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Bryant A, Hiu S, Kunonga PT, Gajjar K, Craig D, Vale L, Winter-Roach BA, Elattar A, Naik R. Impact of residual disease as a prognostic factor for survival in women with advanced epithelial ovarian cancer after primary surgery. Cochrane Database Syst Rev 2022; 9:CD015048. [PMID: 36161421 PMCID: PMC9512080 DOI: 10.1002/14651858.cd015048.pub2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
BACKGROUND Ovarian cancer is the seventh most common cancer among women and a leading cause of death from gynaecological malignancies. Epithelial ovarian cancer is the most common type, accounting for around 90% of all ovarian cancers. This specific type of ovarian cancer starts in the surface layer covering the ovary or lining of the fallopian tube. Surgery is performed either before chemotherapy (upfront or primary debulking surgery (PDS)) or in the middle of a course of treatment with chemotherapy (neoadjuvant chemotherapy (NACT) and interval debulking surgery (IDS)), with the aim of removing all visible tumour and achieving no macroscopic residual disease (NMRD). The aim of this review is to investigate the prognostic impact of size of residual disease nodules (RD) in women who received upfront or interval cytoreductive surgery for advanced (stage III and IV) epithelial ovarian cancer (EOC). OBJECTIVES To assess the prognostic impact of residual disease after primary surgery on survival outcomes for advanced (stage III and IV) epithelial ovarian cancer. In separate analyses, primary surgery included both upfront primary debulking surgery (PDS) followed by adjuvant chemotherapy and neoadjuvant chemotherapy followed by interval debulking surgery (IDS). Each residual disease threshold is considered as a separate prognostic factor. SEARCH METHODS We searched CENTRAL (2021, Issue 8), MEDLINE via Ovid (to 30 August 2021) and Embase via Ovid (to 30 August 2021). SELECTION CRITERIA We included survival data from studies of at least 100 women with advanced EOC after primary surgery. Residual disease was assessed as a prognostic factor in multivariate prognostic models. We excluded studies that reported fewer than 100 women, women with concurrent malignancies or studies that only reported unadjusted results. Women were included into two distinct groups: those who received PDS followed by platinum-based chemotherapy and those who received IDS, analysed separately. We included studies that reported all RD thresholds after surgery, but the main thresholds of interest were microscopic RD (labelled NMRD), RD 0.1 cm to 1 cm (small-volume residual disease (SVRD)) and RD > 1 cm (large-volume residual disease (LVRD)). DATA COLLECTION AND ANALYSIS Two review authors independently abstracted data and assessed risk of bias. Where possible, we synthesised the data in meta-analysis. To assess the adequacy of adjustment factors used in multivariate Cox models, we used the 'adjustment for other prognostic factors' and 'statistical analysis and reporting' domains of the quality in prognosis studies (QUIPS) tool. We also made judgements about the certainty of the evidence for each outcome in the main comparisons, using GRADE. We examined differences between FIGO stages III and IV for different thresholds of RD after primary surgery. We considered factors such as age, grade, length of follow-up, type and experience of surgeon, and type of surgery in the interpretation of any heterogeneity. We also performed sensitivity analyses that distinguished between studies that included NMRD in RD categories of < 1 cm and those that did not. This was applicable to comparisons involving RD < 1 cm with the exception of RD < 1 cm versus NMRD. We evaluated women undergoing PDS and IDS in separate analyses. MAIN RESULTS We found 46 studies reporting multivariate prognostic analyses, including RD as a prognostic factor, which met our inclusion criteria: 22,376 women who underwent PDS and 3697 who underwent IDS, all with varying levels of RD. While we identified a range of different RD thresholds, we mainly report on comparisons that are the focus of a key area of clinical uncertainty (involving NMRD, SVRD and LVRD). The comparison involving any visible disease (RD > 0 cm) and NMRD was also important. SVRD versus NMRD in a PDS setting In PDS studies, most showed an increased risk of death in all RD groups when those with macroscopic RD (MRD) were compared to NMRD. Women who had SVRD after PDS had more than twice the risk of death compared to women with NMRD (hazard ratio (HR) 2.03, 95% confidence interval (CI) 1.80 to 2.29; I2 = 50%; 17 studies; 9404 participants; moderate-certainty). The analysis of progression-free survival found that women who had SVRD after PDS had nearly twice the risk of death compared to women with NMRD (HR 1.88, 95% CI 1.63 to 2.16; I2 = 63%; 10 studies; 6596 participants; moderate-certainty). LVRD versus SVRD in a PDS setting When we compared LVRD versus SVRD following surgery, the estimates were attenuated compared to NMRD comparisons. All analyses showed an overall survival benefit in women who had RD < 1 cm after surgery (HR 1.22, 95% CI 1.13 to 1.32; I2 = 0%; 5 studies; 6000 participants; moderate-certainty). The results were robust to analyses of progression-free survival. SVRD and LVRD versus NMRD in an IDS setting The one study that defined the categories as NMRD, SVRD and LVRD showed that women who had SVRD and LVRD after IDS had more than twice the risk of death compared to women who had NMRD (HR 2.09, 95% CI 1.20 to 3.66; 310 participants; I2 = 56%, and HR 2.23, 95% CI 1.49 to 3.34; 343 participants; I2 = 35%; very low-certainty, for SVRD versus NMRD and LVRD versus NMRD, respectively). LVRD versus SVRD + NMRD in an IDS setting Meta-analysis found that women who had LVRD had a greater risk of death and disease progression compared to women who had either SVRD or NMRD (HR 1.60, 95% CI 1.21 to 2.11; 6 studies; 1572 participants; I2 = 58% for overall survival and HR 1.76, 95% CI 1.23 to 2.52; 1145 participants; I2 = 60% for progression-free survival; very low-certainty). However, this result is biased as in all but one study it was not possible to distinguish NMRD within the < 1 cm thresholds. Only one study separated NMRD from SVRD; all others included NMRD in the SVRD group, which may create bias when comparing with LVRD, making interpretation challenging. MRD versus NMRD in an IDS setting Women who had any amount of MRD after IDS had more than twice the risk of death compared to women with NMRD (HR 2.11, 95% CI 1.35 to 3.29, I2 = 81%; 906 participants; very low-certainty). AUTHORS' CONCLUSIONS In a PDS setting, there is moderate-certainty evidence that the amount of RD after primary surgery is a prognostic factor for overall and progression-free survival in women with advanced ovarian cancer. We separated our analysis into three distinct categories for the survival outcome including NMRD, SVRD and LVRD. After IDS, there may be only two categories required, although this is based on very low-certainty evidence, as all but one study included NMRD in the SVRD category. The one study that separated NMRD from SVRD showed no improved survival outcome in the SVRD category, compared to LVRD. Further low-certainty evidence also supported restricting to two categories, where women who had any amount of MRD after IDS had a significantly greater risk of death compared to women with NMRD. Therefore, the evidence presented in this review cannot conclude that using three categories applies in an IDS setting (very low-certainty evidence), as was supported for PDS (which has convincing moderate-certainty evidence).
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Affiliation(s)
- Andrew Bryant
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Shaun Hiu
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Patience T Kunonga
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Ketankumar Gajjar
- Department of Gynaecological Oncology, 1st Floor Maternity Unit, City Hospital Campus, Nottingham, UK
| | - Dawn Craig
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Luke Vale
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Brett A Winter-Roach
- The Department of Surgery, Christie Hospital NHS Foundation Trust, Manchester, UK
| | - Ahmed Elattar
- City Hospital & Birmingham Treatment Centre, Birmingham, UK
| | - Raj Naik
- Gynaecological Oncology, Northern Gynaecological Oncology Centre, Gateshead, UK
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Colombo N, Sessa C, Bois AD, Ledermann J, McCluggage WG, McNeish I, Morice P, Pignata S, Ray-Coquard I, Vergote I, Baert T, Belaroussi I, Dashora A, Olbrecht S, Planchamp F, Querleu D. ESMO-ESGO consensus conference recommendations on ovarian cancer: pathology and molecular biology, early and advanced stages, borderline tumours and recurrent disease. Int J Gynecol Cancer 2019; 29:ijgc-2019-000308. [PMID: 31048403 DOI: 10.1136/ijgc-2019-000308] [Citation(s) in RCA: 140] [Impact Index Per Article: 28.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2019] [Accepted: 02/25/2019] [Indexed: 12/29/2022] Open
Abstract
The development of guidelines is one of the core activities of the European Society for Medical Oncology (ESMO) and European Society of Gynaecologial Oncology (ESGO), as part of the mission of both societies to improve the quality of care for patients with cancer across Europe. ESMO and ESGO jointly developed clinically relevant and evidence-based recommendations in several selected areas in order to improve the quality of care for women with ovarian cancer. The ESMO-ESGO consensus conference on ovarian cancer was held on April 12-14, 2018 in Milan, Italy, and comprised a multidisciplinary panel of 40 leading experts in the management of ovarian cancer. Before the conference, the expert panel worked on five clinically relevant questions regarding ovarian cancer relating to each of the following four areas: pathology and molecular biology, early-stage and borderline tumours, advanced stage disease and recurrent disease. Relevant scientific literature, as identified using a systematic search, was reviewed in advance. During the consensus conference, the panel developed recommendations for each specific question and a consensus was reached. The recommendations presented here are thus based on the best available evidence and expert agreement. This article presents the recommendations of this ESMO-ESGO consensus conference, together with a summary of evidence supporting each recommendation.
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Affiliation(s)
- N Colombo
- Division of Medical Gynecologic Oncology, European Institute of Oncology IRCCS, University of Milan-Bicocca, Milan, Italy
| | - C Sessa
- Department of Medical Oncology, Oncology Institute of Southern Switzerland, Ospedale San Giovanni, Bellinzona, Switzerland
| | - A du Bois
- Department of Gynecology and Gynecologic Oncology, Kliniken Essen-Mitte, Essen, Germany
| | - J Ledermann
- Department of Oncology and Cancer Trials, UCL Cancer Institute, London, UK
| | - W G McCluggage
- Department of Pathology, Belfast Health and Social Care Trust, Belfast, UK
| | - I McNeish
- Department of Surgery and Cancer, Imperial College, London, UK
| | - P Morice
- Department of Gynecologic Surgery, Gustave Roussy Cancer Campus, Villejuif, France
| | - S Pignata
- Division of Medical Oncology, Department of Uro-Gynaecological Oncology, Istituto Nazionale Tumori IRCCS 'Fondazione G. Pascale', Naples, Italy
| | - I Ray-Coquard
- Department of Medical and Surgical Oncology, Centre Léon Bérard, Lyon, France
| | - I Vergote
- Department of Gynaecological Oncology, Leuven Cancer Institute, Leuven, Belgium
- Department of Obstetrics and Gynecology, University Hospitals Leuven, Leuven, Belgium
| | - T Baert
- Department of Gynecology and Gynecologic Oncology, Kliniken Essen-Mitte, Essen, Germany
| | - I Belaroussi
- Department of Gynecologic Surgery, Gustave Roussy Cancer Campus, Villejuif, France
| | - A Dashora
- Department of Cellular Pathology, Maidstone and Tunbridge Wells NHS Trust, Kent, UK
| | - S Olbrecht
- Department of Gynaecological Oncology, Leuven Cancer Institute, Leuven, Belgium
- Department of Obstetrics and Gynecology, University Hospitals Leuven, Leuven, Belgium
| | - F Planchamp
- Clinical Research Unit, Institut Bergonié, Bordeaux, France
| | - D Querleu
- Department of Surgery, Institut Bergonié, Bordeaux, France
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3
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Colombo N, Sessa C, du Bois A, Ledermann J, McCluggage WG, McNeish I, Morice P, Pignata S, Ray-Coquard I, Vergote I, Baert T, Belaroussi I, Dashora A, Olbrecht S, Planchamp F, Querleu D. ESMO-ESGO consensus conference recommendations on ovarian cancer: pathology and molecular biology, early and advanced stages, borderline tumours and recurrent disease†. Ann Oncol 2019; 30:672-705. [PMID: 31046081 DOI: 10.1093/annonc/mdz062] [Citation(s) in RCA: 634] [Impact Index Per Article: 126.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/09/2023] Open
Abstract
The development of guidelines recommendations is one of the core activities of the European Society for Medical Oncology (ESMO) and European Society of Gynaecologial Oncology (ESGO), as part of the mission of both societies to improve the quality of care for patients with cancer across Europe. ESMO and ESGO jointly developed clinically relevant and evidence-based recommendations in several selected areas in order to improve the quality of care for women with ovarian cancer. The ESMO-ESGO consensus conference on ovarian cancer was held on 12-14 April 2018 in Milan, Italy, and comprised a multidisciplinary panel of 40 leading experts in the management of ovarian cancer. Before the conference, the expert panel worked on five clinically relevant questions regarding ovarian cancer relating to each of the following four areas: pathology and molecular biology, early-stage and borderline tumours, advanced stage disease and recurrent disease. Relevant scientific literature, as identified using a systematic search, was reviewed in advance. During the consensus conference, the panel developed recommendations for each specific question and a consensus was reached. The recommendations presented here are thus based on the best available evidence and expert agreement. This article presents the recommendations of this ESMO-ESGO consensus conference, together with a summary of evidence supporting each recommendation.
