1
|
Bachmann R, Brucker S, Stäbler A, Krämer B, Ladurner R, Königsrainer A, Wallwiener D, Bachmann C. Prognostic relevance of high pretreatment CA125 levels in primary serous ovarian cancer. Mol Clin Oncol 2020; 14:8. [PMID: 33262888 PMCID: PMC7690236 DOI: 10.3892/mco.2020.2170] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2019] [Accepted: 08/12/2020] [Indexed: 02/01/2023] Open
Abstract
The objective of the present study was to analyze the prognostic relevance of pretreatment serum CA125 ≥500 U/ml and its role as a non-invasive factor for estimating optimal cytoreduction (≤1 cm) in primary serous ovarian cancer. Clinicopathological parameters and CA125 levels prior to primary cytoreductive surgery were retrospectively evaluated in all 261 consecutive patients with primary epithelial ovarian cancer from a single centre. Inclusion criteria were existing preoperative CA125 level, serous ovarian cancer and performed full primary treatment (surgery/platinum-based chemotherapy). A total of 136 patients met the criteria. Among them, 74 patients had CA125 ≥500 U/ml. The other 62 patients that met the aforementioned criteria and had CA125 <500 U/ml were defined as controls. The present study tested cut-off CA125 values to detect subgroups affecting prognosis. The goal was to evaluate patients with optimal cytoreduction (R≤1 cm). Univariate analyses were performed with PASW to identify clinicopathological parameters associated with the pretreatment CA125 level. For survival analyses, a cut-off-value of CA125 ≥500 U/ml was used to identify the association between preoperative CA125 levels, resection status and prognosis. To test significant differences between examined groups, Student's t-test and the Mann-Whitney test were used. P<0.05 was considered to indicate a statistically significant difference. Significantly worse prognosis in terms of overall survival (P=0.023) and progression-free survival (P=0.011) was detected in the CA125 ≥500 U/ml group of optimally cytoreduced patients compared with in the CA125 <500 U/ml group. The complete cytoreduction rate was higher in CA125 <500 U/ml (33.9%) vs. CA125 ≥500 U/ml (21.6%). A CA125 level >1,404 U/ml had a higher rate of suboptimal cytoreduction (32.4%) compared with lower CA125 levels. A pretreatment CA125 level ≥500 U/ml had significantly worse prognostic impact after optimal cytoreduction compared with CA125 <500 U/ml. The higher the CA125 level the higher the suboptimal cytoreduction rate. Patients with CA125 ≥500 U/ml may be candidates for an initial laparoscopic approach to specify resectability and to determine how to proceed. Overall, CA125 levels appear to be helpful in predicting suboptimal cytoreductive surgery for patients with primary ovarian cancer, but should be interpreted together with clinical and radiologic findings. This may improve defining the optimal treatment strategy in these patients.
Collapse
Affiliation(s)
- Robert Bachmann
- Department of General, Visceral and Transplant Surgery, University Hospital Tübingen, D-72076 Tübingen, Germany
| | - Sara Brucker
- Department of Obstetrics and Gynecology, University of Tuebingen, D-72076 Tübingen, Germany
| | - Annette Stäbler
- Institute of Pathology and Neuropathology and Comprehensive Cancer Center Tübingen, University Hospital Tübingen, Eberhard-Karls-University, D-72076 Tübingen, Germany
| | - Bernhard Krämer
- Department of Obstetrics and Gynecology, University of Tuebingen, D-72076 Tübingen, Germany
| | - Ruth Ladurner
- Department of General, Visceral and Transplant Surgery, University Hospital Tübingen, D-72076 Tübingen, Germany
| | - Alfred Königsrainer
- Department of General, Visceral and Transplant Surgery, University Hospital Tübingen, D-72076 Tübingen, Germany
| | - Diethelm Wallwiener
- Department of Obstetrics and Gynecology, University of Tuebingen, D-72076 Tübingen, Germany
| | - Cornelia Bachmann
