the intended first-line treatment or center, the tumor size and dissemination was the most influential clinical aspect. CONCLUSIONS In Denmark, substantial differences exist between intended and actual first-line treatments as well as in the diagnostic process and use of NACT, calling for further discussion on diagnostic strategy and therapeutically approach for patients with advanced ovarian cancer.
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Gómez-Hidalgo NR, Martinez-Cannon BA, Nick AM, Lu KH, Sood AK, Coleman RL, Ramirez PT. Predictors of optimal cytoreduction in patients with newly diagnosed advanced-stage epithelial ovarian cancer: Time to incorporate laparoscopic assessment into the standard of care. Gynecol Oncol 2015; 137:553-8. [PMID: 25827290 DOI: 10.1016/j.ygyno.2015.03.049] [Citation(s) in RCA: 59] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2015] [Accepted: 03/20/2015] [Indexed: 11/25/2022]
Abstract
The standard management of advanced-stage ovarian cancer has been a subject of debate, and much controversy remains as to whether patients should have primary cytoreductive surgery followed by chemotherapy or neoadjuvant chemotherapy followed by interval cytoreductive surgery. In addition, there is increasing evidence that the patients who ultimately gain the most benefit from surgery are those with no residual disease at the completion of surgery (R0 resection). Therefore, to determine the best therapeutic strategy (primary cytoreductive surgery vs. neoadjuvant chemotherapy) for an individual patient, it is critically important to estimate the likelihood that primary cytoreductive surgery will leave no macroscopic residual disease. A number of studies have evaluated the use of serologic markers, such as CA-125, and imaging modalities, such as computed tomography (CT) or positron emission tomography/CT (PET/CT), to determine which patients are ideal candidates for primary cytoreductive surgery. More recently, laparoscopy has been proposed as a reliable predictor of R0 resection. In this report, we provide a review of the existing literature on the proposed criteria to predict the outcome of cytoreductive surgery and the role of laparoscopy-based scores in the management of advanced ovarian cancer.
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Affiliation(s)
| | - Bertha Alejandra Martinez-Cannon
- School of Medicine and Health Sciences of Tecnologico de Monterrey - TEC Salud, Doctor Ignacio Morones Prieto Avenue 3000, Colonia Los Doctores, 64710 Monterrey, NL, Mexico
| | - Alpa M Nick
- Department of Gynecologic Oncology and Reproductive Medicine, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Unit 1362, Houston, TX 77030, United States
| | - Karen H Lu
- Department of Gynecologic Oncology and Reproductive Medicine, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Unit 1362, Houston, TX 77030, United States
| | - Anil K Sood
- Department of Gynecologic Oncology and Reproductive Medicine, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Unit 1362, Houston, TX 77030, United States
| | - Robert L Coleman
- Department of Gynecologic Oncology and Reproductive Medicine, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Unit 1362, Houston, TX 77030, United States
| | - Pedro T Ramirez
- Department of Gynecologic Oncology and Reproductive Medicine, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Unit 1362, Houston, TX 77030, United States.
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Menczer J, Ben-Shem E, Golan A, Levy T. The Significance of Normal Pretreatment Levels of CA125 (<35 U/mL) in Epithelial Ovarian Carcinoma. Rambam Maimonides Med J 2015; 6:e0005. [PMID: 25717387 PMCID: PMC4327321 DOI: 10.5041/rmmj.10180] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/14/2023] Open
Abstract
OBJECTIVE To assess the association between normal CA125 levels at diagnosis of epithelial ovarian carcinoma (EOC) with prognostic factors and with outcome. METHODS The study group consisted of histologically confirmed EOC patients with normal pretreatment CA125 levels, and the controls consisted of EOC patients with elevated (≥35 U/mL) pretreatment CA125 levels, diagnosed and treated between 1995 and 2112. Study and control group patients fulfilled the following criteria: 1) their pretreatment CA125 levels were assessed; 2) they had full standard primary treatment, i.e. cytoreductive surgery and cisplatin-based chemotherapy; and 3) they were followed every 2-4 months during the first two years and every 4-6 months thereafter. RESULTS Of 114 EOC patients who fulfilled the inclusion criteria, 22 (19.3%) had normal pretreatment CA125 levels. The control group consisted of the remaining 92 patients with ≥35 U/mL serum CA125 levels pretreatment. The proportion of patients with early-stage and low-grade disease, with optimal cytoreduction, and with platin-sensitive tumors was significantly higher in the study group than in the control group. The progression-free survival (PFS) and overall survival (OS) were significantly higher in the study group than in the control group on univariate analysis but not on multivariate analysis. CONCLUSION It seems that a normal CA125 level at diagnosis in EOC may also be of prognostic significance for the individual patient.