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Affiliation(s)
- N Colombo
- Division of Medical Gynecologic Oncology, European Institute of Oncology IRCCS, University of Milan-Bicocca, Milan, Italy.
| | - C Sessa
- Department of Medical Oncology, Oncology Institute of Southern Switzerland, Ospedale San Giovanni, Bellinzona, Switzerland
| | - A du Bois
- Department of Gynecology and Gynecologic Oncology, Kliniken Essen-Mitte, Essen, Germany
| | - J Ledermann
- Department of Oncology and Cancer Trials, UCL Cancer Institute, London
| | - W G McCluggage
- Department of Pathology, Belfast Health and Social Care Trust, Belfast
| | - I McNeish
- Department of Surgery and Cancer, Imperial College, London, UK
| | - P Morice
- Department of Gynecologic Surgery, Gustave Roussy Cancer Campus, Villejuif, France
| | - S Pignata
- Division of Medical Oncology, Department of Uro-Gynaecological Oncology, Istituto Nazionale Tumori IRCCS 'Fondazione G. Pascale', Naples, Italy
| | - I Ray-Coquard
- Department of Medical and Surgical Oncology, Centre Léon Bérard, Lyon, France
| | - I Vergote
- Department of Gynaecological Oncology, Leuven Cancer Institute, Leuven; Department of Obstetrics and Gynecology, University Hospitals Leuven, Leuven, Belgium
| | - T Baert
- Department of Gynecology and Gynecologic Oncology, Kliniken Essen-Mitte, Essen, Germany
| | - I Belaroussi
- Department of Gynecologic Surgery, Gustave Roussy Cancer Campus, Villejuif, France
| | - A Dashora
- Department of Cellular Pathology, Maidstone and Tunbridge Wells NHS Trust, Kent, UK
| | - S Olbrecht
- Department of Gynaecological Oncology, Leuven Cancer Institute, Leuven; Department of Obstetrics and Gynecology, University Hospitals Leuven, Leuven, Belgium
| | | | - D Querleu
- Department of Surgery, Institut Bergonié, Bordeaux, France.
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Liu XD, Liu Y, Gong TT, Guo JY, Wang YN, Wang L, Wu QJ, Jiao YS. Prognostic Influence of the Time Interval between Surgery and Chemotherapy in Epithelial Ovarian Cancer. J Cancer 2018; 9:4172-4178. [PMID: 30519317 PMCID: PMC6277625 DOI: 10.7150/jca.27409] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2018] [Accepted: 08/20/2018] [Indexed: 01/09/2023] Open
Abstract
The influence of time to chemotherapy (TTC) on recurrence and survival among epithelial ovarian cancer (EOC) patients still remains unknown. This single center retrospective cohort study was conducted on 489 EOC patients who underwent surgery followed by taxane- plus platinum-based chemotherapy in the Shengjing Hospital of China Medical University between 2011 and 2015. The Multivariate cox proportional regression models were used to calculate hazard ratios (HRs) and 95% confidence intervals (CIs) for progression-free survival (PFS) and overall survival (OS) after adjustment for potential confounders. The median follow-up duration was 2.97 years (inter-quartile range from 2.11 to 4.13 years). The recurrence and mortality rate of the all patients was 50.9% (249/489) and 43.6% (213/489), respectively. Having comorbidity, residual disease, ascites, and advanced FIGO stage (III-IV) was associated worse PFS and OS of EOC patients. Compared to TTC less than 14 days, delayed TTC (more than 28 days) was associated with a worse PFS (HR=1.36; 95%CI: 0.96-1.92) and OS (HR=1.38; 95%CI: 0.95-2.00). Notably, in EOC patients with advanced stage, delayed TTC (more than 28 days) was associated with worse PFS (HR=1.51; 95%CI: 1.02-2.24) and OS (HR=1.53; 95%CI: 1.01-2.32) when comparing to TTC less than 14 days. In conclusion, delayed TTC was associated with higher rates of EOC recurrence and survival among these patients with advanced stage. The findings of the present study may provide evidence for gynecologist as well as these ovarian cancer patients to make further decision for the treatment.
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Affiliation(s)
- Xiao-Dong Liu
- Department of Pharmacy, Shengjing Hospital of China Medical University, Shenyang, China
| | - Yi Liu
- Department of Obstetrics and Gynecology, Shengjing Hospital of China Medical University, Shenyang, China
| | - Ting-Ting Gong
- Department of Obstetrics and Gynecology, Shengjing Hospital of China Medical University, Shenyang, China
| | - Jing-Yi Guo
- School of postgraduate, China Medical University, Shenyang, China
| | - Ya-Nan Wang
- School of postgraduate, China Medical University, Shenyang, China
| | - Ling Wang
- School of postgraduate, China Medical University, Shenyang, China
| | - Qi-Jun Wu
- Department of Clinical Epidemiology, Shengjing Hospital of China Medical University, Shenyang, China
| | - Yi-Sheng Jiao
- Department of Obstetrics and Gynecology, Shengjing Hospital of China Medical University, Shenyang, China
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5
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Ge LN, Wang F. Prognostic significance of preoperative serum albumin in epithelial ovarian cancer patients: a systematic review and dose-response meta-analysis of observational studies. Cancer Manag Res 2018; 10:815-825. [PMID: 29713198 PMCID: PMC5911390 DOI: 10.2147/cmar.s161876] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
Purpose To comprehensively assess the impact of preoperative serum albumin levels on survival of patients with epithelial ovarian cancer (EOC). Materials and methods Two independent researchers searched the PubMed, Embase, and Web of Science databases to identify relevant studies from inception to October 20, 2017. The studies were independently reviewed and those deemed eligible were selected based on predetermined selection criteria. Summarized HRs and 95% CIs were calculated for overall survival (OS) with a profile likelihood random-effects model. Results Twelve cohort studies comprising 3884 EOC patients were included for analysis. Comparison of the highest vs the lowest categories of preoperative serum albumin yielded a summarized HR of 0.63 (95% CI=0.45–0.88, I2=88.8%). Although the results were robust in all subgroup analyses stratified by International Federation of Gynecology and Obstetrics (FIGO) stage, cutoff definition, geographical location, quality of study, number of EOC cases, followup time, and adjustments made for potential confounders, not all were statistically significant. Of note, dose–response analysis showed that for each 10 g/L increment in preoperative serum albumin level, the summary HR was 0.56 (95% CI=0.35–0.92, I2=78.6%). No evidence of publication bias was detected by funnel plot analysis and formal statistical tests. Sensitivity analyses showed no important differences in the estimates of effects. Conclusion The present meta-analysis suggests that preoperative serum albumin can be used as an independent prognostic predictor of OS in EOC patients. Since the included studies had high heterogeneity and retrospective designs, these results require further validation with prospective cohort trials enrolling larger patient populations with longer follow-up examinations.
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Affiliation(s)
- Li-Na Ge
- Department of Obstetrics and Gynecology, Shengjing Hospital of China Medical University, Shenyang, China
| | - Feng Wang
- Department of Orthopaedics, The First Affiliated Hospital of China Medical University, Shenyang, China
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Moujaess E, Fakhoury M, Assi T, Elias H, El Karak F, Ghosn M, Kattan J. The Therapeutic use of human albumin in cancer patients’ management. Crit Rev Oncol Hematol 2017; 120:203-209. [DOI: 10.1016/j.critrevonc.2017.11.008] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2016] [Revised: 03/15/2017] [Accepted: 11/13/2017] [Indexed: 02/07/2023] Open
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Relationship between initiation time of adjuvant chemotherapy and survival in ovarian cancer patients: a dose-response meta-analysis of cohort studies. Sci Rep 2017; 7:9461. [PMID: 28842667 PMCID: PMC5572704 DOI: 10.1038/s41598-017-10197-1] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2017] [Accepted: 08/04/2017] [Indexed: 12/31/2022] Open
Abstract
Although several studies have previously investigated the association between the initiation time of adjuvant chemotherapy and survival in ovarian cancer, inconsistencies remain about the issue. We searched PubMed and Web of Science through the May 24, 2017 to identify cohort studies that investigated the aforementioned topic. Fourteen studies with 59,569 ovarian cancer patients were included in this meta-analysis. We conducted meta-analyses comparing the longest and shortest initiation time of adjuvant chemotherapy and dose-response analyses to estimate summary hazards ratios (HRs) and 95% confidence intervals (CIs). A random-effects model was used to estimate HRs with 95% CIs. When comparing the longest with the shortest category of initiation time of adjuvant chemotherapy, the summary HR was 1.18 (95% CI: 1.06–1.32; I2 = 17.6; n = 7) for overall survival. Additionally, significant dose-response association for overall survival was observed for each week delay (HR = 1.04; 95% CI: 1.00–1.09; I2 = 9.05; n = 5). Notably, these findings were robust in prospective designed cohort studies as well as studies with advanced stage (FIGO III-IV) patients. No evidence of publication bias was observed. In conclusion, prolonged initiation time of adjuvant chemotherapy is associated with a decreased overall survival rate of ovarian cancer, especially in patients with advanced stage ovarian cancer.
