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Wang D, Su N, Wang R, Zhang L, Qi Z, Liu Z, Yang J, Leng J, Xiang Y. Serous surface papillary borderline ovarian tumors: correlation of sonographic features with clinic pathological findings. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2024; 63:691-698. [PMID: 37592848 DOI: 10.1002/uog.27454] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/18/2023] [Revised: 07/23/2023] [Accepted: 08/04/2023] [Indexed: 08/19/2023]
Abstract
Serous surface papillary borderline ovarian tumor (SSPBOT) is a distinct subtype of serous borderline ovarian tumor characterized by solid tissue deposition confined to the ovarian surface. Because SSPBOT is rare, there are few published reports on the ultrasonographic features of this condition. In this retrospective study, we investigated 12 cases of SSPBOT. Ultrasound imaging of SSPBOT showed grossly normal ovaries that were encased partially or wholly by tumor deposits that were confined to the surface, with clear demarcation between normal ovarian tissue and surrounding tumors. Color Doppler imaging demonstrated the 'fireworks sign' in all cases of SSPBOT, corresponding to an intratumoral vascular bundle originating from the ovarian vessels and supplying hierarchical branching blood flow to the surrounding tumor. No patient with ovarian high-grade serous carcinoma showed these morphological and Doppler features. In our series, the fireworks sign appeared to be a characteristic feature of SSPBOT that could facilitate correct identification of this tumor. © 2023 International Society of Ultrasound in Obstetrics and Gynecology.
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Affiliation(s)
- D Wang
- Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, National Clinical Research Center for Obstetric and Gynecologic Diseases, Beijing, People's Republic of China
| | - N Su
- Department of Ultrasound, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People's Republic of China
| | - R Wang
- Department of Ultrasound, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People's Republic of China
| | - L Zhang
- Department of Ultrasound, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People's Republic of China
| | - Z Qi
- Department of Ultrasound, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People's Republic of China
| | - Z Liu
- Department of Ultrasound, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People's Republic of China
| | - J Yang
- Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, National Clinical Research Center for Obstetric and Gynecologic Diseases, Beijing, People's Republic of China
| | - J Leng
- Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, National Clinical Research Center for Obstetric and Gynecologic Diseases, Beijing, People's Republic of China
| | - Y Xiang
- Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, National Clinical Research Center for Obstetric and Gynecologic Diseases, Beijing, People's Republic of China
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Li Y, Zhang J, Wang B, Zhang H, He J, Wang K. A nomogram based on clinicopathological features and serological indicators predicting breast pathologic complete response of neoadjuvant chemotherapy in breast cancer. Sci Rep 2021; 11:11348. [PMID: 34059778 PMCID: PMC8167133 DOI: 10.1038/s41598-021-91049-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2020] [Accepted: 05/17/2021] [Indexed: 02/04/2023] Open
Abstract
A single tumor marker is not enough to predict the breast pathologic complete response (bpCR) after neoadjuvant chemotherapy (NAC) in breast cancer patients. We aimed to establish a nomogram based on multiple clinicopathological features and routine serological indicators to predict bpCR after NAC in breast cancer patients. Data on clinical factors and laboratory indices of 130 breast cancer patients who underwent NAC and surgery in First Affiliated Hospital of Xi'an Jiaotong University from July 2017 to July 2019 were collected. Multivariable logistic regression analysis identified 11 independent indicators: body mass index, carbohydrate antigen 125, total protein, blood urea nitrogen, cystatin C, serum potassium, serum phosphorus, platelet distribution width, activated partial thromboplastin time, thrombin time, and hepatitis B surface antibodies. The nomogram was established based on these indicators. The 1000 bootstrap resampling internal verification calibration curve and the GiViTI calibration belt showed that the model was well calibrated. The Brier score of 0.095 indicated that the nomogram had a high accuracy. The area under the curve (AUC) of receiver operating characteristic (ROC) curve was 0.941 (95% confidence interval: 0.900-0.982) showed good discrimination of the model. In conclusion, this nomogram showed high accuracy and specificity and did not increase the economic burden of patients, thereby having a high clinical application value.
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Affiliation(s)
- Yijun Li
- grid.43169.390000 0001 0599 1243Department of Breast Surgery, First Affiliate Hospital, Xi’an Jiaotong University, 277 Yanta West Road, Xi’an, 710061 People’s Republic of China
| | - Jian Zhang
- grid.43169.390000 0001 0599 1243Department of Breast Surgery, First Affiliate Hospital, Xi’an Jiaotong University, 277 Yanta West Road, Xi’an, 710061 People’s Republic of China
| | - Bin Wang
- grid.43169.390000 0001 0599 1243Department of Breast Surgery, First Affiliate Hospital, Xi’an Jiaotong University, 277 Yanta West Road, Xi’an, 710061 People’s Republic of China
| | - Huimin Zhang
- grid.43169.390000 0001 0599 1243Department of Breast Surgery, First Affiliate Hospital, Xi’an Jiaotong University, 277 Yanta West Road, Xi’an, 710061 People’s Republic of China
| | - Jianjun He
- grid.43169.390000 0001 0599 1243Department of Breast Surgery, First Affiliate Hospital, Xi’an Jiaotong University, 277 Yanta West Road, Xi’an, 710061 People’s Republic of China
| | - Ke Wang
- grid.43169.390000 0001 0599 1243Department of Breast Surgery, First Affiliate Hospital, Xi’an Jiaotong University, 277 Yanta West Road, Xi’an, 710061 People’s Republic of China
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Association of expression of p53, livin, ERCC1, BRCA1 and PARP1 in epithelial ovarian cancer tissue with drug resistance and prognosis. Pathol Res Pract 2020; 216:152794. [DOI: 10.1016/j.prp.2019.152794] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2018] [Revised: 11/28/2019] [Accepted: 12/12/2019] [Indexed: 01/01/2023]
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Nyangoh-Timoh K, Bendifallah S, Dion L, Ouldamer L, Levêque J. [Borderline Ovarian Tumours: CNGOF Guidelines for Clinical Practice - Value of Tumor Markers]. ACTA ACUST UNITED AC 2020; 48:277-286. [PMID: 32004789 DOI: 10.1016/j.gofs.2020.01.015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
OBJECTIVES To evaluate the diagnostic value of serum biomarkers in the management strategy of borderline ovarian tumours (BOT) to make management recommendations. METHODS English and French review of literature from 1990 to 2019 based on publications from Pubmed, Medline, Cochrane, with keywords: borderline ovarian tumors, tumour markers, CA125, CA19 9, ACE, CA72 4, TAG72, HE4, ROMA, mucinous, serous, mucinous, endometrioid ovarian tumours, peritoneal implants, recurrence, overall survival, follow-up. Among 1000 references, 400 were selected and only 30 were screened for this work. RESULTS Literature review: there is low evidence in literature concerning the discriminating value of serum tumour biomarkers (CA125, CA19-9, CEA, CA72-4, HE4) and specific score between presumed benign ovarian tumour/BOT/ovarian cancer (LE4). Serum CA125 antigen is higher in case of serous borderline ovarian tumour (LE4), increase with the tumor height, the FIGO stage, notably in case of serous borderline ovarian tumor. However, a normal value rate of serum CA125 antigen does not rule out a BOT (LE4). The preoperative positivity rate of CA19 9 in case of TFO is relatively lower than that of CA125 and is higher in mucinous TFO. The preoperative rate of serum CA19 9 antigen increases with the tumour height and the FIGO stage (LE4) and are higher in case of mucinous BOT (LE4). Preoperative rates of serum HE4 are not different between histologic type of BOT. A high level of serum biomarkers (CA125) is a predictive factor of peritoneal implants (LE4) and an independent predictive factor of recurrence (CA125) (LE4). RECOMMENDATIONS no recommendation can be made about the use of serum tumour biomarkers (CA125, CA19-9, CEA, CA72-4, HE4) or specific score in order to distinguish benign ovarian tumor/borderline ovarian tumor/ovarian cancer in case of indeterminate mass. In case of suspicion of mucinous ovarian tumour on imaging, the systematic dosage of serum CA19-9 antigen can be proposed (grade C). In case of an ovarian indeterminate mass on imaging; dosage of serum HE4 and C125 is recommended. If preoperative dosage of serum tumor biomarkers is normal, their systematic dosage is not recommended in the follow-up of BOT (grade C). If preoperative dosage of CA125 is high, the systematic dosage of CA125 is recommended in the follow-up of BOT with no precisions about the rhythm and the duration of the follow-up (grade B).