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Affiliation(s)
- Joseph Menczer
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, E. Wolfson Medical Center, Holon, Tel Aviv University, Sackler Faculty of Medicine, Tel Aviv, Israel
| | - Erez Ben-Shem
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, E. Wolfson Medical Center, Holon, Tel Aviv University, Sackler Faculty of Medicine, Tel Aviv, Israel
| | - Abraham Golan
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, E. Wolfson Medical Center, Holon, Tel Aviv University, Sackler Faculty of Medicine, Tel Aviv, Israel
| | - Tally Levy
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, E. Wolfson Medical Center, Holon, Tel Aviv University, Sackler Faculty of Medicine, Tel Aviv, Israel
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Pelissier A, Bonneau C, Chéreau E, de La Motte Rouge T, Fourchotte V, Daraï E, Rouzier R. CA125 kinetic parameters predict optimal cytoreduction in patients with advanced epithelial ovarian cancer treated with neoadjuvant chemotherapy. Gynecol Oncol 2014; 135:542-6. [PMID: 25223808 DOI: 10.1016/j.ygyno.2014.09.005] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2014] [Revised: 08/30/2014] [Accepted: 09/03/2014] [Indexed: 10/24/2022]
Abstract
OBJECTIVE To evaluate the different kinetic parameters of serum CA125 during neoadjuvant chemotherapy (NAC) to predict optimal interval debulking surgery (IDS). METHODS The present retrospective multicenter study included patients with advanced ovarian cancer treated with neoadjuvant platinum-based chemotherapy followed by IDS between 2002 and 2009. Demographic data, CA125 levels, radiographic data, chemotherapy and surgical-pathologic information were obtained. Univariate and multivariate analyses were performed to evaluate variables associated with complete IDS. ROC analysis was used to determine potential cut-off values to predict the likelihood of complete cytoreduction via IDS. RESULTS One hundred and forty-eight patients met the study criteria. Ninety-three patients (62.8%) had optimal cytoreduction with no residual macroscopic disease (CC-0) after IDS. In multivariate analyses, the CA125 level after the 3rd NAC was an independent predictor for optimal cytoreduction (odds ratio: 0.98 [0.97-0.99], p=0.04). The area under the ROC curve was 0.73. A threshold of 75 UI/ml displayed the most predictive power. The odds ratio to predict complete cytoreduction was 3.29 [1.56-7.10] (p=0.0008). CONCLUSION Our data indicate that for advanced ovarian cancer, a CA125 level less than 75 UI/ml after the 3rd NAC was an independent predictor factor for complete IDS.