- Department of Obstetrics and Gynecology, University of Tuebingen, D-72076 Tübingen, Germany
| |
Collapse
|
2
|
Winarno GNA, Hidayat Y, Soetopo S, Krisnadi SR, Tobing MDL, Rauf S. Higher Level of Fatty Acid Synthase Enzyme Predicts Lower Rate of Completing Debulking Surgery in Epithelial Ovarian Cancer. Asian Pac J Cancer Prev 2020; 21:2859-2863. [PMID: 33112541 PMCID: PMC7798157 DOI: 10.31557/apjcp.2020.21.10.2859] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2019] [Indexed: 11/25/2022] Open
Abstract
Background: The most dominant histopathologic type of ovarian cancer is epithelial ovarian cancer (EOC). Primary debulking surgery determines the treatment success and prognosis of advanced stage EOC. To maintain survival and progression, cancer cells need fatty acid synthase enzyme (FASN). The aim of this study was to evaluate preoperative serum FASN and CA 125 as predictors of primary debulking surgery results in patients with EOC. Methods: An observational cross-sectional study was performed on consecutive patients who underwent debulking surgery for suspected ovarian cancer at Dr. Hasan Sadikin Hospital Bandung from 2017 to 2019. Before debulking surgery, blood samples were examined for the serum levels of FASN and CA 125 using ELISA. Results: There were 53 patients enrolled in this study. Compared with the optimal debulking surgery group, the significant suboptimal debulking surgery group had significantly lower mean serum levels of FASN (0.46 ± 0.144 vs. 0.36 ± 0.128, p = 0.012) and CA 125 (964.22 ± 1722.5 vs. 264.98 ± 251.8, p = 0.002). The cutoff value was highest for the combination of FASN and CA 125 [410.06, area under the curve (AUC) = 77.5% (95% CI 65.5% to 81.9%, p = 0.001)] than for FASN alone [0.375, AUC = 71.3% (95% CI 56.8% to 85.8%, p = 0.009)] and CA 125 alone [222.5, AUC = 75.3% (95% CI 62.5% to 88.1%, p =0.002)]. Conclusion: The serum levelof FASN was correlated with suboptimal debulking surgery.
Collapse
Affiliation(s)
| | - Yudi Hidayat
- Department of Obstetrics and Gynecology, Faculty of Medicine, Padjadjaran University, Bandung, Indonesia
| | - Setiawan Soetopo
- Department of Radiology, Faculty of Medicine, Padjadjaran University, Bandung, Indonesia
| | - Sofie Rifayani Krisnadi
- Department of Obstetrics and Gynecology, Faculty of Medicine, Padjadjaran University, Bandung, Indonesia
| | | | - Syahrul Rauf
- Department of Obstetrics and Gynecology, Faculty of Medicine, Hasanuddin University, Makasar, Indonesia
| |
Collapse
|
3
|
Winarno GNA, Hidayat YM, Soetopo S, Krisnadi SR, Tobing MDL, Rauf S. The role of CA-125, GLS and FASN in predicting cytoreduction for epithelial ovarian cancers. BMC Res Notes 2020; 13:346. [PMID: 32698888 PMCID: PMC7376706 DOI: 10.1186/s13104-020-05188-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2020] [Accepted: 07/15/2020] [Indexed: 11/10/2022] Open
Abstract
OBJECTIVE Cytoreduction has an important role in improving the survival rate of epithelial ovarian cancer (EOC) patients. This study aimed to assess the ability of preoperative serum CA125, FASN and GLS as predictors of cytoreductive surgery for epithelial ovarian cancer (EOC). RESULTS The average values of serum CA-125, FASN, and GLS in the suboptimal cytoreduction group were higher than those in optimal cytoreduction group. The cut off point (COP) was 248.55 (p = 0.0001) with 73.2% sensitivity and 73.6% specificity for CA-125, 0.445 (p = 0.017) with 62.5% sensitivity and 60.4% specificity for FASN, and 22.895 (p = 0.0001) with 73.2% sensitivity and 75.5% specificity for GLS. The COP of CA-125 and GLS combined was 29.16 (p = 0.0001) with sensitivity 82.1% and specificity 73.6%, while the COP of CA-125, GLS, and FASN combined was 0.83 (p = 0.0001) with 87.5% sensitivity and 73.6% specificity.
Collapse
Affiliation(s)
- G N A Winarno
- Department of Obstetrics and Gynecology, Faculty of Medicine, Padjadjaran University, Jl Pasteur No.38, Bandung, Indonesia.