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Alexander M, Blum R, Burbury K, Coutsouvelis J, Dooley M, Fazil O, Griffiths T, Ismail H, Joshi S, Love N, Opat S, Parente P, Porter N, Ross E, Siderov J, Thomas P, White S, Kirsa S, Rischin D. Timely initiation of chemotherapy: a systematic literature review of six priority cancers - results and recommendations for clinical practice. Intern Med J 2017; 47:16-34. [DOI: 10.1111/imj.13190] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2015] [Revised: 01/10/2016] [Accepted: 01/11/2016] [Indexed: 12/01/2022]
Affiliation(s)
- M. Alexander
- Department of Pharmacy; Peter MacCallum Cancer Centre; Melbourne Victoria Australia
- Department of Epidemiology and Preventive Medicine; Monash University; Melbourne Victoria Australia
| | - R. Blum
- Department of Medical Oncology; Bendigo Health; Bendigo Victoria Australia
| | - K. Burbury
- Department of Haematology; Peter MacCallum Cancer Centre; Melbourne Victoria Australia
| | - J. Coutsouvelis
- Pharmacy Department; Alfred Health; Melbourne Victoria Australia
- Department of Centre for Medicine Use and Safety; Monash University; Melbourne Victoria Australia
| | - M. Dooley
- Pharmacy Department; Alfred Health; Melbourne Victoria Australia
- Department of Centre for Medicine Use and Safety; Monash University; Melbourne Victoria Australia
| | - O. Fazil
- Pharmacy Department; Monash Health; Melbourne Victoria Australia
| | - T. Griffiths
- Olivia Newton-John Cancer Wellness and Research Centre; Austin Health; Melbourne Victoria Australia
| | - H. Ismail
- Departments of Pharmacy; Royal Women's Hospital; Melbourne Victoria Australia
| | - S. Joshi
- Department of Medical Oncology; Latrobe Regional Hospital; Traralgon Victoria Australia
| | - N. Love
- Department of Nursing; Peter MacCallum Cancer Centre; Melbourne Victoria Australia
| | - S. Opat
- Department of Clinical Haematology; Monash Health; Melbourne Victoria Australia
| | - P. Parente
- Department of Medical Oncology; Eastern Health; Melbourne Victoria Australia
- Department of Eastern Clinical School; Monash University; Melbourne Victoria Australia
| | - N. Porter
- Department of Clinical Haematology; Monash Health; Melbourne Victoria Australia
| | - E. Ross
- Division of Neurosciences, Cancer and Infection Medicine; The Royal Melbourne Hospital; Melbourne Victoria Australia
| | - J. Siderov
- Pharmacy Department; Austin Health; Melbourne Victoria Australia
| | - P. Thomas
- Departments of Nursing; Royal Women's Hospital; Melbourne Victoria Australia
| | - S. White
- Department of Medical Oncology; Northern Hospital; Melbourne Victoria Australia
| | - S. Kirsa
- Department of Pharmacy; Peter MacCallum Cancer Centre; Melbourne Victoria Australia
| | - D. Rischin
- Department of Medical Oncology; Peter MacCallum Cancer Centre; Melbourne Victoria Australia
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Chan JK, Java JJ, Fuh K, Monk BJ, Kapp DS, Herzog T, Bell J, Young R. The association between timing of initiation of adjuvant therapy and the survival of early stage ovarian cancer patients - An analysis of NRG Oncology/Gynecologic Oncology Group trials. Gynecol Oncol 2016; 143:490-495. [PMID: 27771168 DOI: 10.1016/j.ygyno.2016.09.015] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2016] [Revised: 09/09/2016] [Accepted: 09/13/2016] [Indexed: 11/27/2022]
Abstract
OBJECTIVES To determine the association between timing of adjuvant therapy initiation and survival of early stage ovarian cancer patients. METHODS Data were obtained from women who underwent primary surgical staging followed by adjuvant therapy from two Gynecologic Oncology Group trials (protocols # 95 and 157). Kaplan-Meier estimates and Cox proportional hazards model adjusted for covariates were used for analyses. RESULTS Of 497 stage I-II epithelial ovarian cancer patients, the median time between surgery and initiation of adjuvant therapy was 23days (25th-75th%: 12-33days). The time interval from surgery to initiation of adjuvant therapy was categorized into three groups: <2weeks, 2-4weeks, and >4weeks. The corresponding 5-year recurrence-free survival rates were 72.8%, 73.9%, and 79.5% (p=0.62). The 5-year overall survival rates were 79.4%, 81.9%, and 82.8%, respectively (p=0.51; p=0.33 - global test). As compared to <2weeks, the hazard ratio for recurrence-free survival was 0.90 (95%CI=0.59-1.37) for 2-4weeks and 0.72 (95%CI=0.46-1.13) for >4weeks. Age, stage, grade, and cytology were important prognostic factors. CONCLUSIONS Timing of adjuvant therapy initiation was not associated with survival in early stage epithelial ovarian cancer patients.
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Affiliation(s)
- John K Chan
- Division of Gynecologic Oncology, California Pacific-Palo Alto Medical Foundation Sutter Research Institute, 3838 California Street #410, San Francisco, CA 94115, United States.
| | - James J Java
- NRG Oncology/Gynecologic Oncology Group Statistics & Data Center, Roswell Park Cancer Institute, Buffalo, NY 14263, United States.
| | - Katherine Fuh
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Washington University, School of Medicine, St. Louis, MO 63108, United States.
| | - Bradley J Monk
- Division of Gynecologic Oncology, University of Arizona Cancer Center, Creighton University School of Medicine, and St. Joseph's Hospital and Medical Center, 500 W. Thomas Road, suite 660, Phoenix, AZ 85013, United States.
| | - Daniel S Kapp
- Department of Radiation Oncology, Stanford University School of Medicine, 875 Blake Wilbur Drive, Stanford, CA 94305, United States.
| | - Thomas Herzog
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Cincinnati Cancer Institute, Health Professions Building Suite, 3255 Eden Avenue, Cincinnati, OH 45267-0662, United States.
| | - Jeffrey Bell
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Ohio State University, Riverside Methodist Hospital, Columbus, OH 43210, United States.
| | - Robert Young
- Fox Chase Cancer Center, 333 Cottman Avenue, Philadelphia, PA 19111, United States.
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Garcia-Soto AE, Java JJ, Nieves Neira W, Pearson JM, Cohn DE, Lele SB, Tewari KS, Walker JL, Alvarez Secord A, Armstrong DK, Copeland LJ. Does time interval between surgery and intraperitoneal chemotherapy administration in advanced ovarian cancer carry a prognostic impact? An NRG Oncology/Gynecologic Oncology Group study ancillary study. Gynecol Oncol 2016; 143:484-489. [PMID: 27726923 DOI: 10.1016/j.ygyno.2016.10.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2016] [Revised: 09/29/2016] [Accepted: 10/01/2016] [Indexed: 11/25/2022]
Abstract
OBJECTIVES To determine the relationship of the time from surgery to intraperitoneal (IP) chemotherapy (TSIC) initiation with survival of patients with stage III epithelial ovarian cancer (EOC) patients using ancillary data from cooperative group clinical trials. METHODS Data from 420 patients with stage III EOC treated with IP chemotherapy under GOG-0114 and 172 were reviewed. The Cox proportional hazards model was used to evaluate independent prognostic factors and estimate their covariate-adjusted effects on PFS and OS. RESULTS The median TSIC was 62.5days (interquartile range 28-83). The median TSIC was longer for patients in GOG-0114 vs those in GOG-172 (83 vs 26days, p<0.001). TSIC was significantly associated (p=0.049) with PFS: each 10% increase in TSIC (days) decreases the risk of progression by 3%. TSIC was not significantly associated with OS in this model. In a linear regression model, gross residual disease was significantly associated with shorter TSIC (R2 -0.141, 95%CI -0.217, -0.064, p<0.001). When only data from GOG-172 were considered, no statistical significant association was found between TSIC and PFS or OS. CONCLUSIONS In this ancillary data study, TSIC was not associated with improved OS in patients with stage III epithelial ovarian cancer. TSIC was significantly associated with PFS for the entire cohort, suggesting increase in PFS with longer TSIC. However, this was not found when only data from GOG 172 or GOG 114 were analyzed separately. Hence, the relationship between IP chemotherapy initiation and time from surgery needs to be studied further.
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Affiliation(s)
- Arlene E Garcia-Soto
- Division of Gynecology Oncology, Department of OB-GYN, University of Miami Miller School of Medicine, Miami, FL, United States.
| | - James J Java
- NRG Statistics and Data Management Center, Roswell Park Cancer Institute, Buffalo, NY, United States.
| | - Wilberto Nieves Neira
- Division of Gynecology Oncology, Department of OB-GYN, University of Miami Miller School of Medicine, Miami, FL, United States.
| | - J Matthew Pearson
- Division of Gynecology Oncology, Department of OB-GYN, University of Miami Miller School of Medicine, Miami, FL, United States.
| | - David E Cohn
- The Ohio State University, Columbus, OH, United States.
| | - Shashikant B Lele
- Gynecologic Oncology, Roswell Park Cancer Institute, Buffalo, NY, United States.
| | - Krishnansu S Tewari
- Obstetrics-Gynecology, University of California, Irvine, Orange, CA, United States.
| | - Joan L Walker
- Gynecologic Oncology, Peggy and Charles Stephenson Oklahoma Cancer Center, Oklahoma City, OK, United States.
| | | | - Deborah K Armstrong
- Gynecology and Obstetrics, Johns Hopkins Kimmel Cancer Center, Baltimore, MD, United States.
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11
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Omichi C, Nakamura K, Haraga J, Masuyama H, Hiramatsu Y. Glasgow prognostic score is an independent marker for poor prognosis with all cases of epithelial ovarian cancer. Cancer Med 2016; 5:1074-80. [PMID: 26929186 PMCID: PMC4924365 DOI: 10.1002/cam4.681] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2015] [Revised: 01/25/2016] [Accepted: 02/01/2016] [Indexed: 12/12/2022] Open
Abstract
Inflammatory markers are important prognostic factors in various cancers. This study investigated whether inflammatory markers of the Glasgow prognostic score (GPS) predicted progression‐free survival (PFS) and overall survival (OS) for patients with all cases of epithelial ovarian cancer (OC). Pretreatment GPS was examined for the correlations with PFS and OS in 216 patients in all stages of epithelial OC. Statistical analyses were performed using the Mann–Whitney U‐test. PFS and OS were analyzed using the Kaplan–Meier method. Cox's proportional hazard regression was used for univariate and multivariate analyses. For all patients, the median PFS was 35.1 months, and median OS was 46.7 months; follow‐up range was 1–162 months. Kaplan–Meier analysis revealed that patients with high GPS (GPS 2) at pretreatment had a shorter PFS and OS than did patients with lower GPS (GPS 0 + 1) in for early, advanced, and all‐stages of OC (PFS: P < 0.001 for early‐, advanced‐ and all‐stages; OS; P < 0.001 for early‐ and all‐stage, P = 0.015 for advanced‐stage). GPS (GPS 2) was also found to be an independent predictor of both recurrence (P = 0.002) and survival (P = 0.001) of all cases of epithelial OC by a multivariate analysis. GPS can serve as an indicator of poor prognosis in patients with all stages of epithelial OC, including early‐stage disease and regardless of histology.
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Affiliation(s)
- Chiaki Omichi
- Department of Obstetrics and Gynecology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - Keiichiro Nakamura
- Department of Obstetrics and Gynecology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - Junko Haraga
- Department of Obstetrics and Gynecology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - Hisashi Masuyama
- Department of Obstetrics and Gynecology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - Yuji Hiramatsu
- Department of Obstetrics and Gynecology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
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12
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Eeles RA, Morden JP, Gore M, Mansi J, Glees J, Wenczl M, Williams C, Kitchener H, Osborne R, Guthrie D, Harper P, Bliss JM. Adjuvant Hormone Therapy May Improve Survival in Epithelial Ovarian Cancer: Results of the AHT Randomized Trial. J Clin Oncol 2015; 33:4138-44. [PMID: 26417001 DOI: 10.1200/jco.2015.60.9719] [Citation(s) in RCA: 73] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE To assess the effects of adjuvant hormone therapy (AHT) on survival and disease outcome in women with epithelial ovarian cancer. PATIENTS AND METHODS Participants were premenopausal and postmenopausal women who had been diagnosed with epithelial ovarian cancer (any International Federation of Gynecology and Obstetrics stage) 9 or fewer months previously. Ineligible patients included those with deliberately preserved ovarian function, with a history of a hormone-dependent malignancy, or with any contraindications to hormone-replacement therapy. Patients were centrally randomly assigned in a 1:1 ratio to either AHT for 5 years after random assignment or no AHT (control). Main outcome measures were overall survival (OS), defined as time from random assignment to death (any cause), and relapse-free survival, defined as time from random assignment to relapse or death (any cause). Patients who continued, alive and relapse free, were censored at their last known follow-up. RESULTS A total of 150 patients (n = 75, AHT; n = 75, control) were randomly assigned from 1990 to 1995 from 19 centers in the United Kingdom, Spain, and Hungary; all patients were included in intention-to-treat analyses. The median follow-up in alive patients is currently 19.1 years. Of the 75 patients with AHT, 53 (71%) have died compared with 68 (91%) of 75 patients in the control group. OS was significantly improved in patients who were receiving AHT (hazard ratio, 0.63; 95% CI, 0.44 to 0.90; P = .011). A similar effect was seen for relapse-free survival (hazard ratio, 0.67; 95% CI, 0.47 to 0.97; P = .032). Effects remained after adjustment for known prognostic factors. CONCLUSION These results show that women who have severe menopausal symptoms after ovarian cancer treatment can safely take hormone-replacement therapy, and this may, in fact, infer benefits in terms of OS in addition to known advantages in terms of quality of life.