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Affiliation(s)
- Aurélie Pelissier
- Department of breast and gynecological surgery, Institut Curie, 26 rue d'Ulm, 75248 Paris cedex, France; Department of gynecology-obstetrics, University Reims Hospital, 45 rue Cognacq Jay, 51092 Reims cedex, France
| | - Claire Bonneau
- Department of breast and gynecological surgery, Institut Curie, 26 rue d'Ulm, 75248 Paris cedex, France; Department of gynecological surgery, Tenon Hospital, 4 rue de la Chine, 75020 Paris, France
| | - Elisabeth Chéreau
- Department of surgical oncology, Institut Paoli-Calmettes, 232 bd Sainte Marguerite, 13009 Marseille, France
| | | | - Virginie Fourchotte
- Department of breast and gynecological surgery, Institut Curie, 26 rue d'Ulm, 75248 Paris cedex, France
| | - Emile Daraï
- Department of gynecological surgery, Tenon Hospital, 4 rue de la Chine, 75020 Paris, France
| | - Roman Rouzier
- Department of breast and gynecological surgery, Institut Curie, 26 rue d'Ulm, 75248 Paris cedex, France; Versailles-St-Quentin-en-Yvelines University, EA 7285: Risques cliniques et sécurité en santé des femmes et en santé périnatale, France
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Antwi S, Everson TM. Prognostic impact of definitive local therapy of the primary tumor in men with metastatic prostate cancer at diagnosis: A population-based, propensity score analysis. Cancer Epidemiol 2014; 38:435-41. [DOI: 10.1016/j.canep.2014.04.002] [Citation(s) in RCA: 59] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2014] [Revised: 04/07/2014] [Accepted: 04/08/2014] [Indexed: 11/24/2022]
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Suidan RS, Ramirez PT, Sarasohn DM, Teitcher JB, Mironov S, Iyer RB, Zhou Q, Iasonos A, Paul H, Hosaka M, Aghajanian CA, Leitao MM, Gardner GJ, Abu-Rustum NR, Sonoda Y, Levine DA, Hricak H, Chi DS. A multicenter prospective trial evaluating the ability of preoperative computed tomography scan and serum CA-125 to predict suboptimal cytoreduction at primary debulking surgery for advanced ovarian, fallopian tube, and peritoneal cancer. Gynecol Oncol 2014; 134:455-61. [PMID: 25019568 DOI: 10.1016/j.ygyno.2014.07.002] [Citation(s) in RCA: 160] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2014] [Revised: 07/01/2014] [Accepted: 07/04/2014] [Indexed: 12/30/2022]
Abstract
OBJECTIVE To assess the ability of preoperative computed tomography (CT) scan of the abdomen/pelvis and serum CA-125 to predict suboptimal (>1cm residual disease) primary cytoreduction in advanced ovarian, fallopian tube, and peritoneal cancer. METHODS This was a prospective, non-randomized, multicenter trial of patients who underwent primary cytoreduction for stage III-IV ovarian, fallopian tube, and peritoneal cancer. A CT scan of the abdomen/pelvis and serum CA-125 were obtained within 35 and 14 days before surgery, respectively. Four clinical and 20 radiologic criteria were assessed. RESULTS From 7/2001 to 12/2012, 669 patients were enrolled; 350 met eligibility criteria. The optimal debulking rate was 75%. On multivariate analysis, three clinical and six radiologic criteria were significantly associated with suboptimal debulking: age ≥ 60 years (p=0.01); CA-125 ≥ 500 U/mL (p<0.001); ASA 3-4 (p<0.001); suprarenal retroperitoneal lymph nodes >1cm (p<0.001); diffuse small bowel adhesions/thickening (p<0.001); and lesions >1cm in the small bowel mesentery (p=0.03), root of the superior mesenteric artery (p=0.003), perisplenic area (p<0.001), and lesser sac (p<0.001). A 'predictive value score' was assigned for each criterion, and the suboptimal debulking rates of patients who had a total score of 0, 1-2, 3-4, 5-6, 7-8, and ≥ 9 were 5%, 10%, 17%, 34%, 52%, and 74%, respectively. A prognostic model combining these nine factors had a predictive accuracy of 0.758. CONCLUSIONS We identified nine criteria associated with suboptimal cytoreduction, and developed a predictive model in which the suboptimal rate was directly proportional to a predictive value score. These results may be helpful in pretreatment patient assessment.
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Affiliation(s)
- Rudy S Suidan
- Gynecology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center (MSKCC), New York, NY, USA
| | - Pedro T Ramirez
- Department of Gynecologic Oncology, MD Anderson Cancer Center (MDACC), Houston, TX, USA
| | | | | | | | | | - Qin Zhou
- Department of Epidemiology and Biostatistics, MSKCC, New York, NY, USA
| | - Alexia Iasonos
- Department of Epidemiology and Biostatistics, MSKCC, New York, NY, USA
| | - Harold Paul
- Gynecology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center (MSKCC), New York, NY, USA
| | - Masayoshi Hosaka
- Department of Gynecologic Oncology, MD Anderson Cancer Center (MDACC), Houston, TX, USA
| | - Carol A Aghajanian
- Gynecologic Medical Oncology Service, Department of Medicine, MSKCC, New York, NY, USA; Weill Cornell Medical College, New York, NY, USA
| | - Mario M Leitao
- Gynecology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center (MSKCC), New York, NY, USA; Weill Cornell Medical College, New York, NY, USA
| | - Ginger J Gardner
- Gynecology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center (MSKCC), New York, NY, USA; Weill Cornell Medical College, New York, NY, USA
| | - Nadeem R Abu-Rustum
- Gynecology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center (MSKCC), New York, NY, USA; Weill Cornell Medical College, New York, NY, USA
| | - Yukio Sonoda
- Gynecology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center (MSKCC), New York, NY, USA; Weill Cornell Medical College, New York, NY, USA
| | - Douglas A Levine
- Gynecology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center (MSKCC), New York, NY, USA; Weill Cornell Medical College, New York, NY, USA
| | | | - Dennis S Chi
- Gynecology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center (MSKCC), New York, NY, USA; Weill Cornell Medical College, New York, NY, USA.