| | - Y M Hidayat
- Department of Obstetrics and Gynecology, Faculty of Medicine, Padjadjaran University, Jl Pasteur No.38, Bandung, Indonesia
| | - S Soetopo
- Department of Radiology, Faculty of Medicine, Padjadjaran University, Jl Pasteur No.38, Bandung, Indonesia
| | - S R Krisnadi
- Department of Obstetrics and Gynecology, Faculty of Medicine, Padjadjaran University, Jl Pasteur No.38, Bandung, Indonesia
| | - M D L Tobing
- Department of Obstetrics and Gynecology, Faculty of Medicine, Padjadjaran University, Jl Pasteur No.38, Bandung, Indonesia
| | - S Rauf
- Department of Obstetrics and Gynecology, Faculty of Medicine, Hasanuddin University, Jl. Perintis Kemerdekaan KM. 10, Makasar, Indonesia
| |
Collapse
|
4
|
Feng LY, Liao SB, Li L. Preoperative serum levels of HE4 and CA125 predict primary optimal cytoreduction in advanced epithelial ovarian cancer: a preliminary model study. J Ovarian Res 2020; 13:17. [PMID: 32050995 PMCID: PMC7014747 DOI: 10.1186/s13048-020-0614-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2019] [Accepted: 01/22/2020] [Indexed: 12/18/2022] Open
Abstract
Objective The aim of this study is to establish a noninvasive preoperative model for predicting primary optimal cytoreduction in advanced epithelial ovarian cancer by HE4 and CA125 combined with clinicopathological parameters. Methods Clinical data including preoperative serum HE4 and CA125 level of 83 patients with advanced epithelial ovarian cancer were collected. The sensitivity, specificity, positive predictive value, negative predictive value and overall accuracy of each clinical parameter were calculated. The Predictive Index score model and the logistic model were constructed to predict the primary optimal cytoreduction. Results Optimal surgical cytoreduction was achieved in 62.65% (52/83) patients. Cutoff values of preoperative serum HE4 and CA125 were 777.10 pmol/L and 313.60 U/ml. (1) Patients with PIV ≥ 6 may not be able to achieve optimal surgical cytoreduction. The diagnostic accuracy, NPV, PPV and specificity for diagnosing suboptimal cytoreduction were 71, 100, 68, and 100%, respectively. (2) The logistic model was: logit p = 0.12 age − 2.38 preoperative serum CA125 level − 1.86 preoperative serum HE4 level-2.74 histological type-3.37. AUC of the logistic model in the validation group was 0.71(95%CI 0.54–0.88, P = 0.025). Sensitivity and specificity were 1.00 and 0.44, respectively. Conclusion Age, preoperative serum CA125 level and preoperative serum HE4 level are important non-invasive predictors of primary optimal surgical cytoreduction in advanced epithelial ovarian cancer. Our PIV and logistic model can be used for assessment before expensive and complex predictive methods including laparoscopy and diagnostic imaging. Further future clinical validation is needed.
Collapse
Affiliation(s)
- Li-Yuan Feng
- Department of Gynecologic oncology, Guangxi Medical University Cancer Hospital, 71 Hedi Road, Nanning, Guangxi, 530021, People's Republic of China
| | - Sheng-Bin Liao
- Department of Gynecologic oncology, Guangxi Medical University Cancer Hospital, 71 Hedi Road, Nanning, Guangxi, 530021, People's Republic of China
| | - Li Li
- Department of Gynecologic oncology, Guangxi Medical University Cancer Hospital, 71 Hedi Road, Nanning, Guangxi, 530021, People's Republic of China.
| |
Collapse
|
5
|
Al Mutairi N, Le T. Does Neoadjuvant Chemotherapy Impact Prognosis in Advanced-Stage Epithelial Ovarian Cancer Optimally Debulked at Surgery? JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2018; 41:185-190. [PMID: 30316718 DOI: 10.1016/j.jogc.2018.05.031] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2018] [Accepted: 05/21/2018] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Neoadjuvant chemotherapy (NAC) has been shown to be noninferior to primary surgery in advanced stage ovarian cancer. We examined the impact of the neoadjuvant approach in patients with optimal residuals (<1 cm). METHODS Retrospective review of optimally debulked stage 3/4 ovarian cancer was performed. Chi-square tests were used to detect significant associations between categorical variables. A Cox regression model was built to predict patients' overall survival, adjusting for age, tumour grade, histology, use of adjuvant intraperitoneal chemotherapy, residual status, and primary treatment modality. RESULTS One hundred one patients were reviewed. Median age was 60.5 (range 39-85). NAC was used in 34 patients. Serous histology was documented in 60 of 101 patients (59%). Microscopic residuals were achieved in 70 patients (69%). There was no significant association between primary treatment modality and microscopic residuals status. With a median follow-up time of 33 months, progression was observed in 53% of patients, with a median progression-free survival of 19.4 months. The use of NAC was an independent adverse prognostic factor (hazard ratio 5.79; 95% CI 2.15-15.55, P = 0.001) for overall survival. Macroscopic residual was an independent adverse prognostic factor (hazard ratio 10.76; 95% CI 2.98-38.89, P < 0.001). The overall Kaplan-Meier median survival estimate was 54.5 months (95% CI 50.64-58.36) in the primary surgery group compared with 41.43 months (95% CI 35.58-47.29) in those given NAC (P = 0.002) CONCLUSION: Primary surgery should be the preferred approach in patients with an initial high likelihood of being optimally cytoreduced.