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Affiliation(s)
- Rosalind A Eeles
- Rosalind A. Eeles, James P. Morden, and Judith M. Bliss, The Institute of Cancer Research; Martin Gore, The Royal Marsden Hospital; Janine Mansi, St George's Hospital; Peter Harper, Guy's Hospital, London; John Glees, Epsom Hospital, Epsom, and The Royal Marsden Hospital, Sutton; Christopher Williams, Southampton General Hospital, Southampton; Henry Kitchener, Aberdeen Royal Infirmary, Aberdeen; Richard Osborne, Addenbrookes Hospital, Cambridge; David Guthrie, Derbyshire Royal Infirmary, Derby, United Kingdom; and Miklos Wenczl, Markusovszky Teaching Hospital, Szombathely, Hungary.
| | - James P Morden
- Rosalind A. Eeles, James P. Morden, and Judith M. Bliss, The Institute of Cancer Research; Martin Gore, The Royal Marsden Hospital; Janine Mansi, St George's Hospital; Peter Harper, Guy's Hospital, London; John Glees, Epsom Hospital, Epsom, and The Royal Marsden Hospital, Sutton; Christopher Williams, Southampton General Hospital, Southampton; Henry Kitchener, Aberdeen Royal Infirmary, Aberdeen; Richard Osborne, Addenbrookes Hospital, Cambridge; David Guthrie, Derbyshire Royal Infirmary, Derby, United Kingdom; and Miklos Wenczl, Markusovszky Teaching Hospital, Szombathely, Hungary
| | - Martin Gore
- Rosalind A. Eeles, James P. Morden, and Judith M. Bliss, The Institute of Cancer Research; Martin Gore, The Royal Marsden Hospital; Janine Mansi, St George's Hospital; Peter Harper, Guy's Hospital, London; John Glees, Epsom Hospital, Epsom, and The Royal Marsden Hospital, Sutton; Christopher Williams, Southampton General Hospital, Southampton; Henry Kitchener, Aberdeen Royal Infirmary, Aberdeen; Richard Osborne, Addenbrookes Hospital, Cambridge; David Guthrie, Derbyshire Royal Infirmary, Derby, United Kingdom; and Miklos Wenczl, Markusovszky Teaching Hospital, Szombathely, Hungary
| | - Janine Mansi
- Rosalind A. Eeles, James P. Morden, and Judith M. Bliss, The Institute of Cancer Research; Martin Gore, The Royal Marsden Hospital; Janine Mansi, St George's Hospital; Peter Harper, Guy's Hospital, London; John Glees, Epsom Hospital, Epsom, and The Royal Marsden Hospital, Sutton; Christopher Williams, Southampton General Hospital, Southampton; Henry Kitchener, Aberdeen Royal Infirmary, Aberdeen; Richard Osborne, Addenbrookes Hospital, Cambridge; David Guthrie, Derbyshire Royal Infirmary, Derby, United Kingdom; and Miklos Wenczl, Markusovszky Teaching Hospital, Szombathely, Hungary
| | - John Glees
- Rosalind A. Eeles, James P. Morden, and Judith M. Bliss, The Institute of Cancer Research; Martin Gore, The Royal Marsden Hospital; Janine Mansi, St George's Hospital; Peter Harper, Guy's Hospital, London; John Glees, Epsom Hospital, Epsom, and The Royal Marsden Hospital, Sutton; Christopher Williams, Southampton General Hospital, Southampton; Henry Kitchener, Aberdeen Royal Infirmary, Aberdeen; Richard Osborne, Addenbrookes Hospital, Cambridge; David Guthrie, Derbyshire Royal Infirmary, Derby, United Kingdom; and Miklos Wenczl, Markusovszky Teaching Hospital, Szombathely, Hungary
| | - Miklos Wenczl
- Rosalind A. Eeles, James P. Morden, and Judith M. Bliss, The Institute of Cancer Research; Martin Gore, The Royal Marsden Hospital; Janine Mansi, St George's Hospital; Peter Harper, Guy's Hospital, London; John Glees, Epsom Hospital, Epsom, and The Royal Marsden Hospital, Sutton; Christopher Williams, Southampton General Hospital, Southampton; Henry Kitchener, Aberdeen Royal Infirmary, Aberdeen; Richard Osborne, Addenbrookes Hospital, Cambridge; David Guthrie, Derbyshire Royal Infirmary, Derby, United Kingdom; and Miklos Wenczl, Markusovszky Teaching Hospital, Szombathely, Hungary
| | - Christopher Williams
- Rosalind A. Eeles, James P. Morden, and Judith M. Bliss, The Institute of Cancer Research; Martin Gore, The Royal Marsden Hospital; Janine Mansi, St George's Hospital; Peter Harper, Guy's Hospital, London; John Glees, Epsom Hospital, Epsom, and The Royal Marsden Hospital, Sutton; Christopher Williams, Southampton General Hospital, Southampton; Henry Kitchener, Aberdeen Royal Infirmary, Aberdeen; Richard Osborne, Addenbrookes Hospital, Cambridge; David Guthrie, Derbyshire Royal Infirmary, Derby, United Kingdom; and Miklos Wenczl, Markusovszky Teaching Hospital, Szombathely, Hungary
| | - Henry Kitchener
- Rosalind A. Eeles, James P. Morden, and Judith M. Bliss, The Institute of Cancer Research; Martin Gore, The Royal Marsden Hospital; Janine Mansi, St George's Hospital; Peter Harper, Guy's Hospital, London; John Glees, Epsom Hospital, Epsom, and The Royal Marsden Hospital, Sutton; Christopher Williams, Southampton General Hospital, Southampton; Henry Kitchener, Aberdeen Royal Infirmary, Aberdeen; Richard Osborne, Addenbrookes Hospital, Cambridge; David Guthrie, Derbyshire Royal Infirmary, Derby, United Kingdom; and Miklos Wenczl, Markusovszky Teaching Hospital, Szombathely, Hungary
| | - Richard Osborne
- Rosalind A. Eeles, James P. Morden, and Judith M. Bliss, The Institute of Cancer Research; Martin Gore, The Royal Marsden Hospital; Janine Mansi, St George's Hospital; Peter Harper, Guy's Hospital, London; John Glees, Epsom Hospital, Epsom, and The Royal Marsden Hospital, Sutton; Christopher Williams, Southampton General Hospital, Southampton; Henry Kitchener, Aberdeen Royal Infirmary, Aberdeen; Richard Osborne, Addenbrookes Hospital, Cambridge; David Guthrie, Derbyshire Royal Infirmary, Derby, United Kingdom; and Miklos Wenczl, Markusovszky Teaching Hospital, Szombathely, Hungary
| | - David Guthrie
- Rosalind A. Eeles, James P. Morden, and Judith M. Bliss, The Institute of Cancer Research; Martin Gore, The Royal Marsden Hospital; Janine Mansi, St George's Hospital; Peter Harper, Guy's Hospital, London; John Glees, Epsom Hospital, Epsom, and The Royal Marsden Hospital, Sutton; Christopher Williams, Southampton General Hospital, Southampton; Henry Kitchener, Aberdeen Royal Infirmary, Aberdeen; Richard Osborne, Addenbrookes Hospital, Cambridge; David Guthrie, Derbyshire Royal Infirmary, Derby, United Kingdom; and Miklos Wenczl, Markusovszky Teaching Hospital, Szombathely, Hungary
| | - Peter Harper
- Rosalind A. Eeles, James P. Morden, and Judith M. Bliss, The Institute of Cancer Research; Martin Gore, The Royal Marsden Hospital; Janine Mansi, St George's Hospital; Peter Harper, Guy's Hospital, London; John Glees, Epsom Hospital, Epsom, and The Royal Marsden Hospital, Sutton; Christopher Williams, Southampton General Hospital, Southampton; Henry Kitchener, Aberdeen Royal Infirmary, Aberdeen; Richard Osborne, Addenbrookes Hospital, Cambridge; David Guthrie, Derbyshire Royal Infirmary, Derby, United Kingdom; and Miklos Wenczl, Markusovszky Teaching Hospital, Szombathely, Hungary
| | - Judith M Bliss
- Rosalind A. Eeles, James P. Morden, and Judith M. Bliss, The Institute of Cancer Research; Martin Gore, The Royal Marsden Hospital; Janine Mansi, St George's Hospital; Peter Harper, Guy's Hospital, London; John Glees, Epsom Hospital, Epsom, and The Royal Marsden Hospital, Sutton; Christopher Williams, Southampton General Hospital, Southampton; Henry Kitchener, Aberdeen Royal Infirmary, Aberdeen; Richard Osborne, Addenbrookes Hospital, Cambridge; David Guthrie, Derbyshire Royal Infirmary, Derby, United Kingdom; and Miklos Wenczl, Markusovszky Teaching Hospital, Szombathely, Hungary
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13
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Rutten MJ, Boldingh JHL, Schuit E, Trum H, van Driel W, Mol BWJ, Kenter GG, Buist MR. Development and internal validation of a prognostic model for survival after debulking surgery for epithelial ovarian cancer. Gynecol Oncol 2014; 135:13-8. [PMID: 25093289 DOI: 10.1016/j.ygyno.2014.07.099] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2014] [Revised: 07/19/2014] [Accepted: 07/28/2014] [Indexed: 01/05/2023]
Abstract
OBJECTIVE Predicting survival of patients with epithelial ovarian cancer (EOC) is based on prognosis of the population. Combining prognostic factors could facilitate survival prediction on the level of the individual patient. The aim of this study was to develop a prognostic model to predict five-year disease specific survival in patients with EOC, and to evaluate whether this would add to prediction based on prognosis of the population. PATIENTS AND METHODS A retrospective cohort study was performed of all EOC patients treated with primary debulking and adjuvant chemotherapy or neo-adjuvant chemotherapy and interval debulking surgery in three gynaecological-oncologic centres between 1998 and 2010. Primary outcome was 5-year disease-specific survival. We developed a Cox proportional hazard model using the LASSO-method to select the best combination of characteristics from 12 potential predictors and to correct for overfitting. Performance of the model was expressed as calibration and discrimination (c-statistic). A nomogram was developed to increase the clinical applicability of the model. RESULTS Of 840 patients with EOC 462 (55%) died within 5 years due to the disease. A combination of FIGO stage, residual tumour after surgery, primary or interval surgery, histology, performance status, age, amount of ascites and a family history suggestive of breast/ovarian cancer best predicted 5-year survival. The final model showed accurate calibration and the c-statistic was 0.71 (95% CI 0.69-0.74). CONCLUSIONS Five-year survival in all stage EOC patients can be predicted accurately using available characteristics. After external validation the model can be used for counselling of patients.