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Tucker SL, Gharpure K, Herbrich SM, Unruh AK, Nick AM, Crane EK, Coleman RL, Guenthoer J, Dalton HJ, Wu SY, Rupaimoole R, Lopez-Berestein G, Ozpolat B, Ivan C, Hu W, Baggerly KA, Sood AK. Molecular biomarkers of residual disease after surgical debulking of high-grade serous ovarian cancer. Clin Cancer Res 2014; 20:3280-8. [PMID: 24756370 DOI: 10.1158/1078-0432.ccr-14-0445] [Citation(s) in RCA: 71] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
PURPOSE Residual disease following primary cytoreduction is associated with adverse overall survival in patients with epithelial ovarian cancer. Accurate identification of patients at high risk of residual disease has been elusive, lacking external validity and prompting many to undergo unnecessary surgical exploration. Our goal was to identify and validate molecular markers associated with high rates of residual disease. METHODS We interrogated two publicly available datasets from chemonaïve primary high-grade serous ovarian tumors for genes overexpressed in patients with residual disease and significant at a 10% false discovery rate (FDR) in both datasets. We selected genes with wide dynamic range for validation in an independent cohort using quantitative RT-PCR to assay gene expression, followed by blinded prediction of a patient subset at high risk for residual disease. Predictive success was evaluated using a one-sided Fisher exact test. RESULTS Forty-seven probe sets met the 10% FDR criterion in both datasets. These included FABP4 and ADH1B, which tracked tightly, showed dynamic ranges >16-fold and had high expression levels associated with increased incidence of residual disease. In the validation cohort (n = 139), FABP4 and ADH1B were again highly correlated. Using the top quartile of FABP4 PCR values as a prespecified threshold, we found 30 of 35 cases of residual disease in the predicted high-risk group (positive predictive value = 86%) and 54 of 104 among the remaining patients (P = 0.0002; OR, 5.5). CONCLUSION High FABP4 and ADH1B expression is associated with significantly higher risk of residual disease in high-grade serous ovarian cancer. Patients with high tumoral levels of these genes may be candidates for neoadjuvant chemotherapy.