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Affiliation(s)
- K Nyangoh-Timoh
- Département de gynécologie-obstétrique et reproduction humaine, 16, boulevard de Bulgarie, 35000 Rennes, France; UFR médecine université de Rennes 1, CHU Anne-de-Bretagne, Bretagne, France
| | - S Bendifallah
- Service de chirurgie gynécologique et mammaire, maternité, et médecine de la reproduction, hôpital Tenon, AP-HP, 4, rue de la Chine, 75020 Paris, France; Sorbonne Université, 75006 Paris, France
| | - L Dion
- Département de gynécologie-obstétrique et reproduction humaine, 16, boulevard de Bulgarie, 35000 Rennes, France; UFR médecine université de Rennes 1, CHU Anne-de-Bretagne, Bretagne, France
| | - L Ouldamer
- Département de gynécologie, hôpital Bretonneau, centre hospitalier universitaire de Tours, 2, boulevard Tonnellé, 37000 Tours, France
| | - J Levêque
- Département de gynécologie-obstétrique et reproduction humaine, 16, boulevard de Bulgarie, 35000 Rennes, France; UFR médecine université de Rennes 1, CHU Anne-de-Bretagne, Bretagne, France.
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Li X, Dai D, Chen B, He S, Zhang J, Wen C, Wang B. Prognostic Values Of Preoperative Serum CEA And CA125 Levels And Nomograms For Young Breast Cancer Patients. Onco Targets Ther 2019; 12:8789-8800. [PMID: 31695434 PMCID: PMC6821071 DOI: 10.2147/ott.s221335] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2019] [Accepted: 09/08/2019] [Indexed: 12/13/2022] Open
Abstract
Background Young breast cancer patients have poor prognosis compared to older patients in both overall survival (OS) and loco-regional failure-free survival. Carcinoembryonic antigen (CEA) and Cancer antigen 125 (CA125) have been widely used, but their prognostic value in young breast cancer patients remains unknown. The objectives of this study were to evaluate the prognostic value of preoperative CEA and CA125 serum levels and to build nomograms for better prognostic prediction of young Chinese breast cancer patients using both tumor markers. Methods We included 576 young breast cancer patients (≤40 years at diagnosis) and collected their preoperative information. The best cut-off values of the CEA and CA125 were identified with receiver operating characteristic (ROC) curves. Univariate and multivariate analyses were used to identify the relative risks of factors for the overall survival (OS), and disease-free survival (DFS), and nomograms were constructed based on these identified factors. Results The best cut-off values for CEA and CA125 in young breast cancer patients was 3.38 ng/mL and 19.38 U/mL, respectively. Kaplan-Meier analysis showed that young patients with low levels of CEA and/or CA125, had longer OS and DFS. Multivariate analysis suggested that both CEA and CA125 levels were independent predictive elements for OS. Nomograms were built and showed a better predictive ability for OS (AUC = 0.856) and DFS (AUC = 0.702) in young breast cancer patients. Conclusion Preoperative serum CEA and CA125 levels could be the independent prognostic factors for OS, and the nomograms including these two variables provide more personal forecasts information to help physicians optimize treatment for young breast cancer patients better.
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Affiliation(s)
- Xuan Li
- Department of Breast Surgery, Key Laboratory of Breast Cancer in Shanghai, Fudan University Shanghai Cancer Center, Shanghai, People's Republic of China.,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, People's Republic of China.,Department of Breast Oncology, Sun Yat-Sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou 510060, People's Republic of China
| | - Danian Dai
- Department of Gynecology and Obstetrics, The Fifth Affiliated Hospital of Sun Yat-Sen University, Zhuhai, Guangdong 519000, People's Republic of China.,Institute of Life Sciences, Chongqing Medical University, Chongqing 400016, People's Republic of China
| | - Bo Chen
- Department of Breast Cancer, Cancer Center, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, Guangdong 510080, People's Republic of China
| | - Sirong He
- Department of Immunology, College of Basic Medicine, Chongqing Medical University, Chongqing 400016, People's Republic of China
| | - Jie Zhang
- Department of Breast Oncology, Sun Yat-Sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou 510060, People's Republic of China
| | - Chunjie Wen
- Institute of Life Sciences, Chongqing Medical University, Chongqing 400016, People's Republic of China
| | - Bin Wang
- Institute of Life Sciences, Chongqing Medical University, Chongqing 400016, People's Republic of China
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Furrer D, Grégoire J, Turcotte S, Plante M, Bachvarov D, Trudel D, Têtu B, Douville P, Bairati I. Performance of preoperative plasma tumor markers HE4 and CA125 in predicting ovarian cancer mortality in women with epithelial ovarian cancer. PLoS One 2019; 14:e0218621. [PMID: 31220149 PMCID: PMC6586345 DOI: 10.1371/journal.pone.0218621] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2019] [Accepted: 06/05/2019] [Indexed: 02/01/2023] Open
Abstract
Clinical utility of new biomarkers often requires the identification of their optimal threshold. This external validation study was conducted to assess the performance of the preoperative plasma tumor markers HE4 and CA125 optimal cut-offs to predict cancer mortality in women with epithelial ovarian cancer (EOC). Participating women had upfront debulking surgery in the University Hospital of Quebec City (Canada) between 1998 and 2013. A total of 136 women participated in the training cohort (cohort 1) and 177 in the validation cohort (cohort 2). Preoperative plasma HE4 and CA125 levels were measured by Elecsys. Optimal thresholds were identified in the cohort 1 using time-dependent receiver operating characteristic (ROC) curves. Multivariate Cox models were used to validate the biomarkers using their optimal cut-offs in the cohort 2. The likelihood ratio (LR) test was done to test whether the biomarkers added prognostic information beyond that provided by standard prognostic factors. The Areas Under the Curves (AUC) for HE4 and CA125 were respectively 64.2 (95% CI: 54.7-73.6) and 63.1 (95%CI: 53.6-72.6). The optimal thresholds were 277 pmol/L for HE4 and 282 U/ml for CA125. Preoperative plasma HE4 (≥277 pmol/L) was significantly associated with EOC mortality (adjusted hazard ratio (aHR): 1.90; 95% CI:1.09-3.29). The prognostic effect of HE4 was strongest in the subgroup of women with serous ovarian cancer (aHR: 2.42; 95% CI: 1.25-4.68). Using a multivariate model including all standard prognostic factors, this association was maintained (aHR: 2.21; 95% CI: 1.15-4.23). In addition, preoperative plasma HE4 added prediction for death over the standard prognostic markers in women with serous tumors (p-value for LR-test: 0.01). Preoperative CA125 was not associated with cancer mortality, both in women with EOC and in those with serous tumors. Preoperative HE4 is a promising prognostic biomarker in EOC, especially in serous tumor.