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Affiliation(s)
- M J Rutten
- Centre of Gynaecologic Oncology Amsterdam, Academic Medical Center, Amsterdam, The Netherlands.
| | - J H L Boldingh
- Centre of Gynaecologic Oncology Amsterdam, Academic Medical Center, Amsterdam, The Netherlands
| | - E Schuit
- Julius Centre for Health Sciences and Primary Care, University Medical Centre Utrecht, Utrecht, The Netherlands; Department of Obstetrics and Gynaecology, Academic Medical Center, Amsterdam, The Netherlands
| | - H Trum
- Centre of Gynaecologic Oncology Amsterdam, Free University Medical Center, Amsterdam, The Netherlands
| | - W van Driel
- Centre of Gynaecologic Oncology Amsterdam, Anthony van Leeuwenhoek Hospital, Amsterdam, The Netherlands
| | - B W J Mol
- Department of Obstetrics and Gynaecology, Academic Medical Center, Amsterdam, The Netherlands
| | - G G Kenter
- Centre of Gynaecologic Oncology Amsterdam, Academic Medical Center, Amsterdam, The Netherlands
| | - M R Buist
- Centre of Gynaecologic Oncology Amsterdam, Academic Medical Center, Amsterdam, The Netherlands
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14
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The time interval from surgery to start of chemotherapy significantly impacts prognosis in patients with advanced serous ovarian carcinoma — Analysis of patient data in the prospective OVCAD study. Gynecol Oncol 2013; 131:15-20. [DOI: 10.1016/j.ygyno.2013.07.086] [Citation(s) in RCA: 85] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2013] [Revised: 07/09/2013] [Accepted: 07/15/2013] [Indexed: 11/23/2022]
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15
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van Meurs HS, Tajik P, Hof MH, Vergote I, Kenter GG, Mol BWJ, Buist MR, Bossuyt PM. Which patients benefit most from primary surgery or neoadjuvant chemotherapy in stage IIIC or IV ovarian cancer? An exploratory analysis of the European Organisation for Research and Treatment of Cancer 55971 randomised trial. Eur J Cancer 2013; 49:3191-201. [DOI: 10.1016/j.ejca.2013.06.013] [Citation(s) in RCA: 70] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2013] [Revised: 06/11/2013] [Accepted: 06/13/2013] [Indexed: 10/26/2022]
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16
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Takal MK, Baykal C, Başer E, Kaya MD, Dursun P, Ozen O, Haberal AN, Ayhan A. Does Aquaporin-1 expression have clinical significance in serous epithelial ovarian cancer? J Turk Ger Gynecol Assoc 2013; 14:130-5. [PMID: 24592091 DOI: 10.5152/jtgga.2013.02679] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2013] [Accepted: 05/16/2013] [Indexed: 01/22/2023] Open
Abstract
OBJECTIVE To assess the relationship between Aquaporin-1 (AQP1) expression and clinicopathological variables in serous epithelial ovarian cancer (EOC). MATERIAL AND METHODS Serous EOC cases treated in our institution between January 2007 and December 2009 were included in the study. A semi-quantitative immunohistochemical method was used to determine AQP1 expression levels, intratumoral microvessel density (IMD) and AQP1/IMD ratios. The relationship between these parameters and clinicopathological variables were assessed. P values less than 0.05 was considered statistically significant. RESULTS A total of 55 cases of serous EOC were included in the study. AQP1 was strongly expressed in the membranes of microvessels and small vessels within all tumor tissues. In a few cases, AQP1 expression was also observed in the membrane of interstitial cells and in individual tumor cells. A positive correlation was detected between preoperative CA125 levels and the expression of AQP1 (R: 0.277, p<0.05). AQP1 expression was similar between FIGO stage I-II and FIGO stage III-IV cases (p > 0.05). A significant relationship did not exist between AQP1 expression and FIGO stage, lymph node metastasis or ascites volume (p>0.05). CONCLUSION In this study, AQP1 expression did not have a significant association with important clinicopathological variables in serous EOC. Future studies are needed to determine AQP1 expression in other histological types of EOC.
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Affiliation(s)
- Mustafa Kemal Takal
- Department of Obstetrics and Gynecology, Division of Gynecological Oncology, Başkent University School of Medicine, Ankara, Turkey
| | - Cem Baykal
- Department of Obstetrics and Gynecology, Division of Gynecological Oncology, Başkent University School of Medicine, Ankara, Turkey
| | - Eralp Başer
- Department of Obstetrics and Gynecology, Division of Gynecological Oncology, Başkent University School of Medicine, Ankara, Turkey
| | - Mustafa Derda Kaya
- Department of Obstetrics and Gynecology, Division of Gynecological Oncology, Başkent University School of Medicine, Ankara, Turkey
| | - Polat Dursun
- Department of Obstetrics and Gynecology, Division of Gynecological Oncology, Başkent University School of Medicine, Ankara, Turkey
| | - Ozlem Ozen
- Department of Pathology, Başkent University School of Medicine, Ankara, Turkey
| | | | - Ali Ayhan
- Department of Obstetrics and Gynecology, Division of Gynecological Oncology, Başkent University School of Medicine, Ankara, Turkey
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Mahner S, Eulenburg C, Staehle A, Wegscheider K, Reuss A, Pujade-Lauraine E, Harter P, Ray-Coquard I, Pfisterer J, du Bois A. Prognostic impact of the time interval between surgery and chemotherapy in advanced ovarian cancer: Analysis of prospective randomised phase III trials. Eur J Cancer 2013; 49:142-9. [DOI: 10.1016/j.ejca.2012.07.023] [Citation(s) in RCA: 81] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2012] [Revised: 07/09/2012] [Accepted: 07/26/2012] [Indexed: 01/22/2023]
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18
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Elattar A, Bryant A, Winter‐Roach BA, Hatem M, Naik R. Optimal primary surgical treatment for advanced epithelial ovarian cancer. Cochrane Database Syst Rev 2011; 2011:CD007565. [PMID: 21833960 PMCID: PMC6457688 DOI: 10.1002/14651858.cd007565.pub2] [Citation(s) in RCA: 174] [Impact Index Per Article: 13.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
BACKGROUND Ovarian cancer is the sixth most common cancer among women. In addition to diagnosis and staging, primary surgery is performed to achieve optimal cytoreduction (surgical efforts aimed at removing the bulk of the tumour) as the amount of residual tumour is one of the most important prognostic factors for survival of women with epithelial ovarian cancer. An optimal outcome of cytoreductive surgery remains a subject of controversy to many practising gynae-oncologists. The Gynaecologic Oncology group (GOG) currently defines 'optimal' as having residual tumour nodules each measuring 1 cm or less in maximum diameter, with complete cytoreduction (microscopic disease) being the ideal surgical outcome. Although the size of residual tumour masses after surgery has been shown to be an important prognostic factor for advanced ovarian cancer, it is unclear whether it is the surgical procedure that is directly responsible for the superior outcome that is associated with less residual disease. OBJECTIVES To evaluate the effectiveness and safety of optimal primary cytoreductive surgery for women with surgically staged advanced epithelial ovarian cancer (stages III and IV).To assess the impact of various residual tumour sizes, over a range between zero and 2 cm, on overall survival. SEARCH STRATEGY We searched the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library 2010, Issue 3) and the Cochrane Gynaecological Cancer Review Group Trials Register, MEDLINE and EMBASE (up to August 2010). We also searched registers of clinical trials, abstracts of scientific meetings, reference lists of included studies and contacted experts in the field. SELECTION CRITERIA Retrospective data on residual disease from randomised controlled trials (RCTs) or prospective and retrospective observational studies which included a multivariate analysis of 100 or more adult women with surgically staged advanced epithelial ovarian cancer and who underwent primary cytoreductive surgery followed by adjuvant platinum-based chemotherapy. We only included studies that defined optimal cytoreduction as surgery leading to residual tumours with a maximum diameter of any threshold up to 2 cm. DATA COLLECTION AND ANALYSIS Two review authors independently abstracted data and assessed risk of bias. Where possible, the data were synthesised in a meta-analysis. MAIN RESULTS There were no RCTs or prospective non-RCTs identified that were designed to evaluate the effectiveness of surgery when performed as a primary procedure in advanced stage ovarian cancer.We found 11 retrospective studies that included a multivariate analysis that met our inclusion criteria. Analyses showed the prognostic importance of complete cytoreduction, where the residual disease was microscopic that is no visible disease, as overall (OS) and progression-free survival (PFS) were significantly prolonged in these groups of women. PFS was not reported in all of the studies but was sufficiently documented to allow firm conclusions to be drawn.When we compared suboptimal (> 1 cm) versus optimal (< 1 cm) cytoreduction the survival estimates were attenuated but remained statistically significant in favour of the lower volume disease group There was no significant difference in OS and only a borderline difference in PFS when residual disease of > 2 cm and < 2 cm were compared (hazard ratio (HR) 1.65, 95% CI 0.82 to 3.31; and HR 1.27, 95% CI 1.00 to 1.61, P = 0.05 for OS and PFS respectively).There was a high risk of bias due to the retrospective nature of these studies where, despite statistical adjustment for important prognostic factors, selection bias was still likely to be of particular concern.Adverse events, quality of life (QoL) and cost-effectiveness were not reported by treatment arm or to a satisfactory level in any of the studies. AUTHORS' CONCLUSIONS During primary surgery for advanced stage epithelial ovarian cancer all attempts should be made to achieve complete cytoreduction. When this is not achievable, the surgical goal should be optimal (< 1 cm) residual disease. Due to the high risk of bias in the current evidence, randomised controlled trials should be performed to determine whether it is the surgical intervention or patient-related and disease-related factors that are associated with the improved survival in these groups of women. The findings of this review that women with residual disease < 1 cm still do better than women with residual disease > 1 cm should prompt the surgical community to retain this category and consider re-defining it as 'near optimal' cytoreduction, reserving the term 'suboptimal' cytoreduction to cases where the residual disease is > 1 cm (optimal/near optimal/suboptimal instead of complete/optimal/suboptimal).
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Affiliation(s)
- Ahmed Elattar
- City Hospital & Birmingham Treatment CentreDudley RoadBirminghamWest MidlandsUKB18 7QH
| | - Andrew Bryant
- Newcastle UniversityInstitute of Health & SocietyMedical School New BuildRichardson RoadNewcastle upon TyneUKNE2 4AX
| | - Brett A Winter‐Roach
- Christie Hospital NHS Foundation TrustThe Department of SurgeryWilmslow RoadManchesterUKM20 4BX
| | - Mohamed Hatem
- 14 Albert RoadEaglescliffeStockton‐on‐TeesUKTS16 0DD
| | - Raj Naik
- Northern Gynaecological Oncology CentreQueen Elizabeth HospitalGatesheadTyne and WearUKNE9 6SX
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Deraco M, Kusamura S, Virzì S, Puccio F, Macrì A, Famulari C, Solazzo M, Bonomi S, Iusco DR, Baratti D. Cytoreductive surgery and hyperthermic intraperitoneal chemotherapy as upfront therapy for advanced epithelial ovarian cancer: multi-institutional phase-II trial. Gynecol Oncol 2011; 122:215-20. [PMID: 21665254 DOI: 10.1016/j.ygyno.2011.05.004] [Citation(s) in RCA: 111] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2011] [Revised: 04/29/2011] [Accepted: 05/03/2011] [Indexed: 02/06/2023]
Abstract
OBJECTIVE The primary end-point of this multi-institutional phase-II trial was to assess results in terms of overall survival after cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) in treatment-naive epithelial ovarian cancer (EOC) with advanced peritoneal involvement. Secondary end-points were treatment morbi-mortality and outcome effects of time to subsequent adjuvant systemic chemotherapy (TTC). METHODS Twenty-six women with stage III-IV EOC were prospectively enrolled in 4 Italian centers to undergo CRS and closed-abdomen HIPEC with cisplatin and doxorubicin. Then they received systemic chemotherapy with carboplatin (AUC 6) and paclitaxel (175 mg/m(2)) for 6 cycles. RESULTS Macroscopically complete cytoreduction was achieved in 15 patients; only minimal residual disease (≤2.5 mm) remained in 11. Major complications occurred in four patients and postoperative death in one. After a median follow-up of 25 months, 5-year overall survival was 60.7% and 5-year progression-free survival 15.2% (median 30 months). Excluding operative death, all the patients underwent systemic chemotherapy at a median of 46 days from combined treatment (range: 29-75). The median number of cycles per patient was 6 (range: 1-8). The time to chemotherapy did not affect the OS or PFS. CONCLUSIONS In selected patients with advanced stage EOC, upfront CRS and HIPEC provided promising results in terms of outcome. Morbidity was comparable to aggressive cytoreduction without HIPEC. Postoperative recovery delayed the initiation of adjuvant systemic chemotherapy but not sufficiently to impact negatively on survival. These data warrant further evaluation in a randomized clinical trial.