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Affiliation(s)
- Susan L Tucker
- Authors' Affiliations: Departments of Bioinformatics and Computational Biology, Gynecologic Oncology and Reproductive Medicine, Experimental Therapeutics, Cancer Biology, and Center for RNA Interference and Non-Coding RNA, The University of Texas MD Anderson Cancer Center, Houston, Texas; and Fred Hutchinson Cancer Research Center, Seattle, Washington
| | - Kshipra Gharpure
- Authors' Affiliations: Departments of Bioinformatics and Computational Biology, Gynecologic Oncology and Reproductive Medicine, Experimental Therapeutics, Cancer Biology, and Center for RNA Interference and Non-Coding RNA, The University of Texas MD Anderson Cancer Center, Houston, Texas; and Fred Hutchinson Cancer Research Center, Seattle, Washington
| | - Shelley M Herbrich
- Authors' Affiliations: Departments of Bioinformatics and Computational Biology, Gynecologic Oncology and Reproductive Medicine, Experimental Therapeutics, Cancer Biology, and Center for RNA Interference and Non-Coding RNA, The University of Texas MD Anderson Cancer Center, Houston, Texas; and Fred Hutchinson Cancer Research Center, Seattle, Washington
| | - Anna K Unruh
- Authors' Affiliations: Departments of Bioinformatics and Computational Biology, Gynecologic Oncology and Reproductive Medicine, Experimental Therapeutics, Cancer Biology, and Center for RNA Interference and Non-Coding RNA, The University of Texas MD Anderson Cancer Center, Houston, Texas; and Fred Hutchinson Cancer Research Center, Seattle, Washington
| | - Alpa M Nick
- Authors' Affiliations: Departments of Bioinformatics and Computational Biology, Gynecologic Oncology and Reproductive Medicine, Experimental Therapeutics, Cancer Biology, and Center for RNA Interference and Non-Coding RNA, The University of Texas MD Anderson Cancer Center, Houston, Texas; and Fred Hutchinson Cancer Research Center, Seattle, Washington
| | - Erin K Crane
- Authors' Affiliations: Departments of Bioinformatics and Computational Biology, Gynecologic Oncology and Reproductive Medicine, Experimental Therapeutics, Cancer Biology, and Center for RNA Interference and Non-Coding RNA, The University of Texas MD Anderson Cancer Center, Houston, Texas; and Fred Hutchinson Cancer Research Center, Seattle, Washington
| | - Robert L Coleman
- Authors' Affiliations: Departments of Bioinformatics and Computational Biology, Gynecologic Oncology and Reproductive Medicine, Experimental Therapeutics, Cancer Biology, and Center for RNA Interference and Non-Coding RNA, The University of Texas MD Anderson Cancer Center, Houston, Texas; and Fred Hutchinson Cancer Research Center, Seattle, Washington
| | - Jamie Guenthoer
- Authors' Affiliations: Departments of Bioinformatics and Computational Biology, Gynecologic Oncology and Reproductive Medicine, Experimental Therapeutics, Cancer Biology, and Center for RNA Interference and Non-Coding RNA, The University of Texas MD Anderson Cancer Center, Houston, Texas; and Fred Hutchinson Cancer Research Center, Seattle, Washington
| | - Heather J Dalton
- Authors' Affiliations: Departments of Bioinformatics and Computational Biology, Gynecologic Oncology and Reproductive Medicine, Experimental Therapeutics, Cancer Biology, and Center for RNA Interference and Non-Coding RNA, The University of Texas MD Anderson Cancer Center, Houston, Texas; and Fred Hutchinson Cancer Research Center, Seattle, Washington
| | - Sherry Y Wu
- Authors' Affiliations: Departments of Bioinformatics and Computational Biology, Gynecologic Oncology and Reproductive Medicine, Experimental Therapeutics, Cancer Biology, and Center for RNA Interference and Non-Coding RNA, The University of Texas MD Anderson Cancer Center, Houston, Texas; and Fred Hutchinson Cancer Research Center, Seattle, Washington
| | - Rajesha Rupaimoole
- Authors' Affiliations: Departments of Bioinformatics and Computational Biology, Gynecologic Oncology and Reproductive Medicine, Experimental Therapeutics, Cancer Biology, and Center for RNA Interference and Non-Coding RNA, The University of Texas MD Anderson Cancer Center, Houston, Texas; and Fred Hutchinson Cancer Research Center, Seattle, Washington
| | - Gabriel Lopez-Berestein
- Authors' Affiliations: Departments of Bioinformatics and Computational Biology, Gynecologic Oncology and Reproductive Medicine, Experimental Therapeutics, Cancer Biology, and Center for RNA Interference and Non-Coding RNA, The University of Texas MD Anderson Cancer Center, Houston, Texas; and Fred Hutchinson Cancer Research Center, Seattle, WashingtonAuthors' Affiliations: Departments of Bioinformatics and Computational Biology, Gynecologic Oncology and Reproductive Medicine, Experimental Therapeutics, Cancer Biology, and Center for RNA Interference and Non-Coding RNA, The University of Texas MD Anderson Cancer Center, Houston, Texas; and Fred Hutchinson Cancer Research Center, Seattle, Washington
| | - Bulent Ozpolat