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Affiliation(s)
- Daniela Furrer
- Université Laval Cancer Research Center 11, Côte du Palais, Quebec City, QC, Canada
- Research Center of the CHU de Québec-Université Laval (Oncology division), Côte du palais, Quebec City, QC, Canada
| | - Jean Grégoire
- Research Center of the CHU de Québec-Université Laval (Oncology division), Côte du palais, Quebec City, QC, Canada
- Faculty of Medicine, Université Laval, Avenue de la Médecine, Quebec City, QC, Canada
- Gynecologic Oncology Division, Centre Hospitalier Universitaire (CHU) de Québec-Université Laval, L’Hôtel-Dieu-de-Québec, Québec, Québec, Canada
| | - Stéphane Turcotte
- Research Center of the CHU de Québec-Université Laval (Oncology division), Côte du palais, Quebec City, QC, Canada
| | - Marie Plante
- Research Center of the CHU de Québec-Université Laval (Oncology division), Côte du palais, Quebec City, QC, Canada
- Faculty of Medicine, Université Laval, Avenue de la Médecine, Quebec City, QC, Canada
- Gynecologic Oncology Division, Centre Hospitalier Universitaire (CHU) de Québec-Université Laval, L’Hôtel-Dieu-de-Québec, Québec, Québec, Canada
| | - Dimcho Bachvarov
- Université Laval Cancer Research Center 11, Côte du Palais, Quebec City, QC, Canada
- Research Center of the CHU de Québec-Université Laval (Oncology division), Côte du palais, Quebec City, QC, Canada
- Faculty of Medicine, Université Laval, Avenue de la Médecine, Quebec City, QC, Canada
| | - Dominique Trudel
- Research Center of the CHU de Québec-Université Laval (Oncology division), Côte du palais, Quebec City, QC, Canada
- Department of Pathology, Hôpital Saint-Luc, Centre Hospitalier Universitaire de Montréal, rue Saint-Denis, Montréal, Québec, Canada
| | - Bernard Têtu
- Université Laval Cancer Research Center 11, Côte du Palais, Quebec City, QC, Canada
- Research Center of the CHU de Québec-Université Laval (Oncology division), Côte du palais, Quebec City, QC, Canada
- Faculty of Medicine, Université Laval, Avenue de la Médecine, Quebec City, QC, Canada
| | - Pierre Douville
- Research Center of the CHU de Québec-Université Laval (Oncology division), Côte du palais, Quebec City, QC, Canada
- Faculty of Medicine, Université Laval, Avenue de la Médecine, Quebec City, QC, Canada
| | - Isabelle Bairati
- Université Laval Cancer Research Center 11, Côte du Palais, Quebec City, QC, Canada
- Research Center of the CHU de Québec-Université Laval (Oncology division), Côte du palais, Quebec City, QC, Canada
- Faculty of Medicine, Université Laval, Avenue de la Médecine, Quebec City, QC, Canada
- * E-mail:
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Lin W, Cao D, Shen K. Prognostic significance of preoperative serum CEA in primary mucinous ovarian carcinoma: a retrospective cohort study. Cancer Manag Res 2018; 10:6913-6920. [PMID: 30588097 PMCID: PMC6300373 DOI: 10.2147/cmar.s186258] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Purpose The purpose of this study was to evaluate the prognostic significance of preoperative serum carcinoembryonic antigen (CEA) in primary mucinous ovarian carcinoma (MOC). Patients and methods We reviewed 57 patients with primary MOC, in whom preoperative serum CEA had been measured. All patients were treated at Peking Union Medical College Hospital between June 1996 and September 2016. Results Preoperative serum CEA was elevated (>5.0 ng/mL) in 10 patients (17.5%), with a median serum CEA of 9.6 ng/mL (5.4–111.7 ng/mL). CEA was significantly associated with preoperative serum cancer antigen 125 (P=0.002), surgical debulking status (P=0.015), and tumor stage (P=0.001). Univariate analysis showed that patients with elevated CEA had significantly worse overall survival (OS) than patients with normal CEA (5-year OS: 50.8% vs 91.9%, respectively; P=0.013), but there was no significant difference in progression-free survival between the two groups (P=0.307). Multivariate analysis further demonstrated that advanced stage was an independent prognostic predictor for OS (P=0.002, HR: 15.925, 95% CI: 2.745–92.404). Conclusion Elevated preoperative serum CEA was strongly correlated with advanced stage in primary MOC, which may indicate a poorer prognosis. Further investigation of the intrinsic relationship between CEA and primary MOC is now required.
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Affiliation(s)
- Wei Lin
- Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People's Republic of China,
| | - Dongyan Cao
- Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People's Republic of China,
| | - Keng Shen
- Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People's Republic of China,
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Hu J, Sun J. MUC16 mutations improve patients' prognosis by enhancing the infiltration and antitumor immunity of cytotoxic T lymphocytes in the endometrial cancer microenvironment. Oncoimmunology 2018; 7:e1487914. [PMID: 30288353 PMCID: PMC6169595 DOI: 10.1080/2162402x.2018.1487914] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2018] [Revised: 06/06/2018] [Accepted: 06/06/2018] [Indexed: 12/17/2022] Open
Abstract
The incidence and mortality rates of endometrial cancer are increasing during recent years. CA125 (gene symbol MUC16) is a well-known diagnostic and prognostic serum marker of endometrial cancer. High serum CA125 level is associated with poor prognosis. MUC16 is one of the most frequently mutated genes in endometrial cancer. However, the potential relationship and underlying mechanism between MUC16 mutations and endometrial cancer patients' prognosis and disease progression remain unclear. In present study, we analyzed the whole exome sequencing data, RNA sequencing data and patients' clinical information in TCGA database and demonstrated that MUC16 mutational status was an independent prognostic factor for endometrial cancer patients. Patients with somatic MUC16 mutations had a prolonged overall survival time. MUC16 mutations promoted patients' antitumor immune responses. Cytotoxic immune cells mediated pathways were enriched in endometrial cancer samples with MUC16 mutations. Elevation of two pathways, NO2-dependent IL 12 pathway in NK cells and T cytotoxic cell surface molecules, significantly correlated with a higher rate of MUC16 mutations and a significantly favorable patients' prognosis. An increased level of cytotoxic T lymphocytes, not NK cells, infiltration was observed in the tumor microenvironment of patients with MUC16 mutations. High expression of molecular markers of T cells and CD8+ T cells associated with a higher rate of MUC16 mutations and a better patients' prognosis. These findings may provide deeper insight into potential endometrial cancer immunotherapy approaches.
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Affiliation(s)
- Jing Hu
- Department of Gynecology, Shanghai First Maternity and Infant Hospital, Tongji University School of Medicine, Shanghai, China
| | - Jing Sun
- Department of Gynecology, Shanghai First Maternity and Infant Hospital, Tongji University School of Medicine, Shanghai, China
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Corassa M, Guimarães APG, Sanches SM, Fanelli MF, Rocha BMM, da Costa AABA, Alves V, Baiocchi G, Chinen LTD. Circulating tumor cells as a new and additional approach to follow-up patients with serous low-grade ovarian adenocarcinoma – a case report and review of the literature. ACTA ACUST UNITED AC 2017. [DOI: 10.1186/s41241-017-0030-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
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10
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Yang J, Zhou Y, Ng SK, Huang KC, Ni X, Choi PW, Hasselblatt K, Muto MG, Welch WR, Berkowitz RS, Ng SW. Characterization of MicroRNA-200 pathway in ovarian cancer and serous intraepithelial carcinoma of fallopian tube. BMC Cancer 2017. [PMID: 28623900 PMCID: PMC5473983 DOI: 10.1186/s12885-017-3417-z] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Ovarian cancer is the leading cause of death among gynecologic diseases in Western countries. We have previously identified a miR-200-E-cadherin axis that plays an important role in ovarian inclusion cyst formation and tumor invasion. The purpose of this study was to determine if the miR-200 pathway is involved in the early stages of ovarian cancer pathogenesis by studying the expression levels of the pathway components in a panel of clinical ovarian tissues, and fallopian tube tissues harboring serous tubal intraepithelial carcinomas (STICs), a suggested precursor lesion for high-grade serous tumors. METHODS RNA prepared from ovarian and fallopian tube epithelial and stromal fibroblasts was subjected to quantitative real-time reverse-transcription polymerase chain reaction (qRT-PCR) to determine the expression of miR-200 families, target and effector genes and analyzed for clinical association. The effects of exogenous miR-200 on marker expression in normal cells were determined by qRT-PCR and fluorescence imaging after transfection of miR-200 precursors. RESULTS Ovarian epithelial tumor cells showed concurrent up-regulation of miR-200, down-regulation of the four target genes (ZEB1, ZEB2, TGFβ1 and TGFβ2), and up-regulation of effector genes that were negatively regulated by the target genes. STIC tumor cells showed a similar trend of expression patterns, although the effects did not reach significance because of small sample sizes. Transfection of synthetic miR-200 precursors into normal ovarian surface epithelial (OSE) and fallopian tube epithelial (FTE) cells confirmed reduced expression of the target genes and elevated levels of the effector genes CDH1, CRB3 and EpCAM in both normal OSE and FTE cells. However, only FTE cells had a specific induction of CA125 after miR-200 precursor transfection. CONCLUSIONS The activation of the miR-200 pathway may be an early event that renders the OSE and FTE cells more susceptible to oncogenic mutations and histologic differentiation. As high-grade serous ovarian carcinomas (HGSOC) usually express high levels of CA125, the induction of CA125 expression in FTE cells by miR-200 precursor transfection is consistent with the notion that HGSOC has an origin in the distal fallopian tube.