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Affiliation(s)
- Marcello Deraco
- Peritoneal Surface Malignancy Program, Department of Surgery, National Cancer Institute, via Venezian 1, 20133 Milan, Italy.
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Gerestein CG, Eijkemans MJC, de Jong D, van der Burg MEL, Dykgraaf RHM, Kooi GS, Baalbergen A, Burger CW, Ansink AC. The prediction of progression-free and overall survival in women with an advanced stage of epithelial ovarian carcinoma. BJOG 2009; 116:372-80. [DOI: 10.1111/j.1471-0528.2008.02033.x] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Wright J, Doan T, McBride R, Jacobson J, Hershman D. Variability in chemotherapy delivery for elderly women with advanced stage ovarian cancer and its impact on survival. Br J Cancer 2008; 98:1197-203. [PMID: 18349836 PMCID: PMC2359630 DOI: 10.1038/sj.bjc.6604298] [Citation(s) in RCA: 69] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
Given the survival benefits of adjuvant chemotherapy for advanced ovarian cancer (OC), we examined the associations of survival with the time interval from debulking surgery to initiation of chemotherapy and with the duration of chemotherapy. Among patients > or =65 years with stages III/IV OC diagnosed between 1991 and 2002 in the Surveillance, Epidemiology, and End Results-Medicare database, we developed regression models of predictors of the time interval from surgery to initiation of chemotherapy and of the total duration of chemotherapy. Survival was examined with Cox proportional hazards models. Among 2558 patients, 1712 (67%) initiated chemotherapy within 6 weeks of debulking surgery, while 846 (33%) began treatment >6 weeks. Older age, black race, being unmarried, and increased comorbidities were associated with delayed initiation of chemotherapy. Delay of chemotherapy was associated with an increase in mortality (hazard ratio (HR)=1.11; 95% CI, 1.0-1.2). Among 1932 patients in the duration of treatment analysis, the 1218 (63%) treated for 3-7 months had better survival than the 714 (37%) treated for < or =3 months (HR=0.84; 95% CI, 0.75-0.94). This analysis represents one of the few studies describing treatment delivery and outcome in women with advanced OC. Delayed initiation and early discontinuation of chemotherapy were common and associated with increased mortality.
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Affiliation(s)
- Jd Wright
- Department of Obstetrics and Gynecology, Herbert Irving Comprehensive Cancer Center, College of Physicians and Surgeons, New York, NY 10032, USA
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de Jong D, Eijkemans MJ, Lie Fong S, Gerestein CG, Kooi GS, Baalbergen A, van der Burg MEL, Burger CW, Ansink AC. Preoperative predictors for residual tumor after surgery in patients with ovarian carcinoma. Oncology 2008; 72:293-301. [PMID: 18198490 DOI: 10.1159/000113051] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2006] [Accepted: 07/23/2007] [Indexed: 11/19/2022]
Abstract
OBJECTIVES Suboptimal debulking (>1 cm residual tumor) results in poor survival rates for patients with an advanced stage of ovarian cancer. The purpose of this study was to develop a prediction model, based on simple preoperative parameters, for patients with an advanced stage of ovarian cancer who are at risk of suboptimal cytoreduction despite maximal surgical effort. METHODS Retrospective analysis of 187 consecutive patients with a suspected clinical diagnosis of advanced-stage ovarian cancer undergoing upfront debulking between January 1998 and December 2003. Preoperative parameters were Karnofsky performance status, ascites and serum concentrations of CA 125, hemoglobin, albumin, LDH and blood platelets. The main outcome parameter was residual tumor >1 cm. Univariate and multivariate logistic regression was employed for testing possible prediction models. A clinically applicable graphic model (nomogram) for this prediction was to be developed. RESULTS Serum concentrations of CA 125 and blood platelets in the group with residual tumor >1 cm were higher in comparison to the optimally cytoreduced group (p < 0.0001 and <0.01, respectively). Serum albumin and hemoglobin levels were lower in the group with residual tumor (p < 0.0001 and <0.05, respectively). The frequency of preoperative ascites was higher in the group with residual tumor (p < 0.0005). The prediction model, consisting of CA 125 and albumin, for remaining with residual tumor showed an area under the receiver operating characteristics curve of 0.79. A nomogram for probability of residual tumor >1 cm based on serum levels of CA 125 and albumin was established. CONCLUSION Postoperative residual tumor despite maximal surgical effort can be predicted by preoperative CA 125 and serum albumin levels. With a nomogram based on these two parameters, probability of postoperative residual tumor in each individual patient can be predicted. This proposed nomogram may be valuable in daily routine practice for counseling and to select treatment modality.
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Affiliation(s)
- D de Jong
- Department of Public Health, Erasmus University Medical Center, Rotterdam, The Netherlands
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Aletti GD, Long HJ, Podratz KC, Cliby WA. Is time to chemotherapy a determinant of prognosis in advanced-stage ovarian cancer? Gynecol Oncol 2007; 104:212-6. [PMID: 17023033 DOI: 10.1016/j.ygyno.2006.07.045] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2006] [Revised: 07/19/2006] [Accepted: 07/31/2006] [Indexed: 01/29/2023]
Abstract
OBJECTIVES Clinicians often question when to start chemotherapy after patients undergo surgery for ovarian cancer. A major unproven concern is whether a long postoperative delay reduces the benefits of an extensive procedure and leads to disease progression. Our objectives were to evaluate the correlation between clinical and pathologic variables and to evaluate the effect of the "time to chemotherapy" (TTC) interval on survival. METHODS We retrospectively studied data from 218 patients with International Federation of Gynecology and Obstetrics stage IIIC or IV ovarian cancer (TNM stage T3c or T4) who were consecutively treated between January 1, 1994, and December 31, 1998. RESULTS Mean age at diagnosis was 64 years (range, 24-87 years; median, 65 years), and 206 patients received postoperative platinum-based chemotherapy. Mean TTC interval was 26 days (range, 7-79 days; median, 25 days). No correlation was found between operative time and TTC interval length (P=0.99). Age and performance of rectosigmoidectomy were correlated with longer TTC interval (P=0.009 and P=0.005, respectively), but TTC was not a predictor of overall survival (odds ratio, 1.00; 95% confidence interval, 0.98-1.01; P=0.85). Differences in TTC interval length (< or =17 days, 18-26 days, 27-33 days, or > or =34 days) did not affect survival (P=0.93). Even after categorizing patients by residual disease (<1 cm or > or =1 cm), no statistically significant effect of TTC on prognosis was identified. CONCLUSIONS Concerns about the TTC interval should not be used to justify spending less time in the operative arena or using a more conservative approach for patients with advanced ovarian cancer.
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Affiliation(s)
- Giovanni D Aletti
- Division of Gynecologic Surgery, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA
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Basile S, Angioli R, Manci N, Palaia I, Plotti F, Benedetti Panici P. Gynecological cancers in developing countries: the challenge of chemotherapy in low-resources setting. Int J Gynecol Cancer 2006; 16:1491-7. [PMID: 16884356 DOI: 10.1111/j.1525-1438.2006.00619.x] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
The epidemiologic pattern of cancers in developing countries differs in many aspects from that of industrialized nations. Cancer natural history, microbiologic environment, patient's immune system, and drug availability may differ as well. Four of five new cases of cervical cancer and most of cervical cancer deaths occur in developing countries. Where chemoradiation and supportive care facilities are unavailable, it would be logical to consider an inexpensive effective drug. In locally advanced cases, neoadjuvant chemotherapy followed by surgery should be considered the treatment of choice. For ovarian cancer, it may be reasonable to maintain a secure supply of platinum and/or taxanes. For endometrial cancer, platinum compounds are proved active chemotherapic single agents. Oral medroxyprogesterone acetate (MPA) may represent a good chance for treating an advanced or recurrent disease. For vulvar/vaginal cancer, the role of chemotherapy alone is currently considered limited, and it is mostly used as palliative treatment in advanced or recurrent cases. Whenever possible, standard western chemotherapic regimens should be applied in developing countries as well. When standard therapies are unavailable, drugs of choice should be easily accessible, inexpensive, and effective. The most commonly used drugs are cisplatin, cyclophosphamide, and MPA.
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Affiliation(s)
- S Basile
- Department of Obstetrics and Gynecology, La Sapienza University of Rome, Italy
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Rosa DD, Clamp A, Mullamitha S, Ton NC, Lau S, Byrd L, Clayton R, Slade RJ, Kitchener HC, Shanks JH, Wilson G, McVey R, Hasan J, Swindell R, Jayson GC. The interval from surgery to chemotherapy in the treatment of advanced epithelial ovarian carcinoma. Eur J Surg Oncol 2006; 32:588-91. [PMID: 16569491 DOI: 10.1016/j.ejso.2006.02.013] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2005] [Accepted: 02/17/2006] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND To study the effect of the interval between surgery and the start of chemotherapy in the treatment of patients with advanced ovarian cancer. METHODS We stratified patients according to the start of platinum-based chemotherapy in group 1 (within 4 weeks from surgery), group 2 (between 4 and 8 weeks) and group 3 (between 8 and 12 weeks). RESULTS Three hundred and ninty-four stage III ovarian cancer patients were analysed. In the multivariate analysis there were no differences in survival according to the interval between surgery and chemotherapy among the three groups. The independent prognostic variables were type of procedure (p = 0.014), performance status (p = 0.040) and post-chemotherapy CA-125 (p < 0.0001). CONCLUSIONS The interval between surgery and chemotherapy does not affect outcome.
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Affiliation(s)
- D D Rosa
- Cancer Research UK Department of Medical Oncology, Christie Hospital NHS Trust, Withington, Manchester.
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Gallion H, Christopherson WA, Coleman RL, DeMars L, Herzog T, Hosford S, Schellhas H, Wells A, Sevin BU. Progression-free interval in ovarian cancer and predictive value of an ex vivo chemoresponse assay. Int J Gynecol Cancer 2006; 16:194-201. [PMID: 16445633 DOI: 10.1111/j.1525-1438.2006.00301.x] [Citation(s) in RCA: 50] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
The study objective was to determine the effectiveness of a phenotypic chemoresponse assay in predicting response to chemotherapy measured by progression-free interval (PFI) in a retrospective series of ovarian cancer patients whose tumor specimens had been tested with the ChemoFx assay. A statistically significant correlation between assay prediction of response and PFI was observed in 256 cases with an exact or partial match between drug(s) assayed and received. In 135 cases with an exact match, the hazard ratio for progression of the resistant group was 2.9 (confidence interval [CI]: 1.4-6.3; P < 0.01) compared to the sensitive group and 1.7 (CI: 1.2-2.5) for the intermediate compared to the sensitive group. The median PFI for patients treated with drugs assayed as resistant was 9 months, 14 months for those with drugs assayed as intermediately sensitive, and PFI had not been achieved for those with drugs assayed as sensitive. These data indicate that the ChemoFx assay is predictive of PFI in ovarian cancer. As the majority of ovarian cancers display different degrees of response to different chemotherapy agents ex vivo, the incorporation of assay information into treatment selection has the potential to improve clinical outcomes in ovarian cancer patients.
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Affiliation(s)
- H Gallion
- Precision Therapeutics Inc., 2516 Jane Street, Pittsburgh, PA 15203, USA.