Collapse
Affiliation(s)
- Nashmia Al Mutairi
- Division of Gynecology Oncology, Oncology Department, King Abdulaziz Medical City, Ministry of National Guard Health Affairs, Riyadh, Saudi Arabia
| | - Tien Le
- Division of Gynecologic Oncology, University of Ottawa, Ottawa, ON.
| |
Collapse
|
6
|
The Role of HE4, a Novel Biomarker, in Predicting Optimal Cytoreduction After Neoadjuvant Chemotherapy in Advanced Ovarian Cancer. Int J Gynecol Cancer 2018; 27:696-702. [PMID: 28406844 DOI: 10.1097/igc.0000000000000944] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
OBJECTIVES This study aimed to evaluate serum human epididymis protein 4 (HE4) changes during neoadjuvant chemotherapy (NACT) to establish HE4 predebulking surgery cutoff values and to demonstrate that CA125, HE4, and computed tomography (CT) taken together are better able to predict complete cytoreduction after NACT in advanced ovarian cancer patients. METHODS From January 2006 to November 2015, patients affected by epithelial advanced ovarian cancer (International Federation of Gynecology and Obstetrics stage III-IV), considered not optimally resectable, were included in this prospective study. After 3 cycles of NACT, all patients underwent debulking surgery and were allocated, according to residual tumor (RT), into group A (RT = 0) and group B (RT > 0). Serum CA125, HE4, and CT images were recorded during NACT and compared singularly and with each other in term of accuracy, sensitivity, specificity, and positive and negative predictive value. RESULTS A total of 94 and 20 patients were included in group A and group B, respectively. The HE4 values recorded before debulking surgery correlated with RT. The identified HE4 cutoff value of 226 pmol/L after NACT was able to classify patients at high or low risk of suboptimal surgery, with a sensitivity of 75% and a specificity of 85% (positive predictive value, 0.87; negative predictive value, 0.70). The combination of CA125, HE4, and CT imaging resulted in the best combination with a sensitivity of 96% and a specificity of 92% (positive predictive value, 0.96; negative predictive value, 0.94). CONCLUSIONS The novel biomarker HE4, in addition to CA125 and CT, is better able to predict the RT at debulking surgery and the prognosis of patients.
Collapse
|
7
|
Kaban A, Topuz S, Saip P, Sözen H, Salihoğlu Y. Prognostic Factors in Patients Undergoing Primary Cytoreductive Surgery for FIGO Stage IIIC Ovarian, Tubal or Peritoneal Cancer. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2017; 40:447-453. [PMID: 29055648 DOI: 10.1016/j.jogc.2017.07.026] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2017] [Revised: 07/23/2017] [Accepted: 07/24/2017] [Indexed: 11/26/2022]
Abstract
OBJECTIVE The aim of the study is to investigate factors related to overall survival in advanced stage ovarian, tubal, or peritoneal cancer and to identify strong and weak prognostic factors. METHODS We retrospectively reviewed 190 patients who underwent primary cytoreductive surgery between 2003 and 2013. RESULTS Median overall survival duration was founded 58 months (95% CI 49-67). Five-year overall survival ratio was 48.5%. Presence of tumour at upper abdomen, suboptimal cytoreduction (residual >1 cm), surgery without lymphadenectomy, and presence of peritoneal ascites more than 1 L had a significantly negative effect on overall survival, but not histological grade and CA-125 level, by univariate Cox analysis. Age and presence of tumour in the upper abdomen were independent poor prognostic factors according to multivariate Cox model (HR 1.025; 95% CI 1.009-1.040 and HR 1.533; 95% CI 1.039-2.263, respectively). CONCLUSION This study supports that the presence of tumour in the upper abdomen is the most important independent poor prognostic factor in patients with performed primary surgery for advanced stage ovarian, tubal, and peritoneal cancer. Upper abdominal metastasis is the most important predictive factor for optimal cytoreduction (P <0.001, HR 6.567; 95% CI 3.059-14.096).