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Affiliation(s)
- Junzheng Yang
- Department of Obstetrics/Gynecology and Reproductive Biology, Brigham and Women's Hospital, Boston, MA, 02115, USA
| | - Yilan Zhou
- Department of Obstetrics/Gynecology and Reproductive Biology, Brigham and Women's Hospital, Boston, MA, 02115, USA
| | - Shu-Kay Ng
- School of Medicine and Menzies Health Institute Queensland, Griffith University, QLD, Nathan, 4111, Australia
| | - Kuan-Chun Huang
- Department of Obstetrics/Gynecology and Reproductive Biology, Brigham and Women's Hospital, Boston, MA, 02115, USA
| | - Xiaoyan Ni
- Department of Obstetrics/Gynecology and Reproductive Biology, Brigham and Women's Hospital, Boston, MA, 02115, USA
| | - Pui-Wah Choi
- Department of Obstetrics/Gynecology and Reproductive Biology, Brigham and Women's Hospital, Boston, MA, 02115, USA
| | - Kathleen Hasselblatt
- Department of Obstetrics/Gynecology and Reproductive Biology, Brigham and Women's Hospital, Boston, MA, 02115, USA
| | - Michael G Muto
- Department of Obstetrics/Gynecology and Reproductive Biology, Brigham and Women's Hospital, Boston, MA, 02115, USA
| | - William R Welch
- Department of Pathology, Brigham and Women's Hospital, Boston, MA, 02115, USA
| | - Ross S Berkowitz
- Department of Obstetrics/Gynecology and Reproductive Biology, Brigham and Women's Hospital, Boston, MA, 02115, USA
| | - Shu-Wing Ng
- Department of Obstetrics/Gynecology and Reproductive Biology, Brigham and Women's Hospital, Boston, MA, 02115, USA. .,Laboratory of Gynecologic Oncology, Brigham and Women's Hospital, 221 Longwood Avenue, Boston, MA, 02115, USA.
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Gershenson DM. Management of borderline ovarian tumours. Best Pract Res Clin Obstet Gynaecol 2017; 41:49-59. [DOI: 10.1016/j.bpobgyn.2016.09.012] [Citation(s) in RCA: 44] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2016] [Revised: 08/21/2016] [Accepted: 09/07/2016] [Indexed: 11/29/2022]
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Chen X, Fang C, Zhu T, Zhang P, Yu A, Wang S. Identification of factors that impact recurrence in patients with borderline ovarian tumors. J Ovarian Res 2017; 10:23. [PMID: 28376898 PMCID: PMC5379723 DOI: 10.1186/s13048-017-0316-5] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2017] [Accepted: 03/21/2017] [Indexed: 11/25/2022] Open
Abstract
Background The lack of consensus around best practices for management of borderline ovarian tumors (BOT) is, in part, to the lack of available data and of clarity in interpreting relationships among various factors that impact outcomes. The objective of this study was to identify clinicopathological factors that impact prognosis of patients with borderline ovarian tumors (BOT) and to address features of this disease with the objective of providing clarity in decision making around management of BOT. Results A total of 178 BOT patients were included in this study, with a median age of 43 years and a median follow-up time of 37 months. Thirty-two (18.0%) recurrences and 5 (2.8%) deaths were observed in this study group. Multivariate analysis showed that fertility-preserving surgery (P = 0.0223 for bilateral cystectomy) and invasive implants (P = 0.0030) were significantly associated with worse PFS, whereas lymphadenectomy (P = 0.0129) was related to improved PFS. No factors were found to be associated with OS due to the limited number of deaths. In addition, patients with serous BOT more commonly had abnormal levels of CA125, while patients with mucinous BOT more commonly had abnormal levels of CEA. Patients with abnormal levels of CA125, or CA19-9, or HE4 had significantly larger tumor sizes. Conclusions Our study reveals the impact of certain types of fertility-preserving surgery, lymphadenectomy and invasive implants on PFS of BOT patients. Blood cancer markers may be associated with histology and size of BOT. Our findings may assist in selection of optimum treatment for BOT patients. Electronic supplementary material The online version of this article (doi:10.1186/s13048-017-0316-5) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Xi Chen
- Department of Gynecologic Oncology, Zhejiang Cancer Hospital, 1 Banshan East Road, Hangzhou, Zhejiang, 310022, China
| | - Chenyan Fang
- Department of Gynecologic Oncology, Zhejiang Cancer Hospital, 1 Banshan East Road, Hangzhou, Zhejiang, 310022, China
| | - Tao Zhu
- Department of Gynecologic Oncology, Zhejiang Cancer Hospital, 1 Banshan East Road, Hangzhou, Zhejiang, 310022, China
| | - Ping Zhang
- Department of Gynecologic Oncology, Zhejiang Cancer Hospital, 1 Banshan East Road, Hangzhou, Zhejiang, 310022, China
| | - Aijun Yu
- Department of Gynecologic Oncology, Zhejiang Cancer Hospital, 1 Banshan East Road, Hangzhou, Zhejiang, 310022, China.
| | - Shihua Wang
- Department of Cancer Biology, Wake Forest School of Medicine, Winston Salem, NC, 27157, USA
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Gao Y, Liu X, Li T, Wei L, Yang A, Lu Y, Zhang J, Li L, Wang S, Yin F. Cross-validation of genes potentially associated with overall survival and drug resistance in ovarian cancer. Oncol Rep 2017; 37:3084-3092. [DOI: 10.3892/or.2017.5534] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2016] [Accepted: 03/15/2017] [Indexed: 11/05/2022] Open
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Pradjatmo H, Pradjatmo H. Impact of Preoperative Serum Levels of CA 125 on Epithelial Ovarian Cancer Survival. Asian Pac J Cancer Prev 2017; 17:1881-6. [PMID: 27221870 DOI: 10.7314/apjcp.2016.17.4.1881] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND CA125 is very helpful in treatment monitoring and detection of epithelial ovarian cancer (EOC) recurrence. However there is controversy as to its accuracy and optimal usage. What is the impact of the CA125 levels before primary surgery treatment to the survival of patients? This study aimed to detect any association of preoperative serum levels with prognosis and survival in EOC patients. MATERIALS AND METHODS Our cohort comprised EOC patients in Dr. Sardjito Hospital, Yogyakarta, Indonesia, who complied with follow up. To explore the effect of preoperative CA125 levels and other variables on survival Cox's regression models were applied. RESULTS A total of 90 cases of EOC who had surgery were available for follow up. The level of CA125 poroved to be a prognostic factor for overall survival of EOC patients, with an adjusted HR of 4.10 (p = 0.03). Adjuvant chemotherapy was another prognostic factor, 1 - 2 cycles having an adjusted HR of 0.17 (p = 0.04) and 3 - 8 cycles HR 0.39 (p = 0.06). Other factors such as age of patients adjusted HR 1.54 (p = 0.32), moderate differentiation (adjusted HR 1.61, p = 0.51) poor differentiation (adjusted HR 3.41, p = 0.15), and stage of disease (adjusted HR 1.98, p = 0.27) were statistically not significant. However, this might have been because the power of the study was low. CONCLUSIONS Preoperative level of CA125 is a prognostic factor for overall survival in EOC patients. The best cut-off for prognostic classification of CA125 serum level is 70 U/ml.
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Affiliation(s)
- Heru Pradjatmo
- Obstetric and Gynecology Department, Faculty of Medicine, Universitas Gadjah Mada and Sardjito Central Hospital, Yogyakarta, Indonesia E-mail :
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The Factors Predicting Recurrence in Patients With Serous Borderline Ovarian Tumor. Int J Gynecol Cancer 2016; 26:66-72. [PMID: 26512785 DOI: 10.1097/igc.0000000000000568] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
OBJECTIVE In this study, we aimed to demonstrate the characteristics, recurrence rates, survival, and factors associated with survival of patients with serous borderline ovarian tumor (BOT) who were operated on in a single institution. Our secondary goal was to evaluate the necessity of staging surgery and the importance of a comprehensive lymphadenectomy in these patients. MATERIALS AND METHODS The patients who were diagnosed in our institution between January 1990 and April 2014 with a final diagnosis of serous BOT were evaluated retrospectively. Kaplan-Meier method was used for analysis of progression-free survival (PFS). Univariate Cox proportional hazards model and log rank test were used for analysis of continuous and categorical variables affecting survival, respectively. RESULTS One hundred twenty-one (75%) patients underwent staging surgery. Stage I disease was observed in 63%, stage III was observed in 11% of the patients, and only 0.6% of patients had stage II disease. Among 162 patients, 72 patients (44%) had conservative surgery. Eight (4.9%) patients had recurrence, one of which was invasive. All recurrences were in the patients who had conservative surgery. Median follow-up of the patients was 57 months (range, 37-270 years). Five- and 10-year PFS rates were 94.9% and 92.8%, respectively. In the univariate analysis of patients with serous BOT, PFS was worse in the presence of positive para-aortic lymph nodes, positive abdominal cytology, and conservative surgery (P = 0.008, P < 0.001, P = 0.007, respectively). The patients having noninvasive implant and advanced-stage disease had a tendency to have worse PFS (P = 0.067, P = 0.069, respectively). CONCLUSIONS Staging surgery generally gives us an idea of the probability of recurrence but not an idea of overall survival. Therefore, staging surgery including lymphadenectomy could be suggested to have information about the probability of recurrence and to be able to detect patients with an invasive implant that is the only probable factor affecting overall survival.