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Gronlund B, Christensen IJ, Bülow-Lehnsby AL, Engelholm SA, Hansen HH, Høgdall C. Recurrent epithelial ovarian cancer: validation and improvement of an established prognostic index. Eur J Obstet Gynecol Reprod Biol 2006; 123:98-106. [PMID: 15896897 DOI: 10.1016/j.ejogrb.2005.03.011] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2004] [Accepted: 03/22/2005] [Indexed: 11/16/2022]
Abstract
OBJECTIVES To validate and improve an established prognostic index in patients with recurrent ovarian cancer. METHODS A Canadian three-covariate prognostic index (tumour grade at diagnosis, initial performance status, and time to relapse/primary progression (TRP)) was validated in a well-defined cohort of comparable Danish patients. Potential parameters to be included in an improved prognostic index were revealed by univariate and multivariate analyses in the Danish validation group. RESULTS The Canadian index validated in the Danish patient population (n=189) found a statistical significant difference in survival between the prognostic groups good and intermediate (P<0.0001), whereas there was no significant difference in survival between the prognostic groups intermediate and poor (P=0.51). In order to improve the accuracy of the index, the candidate parameters, treatment free interval (TFI), CA125 level and performance status, at time of relapse/primary progression, were added, whereas the parameters, tumour grade, and initial performance status, from the Canadian index were excluded. As the correlation coefficient between TRP and TFI was very high (r=0.91), TRP was substituted with TFI in the improved prognostic model. The final model was: 0.8 (performance status)+0.33 log (CA125)-1.31 log (TFI). The improved model was a good predictor of one-year survival (AUC 0.85; logistic regression; P<0.0001). The median survival (with 95% CI) of the four prognostic groups (A-D) was 50.6 (34.0-not available), 25.0 (22.1-33.6), 11.3 (8.5-12.9), and 5.2 (3.5-6.3) months, respectively. CONCLUSIONS A novel prognostic model (the Copenhagen index) for patients with recurrent ovarian cancer is presented.
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Affiliation(s)
- Bo Gronlund
- Department of Oncology, Rigshospitalet, Copenhagen University Hospital, 9 Blegdamsvej, DK-2100 Copenhagen, Denmark.
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Gadducci A, Sartori E, Landoni F, Zola P, Maggino T, Maggioni A, Cosio S, Frassi E, LaPresa MT, Fuso L, Cristofani R. Relationship Between Time Interval From Primary Surgery to the Start of Taxane- Plus Platinum-Based Chemotherapy and Clinical Outcome of Patients With Advanced Epithelial Ovarian Cancer: Results of a Multicenter Retrospective Italian Study. J Clin Oncol 2005; 23:751-8. [PMID: 15613698 DOI: 10.1200/jco.2005.03.065] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Purpose To assess whether the interval from primary surgery to the start of taxane- plus platinum-based chemotherapy has any impact on the clinical outcome of advanced ovarian cancer patients. Patients and Methods The study was conducted on 313 patients who underwent surgery followed by taxane- plus platinum-based chemotherapy. The median follow-up of survivors was 30.7 months (range, 6 to 109 months). Results The 25%, 50%, and 75% quantiles of intervals from surgery to the start of chemotherapy were 11, 21, and 31 days, respectively. After the sixth cycle, 102 patients achieved a pathologic complete response at second-look surgery and 98 obtained a clinical complete response but were not submitted to second-look surgery. Taking into consideration the best assessed response, a complete (either clinical or pathologic) response was found in 200 patients. Residual disease (≤ 1 v > 1 cm; P < .0001) and ascites (absent v present; P = .003) were independent predictive factors for achieving a complete response, whereas residual disease (P = .001) and stage (IIc to III v IV; P = .04) were independent prognostic variables for survival. Conversely, statistical analyses failed to detect significant differences in complete response rates and survival among patients with an interval from surgery to chemotherapy shorter than 11 days, 12 to 21 days, 22 to 31 days, and longer than 31 days. Conclusion The interval from surgery to the start of taxane- plus platinum-based chemotherapy seems to have neither a predictive value for response to treatment nor a prognostic relevance for survival of advanced ovarian cancer patients.
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Affiliation(s)
- Angiolo Gadducci
- Department of Gynecology and Obstetrics, University of Pisa, Pisa, Italy.
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Sorbe B. Prognostic importance of the time interval from surgery to chemotherapy in treatment of ovarian carcinoma. Int J Gynecol Cancer 2004; 14:788-93. [PMID: 15361185 DOI: 10.1111/j.1048-891x.2004.014509.x] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
In a large study on 1,220 patients with ovarian carcinoma in FIGO stages I-IV, the prognostic importance of the time factor for start of postoperative chemotherapy was studied together with other important factors for long-term survival. The patient series was a total geographic material of ovarian carcinoma patients treated during the years 1975-1993. All patients were followed up for 10 years or until death. The 5-year cancer-specific survival rate of the complete series was 50%. Significant and independent prognostic factors with regard to long-term cancer-specific survival were FIGO stage, histology, tumor grade, and completeness of the primary surgery. Special attention was paid to the prognostic importance of the time interval between primary surgery and the first course of chemotherapy. Patient groups with intervals shorter or longer than the median value were compared. In early-stage disease, no significant difference was noted. In advanced and bulky disease, an interval longer than the median value seemed to be beneficial compared with a shorter interval. However, after correction for other prognostic factors, the interval was not a significant factor (P = 0.647) with regard to the cancer-specific survival rate. Therefore, the time factor should not be an important argument for how to best organize the gynecologic oncology service.
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Affiliation(s)
- B Sorbe
- Department of Gynecological Oncology, Orebro University Hospital, SE-701 85 Orebro, Sweden.
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Howells REJ, Dhar KK, Hoban PR, Jones PW, Fryer AA, Redman CWE, Strange RC. Association between glutathione-S-transferase GSTP1 genotypes, GSTP1 over-expression, and outcome in epithelial ovarian cancer. Int J Gynecol Cancer 2004; 14:242-50. [PMID: 15086723 DOI: 10.1111/j.1048-891x.2004.014207.x] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
Ovarian cancer accounts for the majority of deaths from gynaecological malignancy, and polymorphisms in genes encoding the glutathione-S-transferase (GST) GSTP1 detoxifying enzymes may lead to variation in detoxification of carcinogens. We describe a study involving 81 women with invasive epithelial ovarian cancer. A number of important clinical variables and outcome data were obtained. GSTP1 genotyping was undertaken using PCR-based techniques, and GSTP1 expression was quantified using immunohistochemistry (IHC). A Cox's proportional hazard regression model was used to analyze the effects on outcome. We also independently examined 11 women with borderline or low malignant potential (LMP) tumors using IHC only. The mean age of the women was 61.5 years +/- 12 (1 SD) (range 36-88 years), the median overall survival was 26 months, and median progression free interval (PFI) 21 months. There was a significant association between GSTP1 (Val(104)/Val(104)) genotypes, and reduced survival (P = 0.05) and the GTP1 (Ile(104)/Val(104)) genotype appeared to have the best outcome (HR = 0.34, P = 0.045, 95% CI = 0.12-0.98). There was no significant association between the GSTP1 genotypes and any clinico-pathological parameters; there were also no associations between GSTP1 genotypes and response to postoperative chemotherapy. Specific nuclear GSTP1 over-expression was associated with less residual disease (P = 0.05); specific cytoplasmic GSTP1 over-expression with more favourable performance status (P = 0.014)). We found that 10/11 (91%) of the LMP (borderline) tumors over-expressed nuclear GSTP1 compared to only 52% of the invasive tumors (chi(2) ((1)) = 5.95, P = 0.015). There was no significant association between the level of GSTP1 expression and response to postoperative chemotherapy. The overall level of GSTP1 expression and the subcellular localization of GSTP1 expression were not associated with either survival or PFI. There was a significant association between the GSTP1 (Ile(104)/Ile(104)) genotypes and increased overall GSTP1 expression (P = 0.049), and the GSTP1 (Ile(104)/Val(104)) genotypes and reduced overall GSTP1 expression (P = 0.046). We speculate that GSTP1 Ile(104)/Val(104) genotypes are associated with improved outcome because the protein/enzyme, which is expressed, may provide a better balance between the effects of detoxification of carcinogens and the effects of metabolism of chemotherapy agents. In addition, over-expression of nuclear GSTP1 appears to be associated with more favorable ovarian tumor characteristics. In our preliminary study, we also reported a relationship between overall GSTP1 expression and certain GSTP1 genotypes. As far as we are aware, this is the first time that a relationship between the GSTP1 genotypes, GSTP1 expression and outcome has been described in ovarian cancer. Whether the genotype directly determines GSTP1 expression is at present unclear and the precise mechanism of this interaction is unknown.
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Affiliation(s)
- R E J Howells
- Department of Obstetrics and Gynaecology, North Staffordshire Hospital, Stoke-on-Trent, Staffordshire, UK.
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Colombo N. Controversies in chemotherapy — what is standard treatment? EJC Suppl 2003. [DOI: 10.1016/s1359-6349(03)90015-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
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Flynn PM, Paul J, Cruickshank DJ. Does the interval from primary surgery to chemotherapy influence progression-free survival in ovarian cancer? Gynecol Oncol 2002; 86:354-7. [PMID: 12217760 DOI: 10.1006/gyno.2002.6750] [Citation(s) in RCA: 38] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
OBJECTIVES The objective of this study was to determine whether the length of the interval from primary surgery to commencement of chemotherapy has any direct effect on progression-free survival in ovarian cancer. METHODS The progression-free survival of 472 patients enrolled in four trials who had all received platinum-containing chemotherapy (either in combination with a taxane or cyclophospamide) was subjected to univariate analysis. Dividing subjects into those above and below the median interval from surgery to chemotherapy formed two groups for analysis. The analysis was stratified by study and arm/cohort within study to remove any possible influence of the different studies and study doses. Multivariate analysis was then performed including stage, bulk of residual disease, and performance status as well as interval to starting chemotherapy. RESULTS The median interval from surgery to chemotherapy was 22 days (range 7-100). Univariate analysis of the above median and below median groups showed worse progression-free survival for those with earlier treatment (hazard ratio 0.84, P = 0.14, 95% CI 0.67-1.06); however, those treated earlier tended to have bulkier residual disease (>2 cm; P = 0.006). When multivariate analysis was performed incorporating residual disease status, FIGO stage, and performance status, the hazard rate ratio for interval to surgery was 0.99 (P = 0.91, 95% CI 0.79-1.24). CONCLUSIONS This study suggests that the interval from surgery to commencement of chemotherapy is not an independent prognostic factor for progression-free survival.
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Affiliation(s)
- Paul M Flynn
- James Cook University Hospital, Middlesbrough, United Kingdom.
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Paclitaxel plus carboplatin versus standard chemotherapy with either single-agent carboplatin or cyclophosphamide, doxorubicin, and cisplatin in women with ovarian cancer: the ICON3 randomised trial. Lancet 2002; 360:505-15. [PMID: 12241653 DOI: 10.1016/s0140-6736(02)09738-6] [Citation(s) in RCA: 374] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
BACKGROUND Previously, we have shown that the combination of cyclophosphamide, doxorubicin, and cisplatin (CAP) and single-agent carboplatin produce similar survival and progression-free survival rates in women with ovarian cancer. Subsequently, paclitaxel combined with platinum has become a widely accepted treatment for the disease. We aimed to compare the safety and efficacy of paclitaxel plus carboplatin with a control of either CAP or carboplatin alone. METHODS Between February, 1995, and October, 1998, we enrolled 2074 patients from 130 centres in eight countries. Women were randomly assigned paclitaxel plus carboplatin or control, the control (CAP or single-agent carboplatin) being chosen by the patient and clinician before randomisation. The primary outcome measure was overall survival. Secondary outcomes were progression-free survival and toxicity. Analysis was by intention to treat. FINDINGS With a median follow-up of 51 months, 1265 patients had died, and survival curves showed no evidence of a difference in overall survival between paclitaxel plus carboplatin and control (hazard ratio 0.98, 95% CI 0.87-1.10, p=0.74). The median overall survival was 36.1 months on paclitaxel plus carboplatin and 35.4 months on control (difference 0.7 months, 95% CI -3.6 to 4.7). 1538 patients had progressive disease or died, and again, Kaplan-Meier curves showed no evidence of a difference between the groups (hazard ratio 0.93, 95% CI 0.84-1.03, p=0.16). Median progression-free survival was 17.3 months on paclitaxel plus carboplatin and 16.1 months on control (difference 1.2 months, 95% CI -0.5 to 2.8). Paclitaxel plus carboplatin caused more alopecia, fever, and sensory neuropathy than carboplatin alone, and more sensory neuropathy than CAP. CAP was associated with more fever than paclitaxel plus carboplatin. INTERPRETATION Single-agent carboplatin and CAP are as effective as paclitaxel plus carboplatin as first-line treatment for women requiring chemotherapy for ovarian cancer. The favourable toxicity profile of single-agent carboplatin suggests that this drug is a reasonable option as first-line chemo therapy for ovarian cancer.