- Authors' Affiliations: Departments of Bioinformatics and Computational Biology, Gynecologic Oncology and Reproductive Medicine, Experimental Therapeutics, Cancer Biology, and Center for RNA Interference and Non-Coding RNA, The University of Texas MD Anderson Cancer Center, Houston, Texas; and Fred Hutchinson Cancer Research Center, Seattle, Washington
| | - Cristina Ivan
- Authors' Affiliations: Departments of Bioinformatics and Computational Biology, Gynecologic Oncology and Reproductive Medicine, Experimental Therapeutics, Cancer Biology, and Center for RNA Interference and Non-Coding RNA, The University of Texas MD Anderson Cancer Center, Houston, Texas; and Fred Hutchinson Cancer Research Center, Seattle, Washington
| | - Wei Hu
- Authors' Affiliations: Departments of Bioinformatics and Computational Biology, Gynecologic Oncology and Reproductive Medicine, Experimental Therapeutics, Cancer Biology, and Center for RNA Interference and Non-Coding RNA, The University of Texas MD Anderson Cancer Center, Houston, Texas; and Fred Hutchinson Cancer Research Center, Seattle, Washington
| | - Keith A Baggerly
- Authors' Affiliations: Departments of Bioinformatics and Computational Biology, Gynecologic Oncology and Reproductive Medicine, Experimental Therapeutics, Cancer Biology, and Center for RNA Interference and Non-Coding RNA, The University of Texas MD Anderson Cancer Center, Houston, Texas; and Fred Hutchinson Cancer Research Center, Seattle, Washington
| | - Anil K Sood
- Authors' Affiliations: Departments of Bioinformatics and Computational Biology, Gynecologic Oncology and Reproductive Medicine, Experimental Therapeutics, Cancer Biology, and Center for RNA Interference and Non-Coding RNA, The University of Texas MD Anderson Cancer Center, Houston, Texas; and Fred Hutchinson Cancer Research Center, Seattle, WashingtonAuthors' Affiliations: Departments of Bioinformatics and Computational Biology, Gynecologic Oncology and Reproductive Medicine, Experimental Therapeutics, Cancer Biology, and Center for RNA Interference and Non-Coding RNA, The University of Texas MD Anderson Cancer Center, Houston, Texas; and Fred Hutchinson Cancer Research Center, Seattle, WashingtonAuthors' Affiliations: Departments of Bioinformatics and Computational Biology, Gynecologic Oncology and Reproductive Medicine, Experimental Therapeutics, Cancer Biology, and Center for RNA Interference and Non-Coding RNA, The University of Texas MD Anderson Cancer Center, Houston, Texas; and Fred Hutchinson Cancer Research Center, Seattle, Washington
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Braicu EI, Chekerov R, Richter R, Pop C, Nassir M, Loefgren H, Stamatian F, Muallem MZ, Hall C, Fotopoulou C, Sehouli J, Pietzner K. HE4 Expression in Plasma Correlates with Surgical Outcome and Overall Survival in Patients with First Ovarian Cancer Relapse. Ann Surg Oncol 2013; 21:955-62. [DOI: 10.1245/s10434-013-3347-1] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2013] [Indexed: 12/25/2022]
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Tangjitgamol S, Hanprasertpong J, Cubelli M, Zamagni C. Neoadjuvant chemotherapy and cytoreductive surgery in epithelial ovarian cancer. World J Obstet Gynecol 2013; 2:153-166. [DOI: 10.5317/wjog.v2.i4.153] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2012] [Accepted: 02/06/2013] [Indexed: 02/05/2023] Open
Abstract
Ovarian cancer is one of the leading causes of death among gynecological cancers. This is because the majority of patients present with advanced stage disease. Primary debulking surgery (PDS) followed by adjuvant chemotherapy is still a mainstay of treatment. An optimal surgery, which is currently defined by leaving no gross residual tumor, is the goal of PDS. The extent of disease as well as the operative setting, including the surgeon’s skill, influences the likelihood of successful debulking. With extensive disease and a poor chance of optimal surgery or high morbidity anticipated, neoadjuvant chemotherapy (NACT) prior to primary surgery is an option. Secondary surgery after induction chemotherapy is termed interval debulking surgery (IDS). Delayed PDS or IDS is offered to patients who show some clinical response and are without progressive disease. NACT or IDS has become more established in clinical practice and there are numerous publications regarding its advantages and disadvantages. However, data on survival are limited and inconsistent. Only one large randomized trial could demonstrate that NACT was not inferior to PDS while the few randomized trials on IDS had inconsistent results. Without a definite benefit of NACT prior to surgery over PDS, one must carefully weigh the chances of safe and successful PDS against the morbidity and risks of suboptimal surgery. Appropriate selection of a patient to undergo PDS followed by chemotherapy or, preferably, to have NACT prior to surgery is very important. Some clinical characteristics from physical examination, serum tumor markers and/or findings from imaging studies may be predictive of resectability. However, no specific features have been consistently identified in the literature. This article will address the clinical data on prediction of surgical outcomes, the role of NACT, and the role of IDS.