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Shazly SAM, Laughlin-Tommaso SK, Dowdy SC, Famuyide AO. Staging for low malignant potential ovarian tumors: a global perspective. Am J Obstet Gynecol 2016; 215:153-168.e2. [PMID: 27131584 DOI: 10.1016/j.ajog.2016.04.035] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2015] [Revised: 03/03/2016] [Accepted: 04/19/2016] [Indexed: 12/17/2022]
Abstract
OBJECTIVE We describe current evidence for staging low malignant potential ovarian tumors and their conformity to current consensus guidelines and practice from an international perspective. DATA SOURCES A search of MEDLINE, EMBASE, and SCOPUS databases was conducted for articles published between January 1990 and April 2015. STUDY ELIGIBILITY CRITERIA Studies on low malignant potential ovarian tumors that evaluated the prognostic value of disease stage, staging vs no staging, complete vs incomplete staging, or discrete components of staging were eligible. Studies that described only crude survival rates were excluded. STUDY APPRAISAL AND SYNTHESIS METHODS Eligible studies were categorized according to their outcome (disease stage, staging procedure, or discrete staging elements). Data were abstracted using a standard form. Inconsistencies on data abstraction were resolved by consensus among the authors. Risk of bias was assessed using the Newcastle-Ottawa Scale. RESULTS Of 1116 studies, 702 were excluded for irrelevance and 364 for not meeting inclusion criteria. Nine studies were excluded for describing crude survival rates without a comparative conclusion. We found that studies supporting the value of defining disease stage or staging procedures (mostly conducted in northern Europe) included more patients than studies that did not find disease stage or staging useful (predominantly from North America, 4072 vs 3951). Disease stage correlated with survival in 13 of 25 studies, whereas none of the studies that evaluated the value of staging found it beneficial (9 studies, 1979 patients). Studies that evaluated isolated components of staging found no benefit to these procedures. Regional guidelines and consensus reviews drew conclusions based on a limited number of studies that generally originated from the same region. CONCLUSIONS Although the correlation of stage with survival was mixed, performing staging procedures for low malignant potential ovarian tumors is not supported by the best available evidence. Guidelines in support of staging based their recommendations on a few regional studies and conflict with better-quality data that do not support staging procedures. An international consensus statement is needed to standardize the surgical management of low malignant potential ovarian tumors.
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Affiliation(s)
- Sherif A M Shazly
- Division of Minimally Invasive Gynecologic Surgery, Department of Obstetrics and Gynecology, Mayo Clinic, Rochester, MN; Department of Obstetrics and Gynecology, Women Health Hospital, Assiut University, Assiut Egypt
| | - Shannon K Laughlin-Tommaso
- Division of Minimally Invasive Gynecologic Surgery, Department of Obstetrics and Gynecology, Mayo Clinic, Rochester, MN
| | - Sean C Dowdy
- Department of Obstetrics and Gynecology, and Division of Gynecologic Surgery, Department of Obstetrics and Gynecology, Mayo Clinic, Rochester, MN
| | - Abimbola O Famuyide
- Division of Minimally Invasive Gynecologic Surgery, Department of Obstetrics and Gynecology, Mayo Clinic, Rochester, MN.
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Clinicopathological aspects of patients with recurrence of borderline ovarian tumors. Obstet Gynecol Sci 2015; 58:98-105. [PMID: 25798422 PMCID: PMC4366876 DOI: 10.5468/ogs.2015.58.2.98] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2014] [Revised: 08/12/2014] [Accepted: 09/02/2014] [Indexed: 11/08/2022] Open
Abstract
OBJECTIVE Despite the good prognosis of borderline ovarian tumors (BOTs), a few BOT patients experience the relapse of disease, either borderline or malignant. However, the risk of recurrence of BOTs is somewhat controversial. We intended to find out the specific characteristics and prognosis of the recurrence of BOTs. METHODS Between 1995 and 2012, 130 women were diagnosed with BOTs at a single institution. Eleven patients diagnosed and treated for the recurrence of BOTs including seven cancerous and four borderline relapses were included for the analysis in this retrospective study. Clinicopathological characteristics and surgical procedures as well as follow-up data with overall survival were assessed. Statistical analyses was performed using the χ(2) test, t-test and log-rank test with Cox regression. RESULTS One hundred and thirty patients with mean follow-up of 65.8 months were evaluated, of whom half were below 40 years old at their first diagnosis of BOTs. Among 11 recurrent cases (8.5%), 7 cancerous transformations (5.4%) and 4 borderline recurrences (3.1%) were detected with median time of 6 and 71 months after the primary surgery, respectively. Nine out of 11 recurrences were happened at their equal or below 40-years-old age at the primary diagnosis (P=0.027). Also, all 7 cancerous relapses arose from premenopausal women of median age of 35 years old. Twenty (15%) patients had laparoscopic surgery and they were all treated conservatively. Among those 20, 5 were suffered from relapse of BOTs and laparoscopic approach was proved to be a significant risk factor for disease relapse in our study (P=0.013). Although laparoscopic surgery was revealed had meaningful influence on disease free survival (P=0.024), it was not significant on overall survival (P=0.226). CONCLUSION Laparoscopic conservative surgery for BOTs can be accepted under close follow-ups. And younger patients should be followed for long period to evaluate recurrence.
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Rizzuto I, Stavraka C, Chatterjee J, Borley J, Hopkins TG, Gabra H, Ghaem-Maghami S, Huson L, Blagden SP. Risk of Ovarian Cancer Relapse score: a prognostic algorithm to predict relapse following treatment for advanced ovarian cancer. Int J Gynecol Cancer 2015; 25:416-22. [PMID: 25647256 PMCID: PMC4340599 DOI: 10.1097/igc.0000000000000361] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2014] [Revised: 10/23/2014] [Accepted: 12/07/2014] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVE The aim of this study was to construct a prognostic index that predicts risk of relapse in women who have completed first-line treatment for ovarian cancer (OC). METHODS A database of OC cases from 2000 to 2010 was interrogated for International Federation of Gynecology and Obstetrics stage, grade and histological subtype of cancer, preoperative and posttreatment CA-125 level, presence or absence of residual disease after cytoreductive surgery and on postchemotherapy computed tomography scan, and time to progression and death. The strongest predictors of relapse were included into an algorithm, the Risk of Ovarian Cancer Relapse (ROVAR) score. RESULTS Three hundred fifty-four cases of OC were analyzed to generate the ROVAR score. Factors selected were preoperative serum CA-125, International Federation of Gynecology and Obstetrics stage and grade of cancer, and presence of residual disease at posttreatment computed tomography scan. In the validation data set, the ROVAR score had a sensitivity and specificity of 94% and 61%, respectively. The concordance index for the validation data set was 0.91 (95% confidence interval, 0.85-0.96). The score allows patient stratification into low (<0.33), intermediate (0.34-0.67), and high (>0.67) probability of relapse. CONCLUSIONS The ROVAR score stratifies patients according to their risk of relapse following first-line treatment for OC. This can broadly facilitate the appropriate tailoring of posttreatment care and support.