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Clark TG, Stewart ME, Altman DG, Gabra H, Smyth JF. A prognostic model for ovarian cancer. Br J Cancer 2001; 85:944-52. [PMID: 11592763 PMCID: PMC2375096 DOI: 10.1054/bjoc.2001.2030] [Citation(s) in RCA: 135] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2001] [Revised: 05/23/2001] [Accepted: 07/05/2001] [Indexed: 11/18/2022] Open
Abstract
About 6000 women in the United Kingdom develop ovarian cancer each year and about two-thirds of the women will die from the disease. Establishing the prognosis of a woman with ovarian cancer is an important part of her evaluation and treatment. Prognostic models and indices in ovarian cancer should be developed using large databases and, ideally, with complete information on both prognostic indicators and long-term outcome. We developed a prognostic model using Cox regression and multiple imputation from 1189 primary cases of epithelial ovarian cancer (with median follow-up of 4.6 years). We found that the significant (P< or = 0.05) prognostic factors for overall survival were age at diagnosis, FIGO stage, grade of tumour, histology (mixed mesodermal, clear cell and endometrioid versus serous papillary), the presence or absence of ascites, albumin, alkaline phosphatase, performance status on the ZUBROD-ECOG-WHO scale, and debulking of the tumour. This model is consistent with other models in the ovarian cancer literature; it has better predictive ability and, after simplification and validation, could be used in clinical practice.
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Affiliation(s)
- T G Clark
- ICRF Medical Statistics Group, Centre for Statistics in Medicine, Institute of Health Sciences, Old Road, Headington, Oxford, OX3 7LF, UK
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Chi DS, Liao JB, Leon LF, Venkatraman ES, Hensley ML, Bhaskaran D, Hoskins WJ. Identification of prognostic factors in advanced epithelial ovarian carcinoma. Gynecol Oncol 2001; 82:532-7. [PMID: 11520151 DOI: 10.1006/gyno.2001.6328] [Citation(s) in RCA: 181] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
OBJECTIVE The Gynecologic Oncology Group (GOG) has demonstrated that age, tumor grade, and size and number of residual lesions after primary cytoreductive surgery are significant prognostic factors in advanced ovarian carcinoma. Recent studies have reported numerous other clinical features as having prognostic value. We sought to identify the independent prognostic factors for survival in a cohort of patients with advanced ovarian cancer. METHODS We performed a retrospective chart review of all patients with stage III and IV ovarian carcinoma who received their primary treatment at our institution between 1987 and 1994. RESULTS A total of 295 patients were identified, 282 of whom were evaluable. Of these 282 patients, 214 (76%) have died of disease or other causes. The median follow-up is 32 months (range: 1-139). Eighteen factors were evaluated for prognostic significance. Significant factors in univariate analysis included patient age, gravidity (0 vs > 0), parity (0 vs > 0), preoperative albumin level, preoperative total protein level, ascites (presence vs absence), disease stage (IIIA/IIIB vs IIIC vs IV), number of residual lesions (< or =20 vs >20), and diameter of largest residual tumor nodule (< or = 1 cm vs 1-2 cm vs > 2 cm). However, on multivariate analysis, only patient age (P < 0.001), ascites (P = 0.001), and size of residual disease (P = 0.005) retained prognostic significance. Substage of disease was of borderline significance (P = 0.086). CONCLUSION Although numerous clinical variables have recently been reported to have prognostic value in advanced ovarian carcinoma, only patient age, presence or absence of ascites, and diameter of the largest residual tumor nodule proved to be of statistical significance in our analysis.
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Affiliation(s)
- D S Chi
- Gynecology Service, Memorial Sloan-Kettering Cancer Center, New York, New York 10021, USA
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Stratton JF, Pharoah P, Tidy JA, Paterson MEL. An analysis of ovarian tumor diameter and survival. Int J Gynecol Cancer 2000; 10:449-451. [PMID: 11240713 DOI: 10.1046/j.1525-1438.2000.00070.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Residual disease following primary debulking surgery is a recognized prognostic factor in ovarian cancer. Few studies have looked at the effect of initial ovarian tumor diameter on survival. As larger tumors are more likely to be detected by ultrasound, this information may be important in determining a survival benefit in screen-detected cancers. We reviewed the case notes and pathology of 168 consecutive cases of primary debulking surgery in epithelial ovarian cancer. We examined the influence of ovarian tumor diameter on survival and its relationship to CA125 levels and stage. For the purposes of analyses, we divided subjects into two groups: those with tumors < 6 cm and those with tumors > 6 cm. There were significant differences between the groups, with smaller tumors having more advanced stage disease compared to larger tumors (chi23 = 15.7, P = 0.0013) The median survival for tumors less than or equal to 6 cm was 17months (95% confidence interval [95% CI], 12 to 22), while for tumors greater than 6cm, the median survival was 36 months (95% CI, 13 to 59; logrank test = 8.61, P = 0.003). However, stage is also an important predictor of survival, and in a multivariate analysis, tumor size was not found to be an independent prognostic factor. There was no significant difference between the groups for CA125 levels. As larger diameter ovaries are more likely to be detected by ultrasound, it may be that screen-detected ovarian cancers will show a survival benefit simply because they detect a subset of ovarian cancers that are associated with a better prognosis.
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Affiliation(s)
- J. F. Stratton
- Department of Obstetrics & Gynaecology, Northern General Hospital, Sheffield and Department of Oncology, University of Cambridge, Strangeways Research Laboratories, Cambridge, United Kingdom
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Dhar KK, Branigan K, Howells REJ, Musgrove C, Jones PW, Strange RC, Fryer AA, Redman CWE, Hoban PR. Prognostic significance of cyclin D1 gene (CCND1) polymorphism in epithelial ovarian cancer. Int J Gynecol Cancer 1999; 9:342-347. [PMID: 11240791 DOI: 10.1046/j.1525-1438.1999.99048.x] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
We have investigated the influence of CCND1 genotype on clinical outcome in 138 women with epithelial ovarian cancer. CCND1 genotypes were identified from peripheral blood DNA by polymerase chain reaction restriction fragment length polymorphism (PCR-RFLP) analysis. Patient CCND1 genotypes were compared with clinical details including FIGO tumor stage, residual tumor volume, tumor histology and differentiation, response to chemotherapy, progression free interval, and survival. We observed no association between patient CCND1 genotypes and tumor characteristics or response to chemotherapy. There was no significant difference in overall survival and progression free interval (PFI) among women with different CCND1 genotypes. However, analysis of data from patients who responded to postoperative chemotherapy revealed that women with CCND1 AA genotype were associated with early disease progression (P = 0.020, HR 4.58, 95% CI 1.27-16.48) and reduced survival (P = 0.026, HR 4.48, 95% CI 1.19-16.79) compared with those with CCND1 AG and GG genotypes. These data show that CCND1 genotype does not influence overall prognosis in a cohort of epithelial ovarian cancer patients, however, it is associated with disease progression in a subgroup of patients following initial response to chemotherapy.
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Affiliation(s)
- K. K. Dhar
- Centre for Cell and Molecular Medicine, University of Keele School of Postgraduate Medicine, North Staffordshire Hospital, Stoke-on-Trent, UK;Department of Obstetrics and Gynaecology, City General, Stoke-on-Trent, UK;Department of Histopathology, North Staffordshire Hospital, Stoke-on-Trent, UK;Department of Mathematics, Keele University, Staffordshire, UK
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Eisenhauer E, Gore M, Neijt J. Ovarian cancer: should we be managing patients with good and bad prognostic factors in the same manner? Ann Oncol 1999. [DOI: 10.1016/s0923-7534(20)31478-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
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Abstract
A decrease in serum albumin concentrations is an almost inevitable finding in disease states, and is primarily mediated in the acute phase by alterations in vascular permeability and redistribution. This change is not disease specific but marked changes that persist are generally associated with a poorer prognosis. Critical appraisal of long-standing practices and the availability of alternative colloid solutions have led to a reduction in albumin replacement therapy, and a widespread tolerance of lower albumin concentrations in patients. The factors determining serum albumin concentrations, their measurement and the implications of hypoalbuminaemia are reviewed. The clinical value of serum albumin measurement is discussed.
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Affiliation(s)
- M P Margarson
- Magill Department of Anaesthesia, Chelsea and Westminster Hospital, London, UK
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Viale G, Maisonneuve P, Bonoldi E, Di Bacco A, Bevilacqua P, Panizzoni GA, Radaelli U, Gasparini G. The combined evaluation of p53 accumulation and of Ki-67 (MIB1) labelling index provides independent information on overall survival of ovarian carcinoma patients. Ann Oncol 1997; 8:469-76. [PMID: 9233527 DOI: 10.1023/a:1008253429700] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
BACKGROUND The prognostic implications of p53 accumulation, bcl-2 immunoreactivity and tumour proliferative fraction in ovarian carcinomas are still debated. PATIENTS AND METHODS One hundred twelve ovarian carcinomas were immunostained for p53 protein, for bcl-2 and for the cell cycle-associated Ki-67 antigen. The immunostaining results were correlated with conventional clinico-pathological variables, response to induction chemotherapy, and patient survival. RESULTS p53 accumulation and bcl-2 immunoreactivity in more than 10% of neoplastic cells were detected in 61 (54.5%) and 42 (37.5%) cases, respectively. A positive correlation between p53 accumulation and high (more than 30% neoplastic cells) MIB1 labelling index (r = 0.235; P = 0.015) was ascertained, whereas no significant association was found between bcl-2 immunoreactivity and p53 accumulation or MIB1 labeling index. Both p53 accumulation and MIB1 immunoreactivity correlated significantly with a reduced overall survival, but the association was lost in multivariate analysis. However, patients with tumours simultaneously showing p53 accumulation and MIB1 labelling index higher than 30% had significantly reduced overall survivals, in both univariate and multivariate analyses. CONCLUSION The simultaneous evaluation of p53 accumulation and MIB1 labelling index has independent prognostic implications in common epithelial malignancies of the ovary, irrespective of the disease stage.
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Affiliation(s)
- G Viale
- Department of Pathology, European Institute of Oncology, Milan, Italy
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Hartmann F, Pfreundschuh M. [Oncology '96]. MEDIZINISCHE KLINIK (MUNICH, GERMANY : 1983) 1997; 92:83-100. [PMID: 9139216 DOI: 10.1007/bf03042290] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Affiliation(s)
- F Hartmann
- Medizinische Klinik und Poliklinik, Universität des Saarlandes, Homburg (Saar)
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Kehoe S. Primary debulking surgery in advanced ovarian carcinoma. BRITISH JOURNAL OF OBSTETRICS AND GYNAECOLOGY 1996; 103:291-3. [PMID: 8605122 DOI: 10.1111/j.1471-0528.1996.tb09730.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
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