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Use of complex surgical procedures, patterns of tumor spread, and CA-125 predicts a risk of incomplete cytoreduction: a Korean Gynecologic Oncology Group study (KGOG-3022). Gynecol Oncol 2013; 131:336-40. [PMID: 23954903 DOI: 10.1016/j.ygyno.2013.07.110] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2013] [Revised: 07/23/2013] [Accepted: 07/27/2013] [Indexed: 11/21/2022]
Abstract
OBJECTIVES We aimed to develop a risk model to predict a risk of suboptimal cytoreduction in primary surgery of ovarian cancer. METHODS The clinical records and computed tomography (CT) data of 358 patients with stages II-IV epithelial ovarian cancer were reviewed. Tumor spread patterns identified by principal component analysis, CA-125, and a newly developed surgical skill index were integrated into a logistic model along with other variables. Internal validation was performed using bootstrapped re-sampling and calibration was assessed by goodness-of-fit test. RESULTS Among the 358 patients, optimal cytoreduction, which was defined as no residual tumor, was achieved in 145 patients (40.5%). The surgical capacity of an individual institution was estimated by a surgical skill index, which was the frequency of complex surgeries in patients with advanced disease. In a multivariate model, two distinctive CT patterns of tumor spread (diffuse spread pattern and upper abdominal extension pattern), a surgical skill index, and serum CA-125 independently predicted a risk of suboptimal cytoreduction (P=0.006, P=0.013, P=0.031, and P=0.001, respectively). The model showed a C-statistic of .73 (95% confidence interval .67 to .79), which was significantly higher than tumor stage or ascites. Rigorous internal validation by bootstrapped re-sampling successfully confirmed the model. CONCLUSIONS We identified two distinct tumor spread patterns of ovarian cancer, which can be integrated to improve a prediction model. Our model may be useful in patient referral or clinical trials for patient stratification.
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Fagö-Olsen CL, Håkansson F, Antonsen SL, Høgdall E, Lundvall L, Nedergaard L, Engelholm SA, Høgdall C. Diagnostic accuracy of risk of malignancy index in predicting complete tumor removal at primary debulking surgery for ovarian cancer patients. Acta Obstet Gynecol Scand 2013; 92:721-6. [DOI: 10.1111/aogs.12127] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2012] [Accepted: 02/20/2013] [Indexed: 11/30/2022]
Affiliation(s)
- Carsten L. Fagö-Olsen
- Department of Gynecology; Rigshospitalet; Copenhagen University Hospital; Copenhagen; Denmark
| | - Fanny Håkansson
- Department of Gynecology; Rigshospitalet; Copenhagen University Hospital; Copenhagen; Denmark
| | - Sofie L. Antonsen
- Department of Gynecology; Rigshospitalet; Copenhagen University Hospital; Copenhagen; Denmark
| | - Estrid Høgdall
- The Danish Cancer Biobank; Department of Pathology; Herlev Hospital, Copenhagen University Hospital; Copenhagen; Denmark
| | - Lene Lundvall
- Department of Gynecology; Rigshospitalet; Copenhagen University Hospital; Copenhagen; Denmark
| | - Lotte Nedergaard
- Department of Pathology; Rigshospitalet; Copenhagen University Hospital; Copenhagen; Denmark
| | - Svend A. Engelholm
- Department of Radiation Oncology; Rigshospitalet; Copenhagen University Hospital; Copenhagen; Denmark
| | - Claus Høgdall
- Department of Gynecology; Rigshospitalet; Copenhagen University Hospital; Copenhagen; Denmark
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