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Affiliation(s)
- Ivana Rizzuto
- *Imperial College Healthcare NHS Trust, Garry Weston Cancer Centre, and †Ovarian Cancer Action Research Centre, Hammersmith Hospital; and ‡Division of Experimental Medicine, Imperial College London, Hammersmith Campus, London, United Kingdom
| | - Chara Stavraka
- *Imperial College Healthcare NHS Trust, Garry Weston Cancer Centre, and †Ovarian Cancer Action Research Centre, Hammersmith Hospital; and ‡Division of Experimental Medicine, Imperial College London, Hammersmith Campus, London, United Kingdom
| | - Jayanta Chatterjee
- *Imperial College Healthcare NHS Trust, Garry Weston Cancer Centre, and †Ovarian Cancer Action Research Centre, Hammersmith Hospital; and ‡Division of Experimental Medicine, Imperial College London, Hammersmith Campus, London, United Kingdom
| | - Jane Borley
- *Imperial College Healthcare NHS Trust, Garry Weston Cancer Centre, and †Ovarian Cancer Action Research Centre, Hammersmith Hospital; and ‡Division of Experimental Medicine, Imperial College London, Hammersmith Campus, London, United Kingdom
| | - Thomas Glass Hopkins
- *Imperial College Healthcare NHS Trust, Garry Weston Cancer Centre, and †Ovarian Cancer Action Research Centre, Hammersmith Hospital; and ‡Division of Experimental Medicine, Imperial College London, Hammersmith Campus, London, United Kingdom
| | - Hani Gabra
- *Imperial College Healthcare NHS Trust, Garry Weston Cancer Centre, and †Ovarian Cancer Action Research Centre, Hammersmith Hospital; and ‡Division of Experimental Medicine, Imperial College London, Hammersmith Campus, London, United Kingdom
| | - Sadaf Ghaem-Maghami
- *Imperial College Healthcare NHS Trust, Garry Weston Cancer Centre, and †Ovarian Cancer Action Research Centre, Hammersmith Hospital; and ‡Division of Experimental Medicine, Imperial College London, Hammersmith Campus, London, United Kingdom
| | - Les Huson
- *Imperial College Healthcare NHS Trust, Garry Weston Cancer Centre, and †Ovarian Cancer Action Research Centre, Hammersmith Hospital; and ‡Division of Experimental Medicine, Imperial College London, Hammersmith Campus, London, United Kingdom
| | - Sarah P. Blagden
- *Imperial College Healthcare NHS Trust, Garry Weston Cancer Centre, and †Ovarian Cancer Action Research Centre, Hammersmith Hospital; and ‡Division of Experimental Medicine, Imperial College London, Hammersmith Campus, London, United Kingdom
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Trillsch F, Mahner S, Vettorazzi E, Woelber L, Reuss A, Baumann K, Keyver-Paik MD, Canzler U, Wollschlaeger K, Forner D, Pfisterer J, Schroeder W, Muenstedt K, Richter B, Fotopoulou C, Schmalfeldt B, Burges A, Ewald-Riegler N, de Gregorio N, Hilpert F, Fehm T, Meier W, Hillemanns P, Hanker L, Hasenburg A, Strauss HG, Hellriegel M, Wimberger P, Kommoss S, Kommoss F, Hauptmann S, du Bois A. Surgical staging and prognosis in serous borderline ovarian tumours (BOT): a subanalysis of the AGO ROBOT study. Br J Cancer 2015; 112:660-6. [PMID: 25562434 PMCID: PMC4333495 DOI: 10.1038/bjc.2014.648] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2014] [Revised: 11/27/2014] [Accepted: 12/06/2014] [Indexed: 01/13/2023] Open
Abstract
BACKGROUND Incomplete surgical staging is a negative prognostic factor for patients with borderline ovarian tumours (BOT). However, little is known about the prognostic impact of each individual staging procedure. METHODS Clinical parameters of 950 patients with BOT (confirmed by central reference pathology) treated between 1998 and 2008 at 24 German AGO centres were analysed. In 559 patients with serous BOT and adequate ovarian surgery, further recommended staging procedures (omentectomy, peritoneal biopsies, cytology) were evaluated applying Cox regression models with respect to progression-free survival (PFS). RESULTS For patients with one missing staging procedure, the hazard ratio (HR) for recurrence was 1.25 (95%-CI 0.66-2.39; P=0.497). This risk increased with each additional procedure skipped reaching statistical significance in case of two (HR 1.95; 95%-CI 1.06-3.58; P=0.031) and three missing steps (HR 2.37; 95%-CI 1.22-4.64; P=0.011). The most crucial procedure was omentectomy which retained a statistically significant impact on PFS in multiple analysis (HR 1.91; 95%-CI 1.15-3.19; P=0.013) adjusting for previously established prognostic factors as FIGO stage, tumour residuals, and fertility preservation. CONCLUSION Individual surgical staging procedures contribute to the prognosis for patients with serous BOT. In this analysis, recurrence risk increased with each skipped surgical step. This should be considered when re-staging procedures following incomplete primary surgery are discussed.
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Affiliation(s)
- F Trillsch
- Universitaetsklinikum Hamburg-Eppendorf, Klinik und Poliklinik fuer Gynaekologie, Martinistr. 52, 20246 Hamburg, Germany
| | - S Mahner
- Universitaetsklinikum Hamburg-Eppendorf, Klinik und Poliklinik fuer Gynaekologie, Martinistr. 52, 20246 Hamburg, Germany
| | - E Vettorazzi
- Universitaetsklinikum Hamburg-Eppendorf, Institut fuer Medizinische Biometrie und Epidemiologie, Martinistr. 52, 20246 Hamburg, Germany
| | - L Woelber
- Universitaetsklinikum Hamburg-Eppendorf, Klinik und Poliklinik fuer Gynaekologie, Martinistr. 52, 20246 Hamburg, Germany
| | - A Reuss
- Philipps-Universitaet Marburg, Koordinierungszentrum fuer Klinische Studien, Karl-von-Frisch-Str. 4, 35043 Marburg, Germany
| | - K Baumann
- Universitaetsklinikum Giessen u. Marburg GmbH, Klinik fuer Gynaekologie, Gyn. Endokrinologie und Onkologie, Baldingerstr., 35043 Marburg, Germany
| | - M-D Keyver-Paik
- Rheinische Friedrich-Wilhelms-Universitaet, Universitaets-Frauenklinik, Sigmund-Freud-Str. 25, 53127 Bonn, Germany
| | - U Canzler
- Technische Universitaet Dresden, Klinik und Poliklinik fuer Frauenheilkunde und Geburtshilfe, Fetscherstr. 74, 01307 Dresden, Germany
| | - K Wollschlaeger
- Universitaetsklinikum Magdeburg, Universitaets-Frauenklinik, Gerhart-Hauptmann-Str. 35, 39108 Magdeburg, Germany
| | - D Forner
- Sana-Klinikum Remscheid, Klinik fuer Frauenheilkunde und Geburtsmedizin, Burger Strasse 211, 42859 Remscheid, Germany
| | - J Pfisterer
- 1] Staedtisches Klinikum Solingen gGmbH, Klinik fuer Gynaekologie und Geburtshilfe, Gotenstrasse 1, 42653 Solingen, Germany [2] Zentrum fuer Gynaekologische Onkologie, Herzog-Friedrich-Str. 21, 24103 Kiel, Germany
| | - W Schroeder
- GYNAEKOLOGICUM Bremen, Schwachhauser Heerstrasse 367, 28211 Bremen, Germany
| | - K Muenstedt
- Universitaetsklinikum Giessen, Zentrum fuer Frauenheilkunde und Geburtshilfe, Klinikstrasse 33, 35352 Giessen, Germany
| | - B Richter
- Elblandkliniken Meissen-Radebeul GmbH & Co. KG, Frauenklinik, Heinrich-Zille-Str. 13, 01445 Radebeul, Germany
| | - C Fotopoulou
- Charité, Campus Virchow Klinikum, Frauenklinik, Augustenburger Platz 1, 13353 Berlin, Germany
| | - B Schmalfeldt
- Klinikum rechts der Isar der Technischen Universitaet, Frauen- und Poliklinik, Ismaninger Str. 22, 81675 Munich, Germany
| | - A Burges
- Klinikum der Universitaet Muenchen, Campus Grosshadern, Klinik und Poliklinik fuer Frauenheilkunde und Geburtshilfe, Marchioninistr.15, 81377 Munich, Germany
| | - N Ewald-Riegler
- Dr Horst Schmidt Klinik GmbH, Klinik fuer Gynaekologie und gynaekologische Onkologie, Ludwig-Erhard-Str. 100, 65199 Wiesbaden, Germany
| | - N de Gregorio
- Universitaetsklinikum Ulm, Frauenklinik, Prittwitzstrasse 43, 89075 Ulm, Germany
| | - F Hilpert
- Universitaetsklinikum Schleswig-Holstein, Campus Kiel, Klinik fuer Gynaekologie und Geburtshilfe, Michaelisstrasse 16, 24105 Kiel, Germany
| | - T Fehm
- 1] Universitaetsklinikum Tuebingen, Department fuer Frauengesundheit, Calwerstrasse 7, 72076 Tuebingen, Germany [2] Universitaetsklinikum Duesseldorf, Universitaetsfrauenklinik, Moorenstrasse 5, 40225 Duesseldorf, Germany
| | - W Meier
- Evangelisches Krankenhaus, Frauenklinik, Kirchfeldstrasse 40, 40217 Duesseldorf, Germany
| | - P Hillemanns
- Medizinische Hochschule Hannover, Frauenklinik, Carl-Neuberg-Str. 1, 30625 Hannover, Germany
| | - L Hanker
- 1] Klinikum der J.W. Goethe-Universitaet, Zentrum fuer Frauenheilkunde und Geburtshilfe, Theodor-Stern-Kai 7, 60590 Frankfurt am Main, Germany [2] Universitaetsklinikum Schleswig-Holstein, Campus Luebeck, Klinik fuer Gynaekologie und Geburtshilfe, Ratzeburger Allee 160, 23562 Luebeck, Germany
| | - A Hasenburg
- Universitaetsklinikum Freiburg, Frauenklinik, Hugstetter Str. 55, 79106 Freiburg im Breisgau, Germany
| | - H-G Strauss
- Universitaetsklinikum Halle (Saale), Universitaetsklinik und Poliklinik fuer Gynaekologie, Ernst-Grube-Str. 40, 06120 Halle (Saale), Germany
| | - M Hellriegel
- Georg-August-Universitaet Goettingen, Gynaekologie und Geburtshilfe, Robert-Koch-Str. 40, 37075 Goettingen, Germany
| | - P Wimberger
- 1] Technische Universitaet Dresden, Klinik und Poliklinik fuer Frauenheilkunde und Geburtshilfe, Fetscherstr. 74, 01307 Dresden, Germany [2] Universitaetsklinikum Essen, Klinik fuer Frauenheilkunde und Geburtshilfe, Essen, Germany
| | - S Kommoss
- 1] Dr Horst Schmidt Klinik GmbH, Klinik fuer Gynaekologie und gynaekologische Onkologie, Ludwig-Erhard-Str. 100, 65199 Wiesbaden, Germany [2] Universitaetsklinikum Tuebingen, Department fuer Frauengesundheit, Calwerstrasse 7, 72076 Tuebingen, Germany
| | - F Kommoss
- Institut fuer Pathologie, Referenzzentrum fuer Gynaekopathologie, A2,2, 68159 Mannheim, Germany
| | - S Hauptmann
- 1] Universitaetsklinikum Halle (Saale), Universitaetsklinik und Poliklinik fuer Gynaekologie, Ernst-Grube-Str. 40, 06120 Halle (Saale), Germany [2] Institut fuer Pathologie Trier-Dueren-Duesseldorf, Roonstrasse 30, 52351 Dueren, Germany
| | - A du Bois
- Kliniken Essen-Mitte, Klinik fuer Gynaekologische Onkologie, Henricistrasse 92, 45136 Essen, Germany
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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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Trillsch F, Mahner S, Woelber L, Vettorazzi E, Reuss A, Ewald-Riegler N, de Gregorio N, Fotopoulou C, Schmalfeldt B, Burges A, Hilpert F, Fehm T, Meier W, Hillemanns P, Hanker L, Hasenburg A, Strauss HG, Hellriegel M, Wimberger P, Baumann K, Keyver-Paik MD, Canzler U, Wollschlaeger K, Forner D, Pfisterer J, Schroeder W, Muenstedt K, Richter B, Kommoss F, Hauptmann S, du Bois A. Age-dependent differences in borderline ovarian tumours (BOT) regarding clinical characteristics and outcome: results from a sub-analysis of the Arbeitsgemeinschaft Gynaekologische Onkologie (AGO) ROBOT study. Ann Oncol 2014; 25:1320-1327. [PMID: 24618151 DOI: 10.1093/annonc/mdu119] [Citation(s) in RCA: 54] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND Approximately one-third of all borderline ovarian tumours (BOT) are diagnosed in patients with child-bearing potential. Detailed information regarding their specific characteristics and prognostic factors is limited. METHODS Clinical parameters of BOT patients treated between 1998 and 2008 in 24 German centres were retrospectively investigated. Central pathology review and prospective follow-up were carried out. Patients <40 versus ≥40 years were analysed separately and then compared regarding clinico-pathological variables and prognosis. RESULTS A total of 950 BOT patients with a median age of 49.1 (14.1-91.5) years were analysed [280 patients <40 years (29.5%), 670 patients ≥40 years (70.5%)]. Fertility-preserving surgery was carried out in 53.2% (149 of 280) of patients <40 years with preservation of the primarily affected ovary in 32 of these 149 cases (21.5%). Recurrence was significantly more frequent in patients <40 years (19.0% versus 10.1% 5-year recurrence rate, P < 0.001), usually in ovarian tissue, whereas disease-specific overall survival did not differ between the subgroups. In case of recurrent disease, malignant transformation was less frequent in younger than in older patients (12.0% versus 66.7%, P < 0.001), mostly presenting as invasive peritoneal carcinomatosis. Multivariate analysis for patients <40 years identified advanced International Federation of Gynecology and Obstetrics (FIGO) stage and fertility-sparing approach as independent prognostic factors negatively affecting progression-free survival (PFS) while, for patients ≥40 years, higher FIGO stage and incomplete staging was associated with impaired PFS. CONCLUSIONS Despite favourable survival, young BOT patients with child-bearing potential are at higher risk for disease recurrence. However, relapses usually remain BOT in the preserved ovaries as opposed to older patients being at higher risk for malignant transformation in peritoneal or distant localisation. Therefore, fertility-sparing approach can be justified for younger patients after thorough consultation.
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Affiliation(s)
- F Trillsch
- Department of Gynaecology and Gynaecologic Oncology
| | - S Mahner
- Department of Gynaecology and Gynaecologic Oncology.
| | - L Woelber
- Department of Gynaecology and Gynaecologic Oncology
| | - E Vettorazzi
- Department of Medical Biometry and Epidemiology, Universitätsklinikum Hamburg-Eppendorf, Hamburg
| | - A Reuss
- Department of Coordinating Center for Clinical Trials, Marburg
| | - N Ewald-Riegler
- Department of Gynaecology and Gynaecologic Oncology, Dr Horst Schmidt Klinik GmbH, Wiesbaden
| | - N de Gregorio
- Department of Gynaecolgy and Obstetrics, Universitätsklinikum Ulm, Ulm
| | - C Fotopoulou
- Department of Gynaecolgy, Charité, Campus Virchow Klinikum, Berlin
| | - B Schmalfeldt
- Department of Obstetrics and Gynaecolgy, Klinikum Rechts der Isar der Technischen Universität, Munich
| | - A Burges
- Department of Obstetrics and Gynaecolgy, Klinikum der Universität München, Munich
| | - F Hilpert
- Department of Gynaecolgy and Obstetrics, Universitätsklinikum Schleswig-Holstein, Kiel
| | - T Fehm
- Department of Gynaecolgy and Obstetrics, Universitätsklinikum Tübingen, Tuebingen
| | - W Meier
- Department of Gynaecolgy and Obstetrics, Evangelisches Krankenhaus, Duesseldorf
| | - P Hillemanns
- Department of Gynaecolgy and Obstetrics, Medizinische Hochschule Hannover, Hannover
| | - L Hanker
- Department of Gynaecolgy and Obstetrics, Klinikum der J.W. Goethe-Universität, Frankfurt/M; Department of Gynaecolgy and Obstetrics, Universitätsklinikum Schleswig-Holstein, Luebeck
| | - A Hasenburg
- Department of Obstetrics and Gynaecolgy, Universitätsklinikum Freiburg, Freiburg
| | - H G Strauss
- Department of Gynaecolgy and Obstetrics, Universitätsklinikum Halle/S., Halle/S
| | - M Hellriegel
- Department of Gynaecolgy and Obstetrics, Georg-August-Universität Göttingen, Goettingen
| | - P Wimberger
- Clinic of Gynaecolgy and Obstetrics, Universitätsklinikum Essen, Essen; Department of Gynaecolgy and Obstetrics, Universitätsklinikum Carl Gustav Carus, Dresden
| | - K Baumann
- Department of Gynaecolgy, Endocrinology and Oncology, Universitätsklinikum Gießen u. Marburg GmbH, Marburg
| | - M D Keyver-Paik
- Department of Obstetrics and Gynaecolgy, Rheinische Friedrich-Wilhelms-Universität, Bonn
| | - U Canzler
- Department of Gynaecolgy and Obstetrics, Universitätsklinikum Carl Gustav Carus, Dresden
| | - K Wollschlaeger
- Department of Gynaecolgy and Obstetrics, Universitätsklinikum Magdeburg, Magdeburg
| | - D Forner
- Department of Gynaecolgy and Obstetrics, Sana-Klinikum Remscheid, Remscheid
| | - J Pfisterer
- Department of Gynaecolgy and Obstetrics, Städtisches Klinikum Solingen gGmbH, Solingen; Zentrum für Gynäkologische Onkologie, Kiel
| | | | - K Muenstedt
- Department of Obstetrics and Gynaecolgy, Universitätsklinikum Gießen, Gießen
| | - B Richter
- Department of Gynaecology and Obstetrics, Elblandkliniken Meißen-Radebeul GmbH & Co. KG, Radebeul
| | - F Kommoss
- Institute of Pathology, Referenzzentrum für Gynäkopathologie, Mannheim
| | - S Hauptmann
- Department of Gynaecolgy and Obstetrics, Universitätsklinikum Halle/S., Halle/S; Institute of Pathology, Trier-Dueren-Duesseldorf, Dueren
| | - A du Bois
- Department of Gynaecolgy and Gynaecolgic Oncology, Kliniken Essen-Mitte, Essen, Germany
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Wang J, Sharma A, Ghamande SA, Bush S, Ferris D, Zhi W, He M, Wang M, Wang X, Miller E, Hopkins D, Macfee M, Guan R, Tang J, She JX. Serum protein profile at remission can accurately assess therapeutic outcomes and survival for serous ovarian cancer. PLoS One 2013; 8:e78393. [PMID: 24244307 PMCID: PMC3823861 DOI: 10.1371/journal.pone.0078393] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2013] [Accepted: 09/11/2013] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Biomarkers play critical roles in early detection, diagnosis and monitoring of therapeutic outcome and recurrence of cancer. Previous biomarker research on ovarian cancer (OC) has mostly focused on the discovery and validation of diagnostic biomarkers. The primary purpose of this study is to identify serum biomarkers for prognosis and therapeutic outcomes of ovarian cancer. EXPERIMENTAL DESIGN Forty serum proteins were analyzed in 70 serum samples from healthy controls (HC) and 101 serum samples from serous OC patients at three different disease phases: post diagnosis (PD), remission (RM) and recurrence (RC). The utility of serum proteins as OC biomarkers was evaluated using a variety of statistical methods including survival analysis. RESULTS Ten serum proteins (PDGF-AB/BB, PDGF-AA, CRP, sFas, CA125, SAA, sTNFRII, sIL-6R, IGFBP6 and MDC) have individually good area-under-the-curve (AUC) values (AUC = 0.69-0.86) and more than 10 three-marker combinations have excellent AUC values (0.91-0.93) in distinguishing active cancer samples (PD & RC) from HC. The mean serum protein levels for RM samples are usually intermediate between HC and OC patients with active cancer (PD & RC). Most importantly, five proteins (sICAM1, RANTES, sgp130, sTNFR-II and sVCAM1) measured at remission can classify, individually and in combination, serous OC patients into two subsets with significantly different overall survival (best HR = 17, p<10(-3)). CONCLUSION We identified five serum proteins which, when measured at remission, can accurately predict the overall survival of serous OC patients, suggesting that they may be useful for monitoring the therapeutic outcomes for ovarian cancer.
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Affiliation(s)
- Jinhua Wang
- Center for Biotechnology and Genomic Medicine, Georgia Health Sciences University, Augusta, Georgia, United States of America
- Sino-American Cancer Research Institute at Nanjing University of Technology and Jiangsu Cancer Hospital, Nanjing, Jiangsu province, China
- Jiangsu Cancer Hospital, Nanjing Medical University, Nanjing, Jiangsu, China
- Institute of Translational Medicine, School of Pharmaceutical Sciences, Nanjing University of Technology, Nanjing, Jiangsu province, China
| | - Ashok Sharma
- Center for Biotechnology and Genomic Medicine, Georgia Health Sciences University, Augusta, Georgia, United States of America
| | - Sharad A. Ghamande
- Department of Obstetrics and Gynecology, Georgia Health Sciences University, Augusta, Georgia, United States of America
| | - Stephen Bush
- Department of Obstetrics and Gynecology, Georgia Health Sciences University, Augusta, Georgia, United States of America
| | - Daron Ferris
- Department of Obstetrics and Gynecology, Georgia Health Sciences University, Augusta, Georgia, United States of America
| | - Wenbo Zhi
- Center for Biotechnology and Genomic Medicine, Georgia Health Sciences University, Augusta, Georgia, United States of America
| | - Mingfang He
- Center for Biotechnology and Genomic Medicine, Georgia Health Sciences University, Augusta, Georgia, United States of America
- Sino-American Cancer Research Institute at Nanjing University of Technology and Jiangsu Cancer Hospital, Nanjing, Jiangsu province, China
- Institute of Translational Medicine, School of Pharmaceutical Sciences, Nanjing University of Technology, Nanjing, Jiangsu province, China
| | - Meiyao Wang
- Center for Biotechnology and Genomic Medicine, Georgia Health Sciences University, Augusta, Georgia, United States of America
| | - Xiaoxiao Wang
- Center for Biotechnology and Genomic Medicine, Georgia Health Sciences University, Augusta, Georgia, United States of America
| | - Eric Miller
- Center for Biotechnology and Genomic Medicine, Georgia Health Sciences University, Augusta, Georgia, United States of America
| | - Diane Hopkins
- Center for Biotechnology and Genomic Medicine, Georgia Health Sciences University, Augusta, Georgia, United States of America
| | - Michael Macfee
- Department of Obstetrics and Gynecology, Georgia Health Sciences University, Augusta, Georgia, United States of America
| | - Ruili Guan
- Center for Biotechnology and Genomic Medicine, Georgia Health Sciences University, Augusta, Georgia, United States of America
- Institute of Urological Surgery, First Hospital of Beijing University, Beijing, China
| | - Jinhai Tang
- Sino-American Cancer Research Institute at Nanjing University of Technology and Jiangsu Cancer Hospital, Nanjing, Jiangsu province, China
- Jiangsu Cancer Hospital, Nanjing Medical University, Nanjing, Jiangsu, China
| | - Jin-Xiong She
- Center for Biotechnology and Genomic Medicine, Georgia Health Sciences University, Augusta, Georgia, United States of America
- Sino-American Cancer Research Institute at Nanjing University of Technology and Jiangsu Cancer Hospital, Nanjing, Jiangsu province, China
- Institute of Translational Medicine, School of Pharmaceutical Sciences, Nanjing University of Technology, Nanjing, Jiangsu province, China
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Nomogram to predict the probability of relapse in patients diagnosed with borderline ovarian tumors. Int J Gynecol Cancer 2013; 23:264-7. [PMID: 23295940 DOI: 10.1097/igc.0b013e31827b8844] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
OBJECTIVE This study aimed to develop a nomogram predicting the probability of relapse in individual patients who have surgery for borderline ovarian tumors (BOTs). METHODS This retrospective study included 801 patients with BOT diagnosed between 1985 and 2008 at 6 gynecologic cancer centers. We analyzed covariates that were associated with the risk of developing a recurrence by multivariate logistic regression. We identified a parsimonious model by backward stepwise logistic regression. The 5 most significant or clinically important variables associated with an increased risk of recurrence were included in the nomogram. The nomogram was internally validated. RESULTS Fifty-one patients developed a recurrence after a median observation period of 57 months. Age at diagnosis, the International Federation of Gynecology and Obstetrics stage, cell type, preoperative serum CA125, and type of surgery (radical vs fertility-sparing) were associated with an increased risk of recurrence and were used in the nomogram. Bootstrap-corrected concordance index was 0.67 and showed good calibration. CONCLUSIONS Five factors that are commonly available to clinicians treating patients with BOT were used in the development of a nomogram to predict the risk of recurrence. The nomogram will be useful to counsel patients about risk-reduction strategies to minimize the risk of recurrence or to inform patients about a very low risk of recurrence making intensive follow-up unwarranted.
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