Collapse
Affiliation(s)
- Alpaslan Kaban
- Division of Gynecologic Oncology, Department Of Obstetrics and Gynecology, Faculty of Medicine, Istanbul University, Istanbul, Turkey.
| | - Samet Topuz
- Division of Gynecologic Oncology, Department Of Obstetrics and Gynecology, Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Pınar Saip
- Medical Oncology department, Istanbul University, Istanbul, Turkey
| | - Hamdullah Sözen
- Division of Gynecologic Oncology, Department Of Obstetrics and Gynecology, Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Yavuz Salihoğlu
- Division of Gynecologic Oncology, Department Of Obstetrics and Gynecology, Faculty of Medicine, Istanbul University, Istanbul, Turkey
| |
Collapse
|
8
|
Son HM, Kim SH, Kwon BR, Kim MJ, Kim CS, Cho SH. Preoperative prediction of suboptimal resection in advanced ovarian cancer based on clinical and CT parameters. Acta Radiol 2017; 58:498-504. [PMID: 27439399 DOI: 10.1177/0284185116658683] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
Background Cytoreduction is important as a survival predictor in advanced ovarian cancer. Purpose To determine the prediction of suboptimal resection (SOR) in advanced ovarian cancer based on clinical and computed tomography (CT) parameters. Material and Methods Between 2007 and 2015, 327 consecutive patients with FIGO stage III-IV ovarian cancer and preoperative CT were included. During 2007-2012, patients were assigned to a derivation dataset ( n = 220) and the others were assigned to a validation dataset ( n = 107). Clinical parameters were reviewed and two radiologists assessed the presence or absence of tabulated parameters on CT images. Logistic regression analyses based on area under the receiver-operating characteristic curve (AUROC) were performed to identify variables predicting SOR, and generated simple score using Cox proportional hazards model. Results There was no statistical difference in patients' characteristics in both datasets, except for residual disease ( P = 0.001). Optimal resection improved from 45.0% (99/220) in the derivation dataset to 64.4% (69/107) in the validation dataset. Logistic regression identified that Eastern Cooperative Oncology Group-performance status (ECOG-PS 2), involvements of peritoneum, diaphragm, bowel mesentery and suprarenal lymph nodes, and pleural effusion were independent variables of SOR. Overall AUROC for score predicting SOR was 0.761 with sensitivity, specificity, and positive and negative predictive values of 70.6%, 73.2%, 68.7%, and 91.9%, respectively. In the derivation dataset, AUROC was 0.792, with sensitivity of 71.4% and specificity of 74.3%, and AUROC of 0.758 with sensitivity of 69.2% and specificity of 72.8% in the validation dataset. Conclusion CT may be a useful preoperative predictor of SOR in advanced ovarian cancer.
Collapse
Affiliation(s)
- Hye Min Son
- Department of Radiology, Dongsan Hospital, Keimyung University, Daegu, Republic of Korea
| | - See Hyung Kim
- Department of Radiology, Dongsan Hospital, Keimyung University, Daegu, Republic of Korea
| | - Bo Ra Kwon
- Department of Radiology, Dongsan Hospital, Keimyung University, Daegu, Republic of Korea
| | - Mi Jeong Kim
- Department of Radiology, Dongsan Hospital, Keimyung University, Daegu, Republic of Korea
| | - Chan Sun Kim
- Department of Radiology, Dongsan Hospital, Keimyung University, Daegu, Republic of Korea
| | - Seung Hyun Cho
- Department of Radiology, National University Hospital, Kyungbook National University Hospital, Daegu, Republic of Korea
| |
Collapse
|
9
|
Vallius T, Hynninen J, Auranen A, Matomäki J, Oksa S, Roering P, Grènman S. Postoperative human epididymis protein 4 predicts primary therapy outcome in advanced epithelial ovarian cancer. Tumour Biol 2017; 39:1010428317691189. [PMID: 28218038 DOI: 10.1177/1010428317691189] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
Abstract
Primary chemotherapy treatment response monitoring in advanced epithelial ovarian cancer (EOC) is currently based on CT-imaging and serum CA125 values. Serum HE4 profile during first line chemotherapy has not been previously studied. We evaluated the HE4 profile during first line chemotherapy after primary (PDS) and interval debulking surgery (IDS). In total, 49 FIGO stage III/IV EOC patients were included in the study. 22 patients underwent PDS and 27 patients neoadjuvant chemotherapy (NACT) followed by IDS. Serial HE4 and CA125 serum samples were taken during first line chemotherapy. The association of postoperative tumor markers to surgery outcome, primary therapy outcome and progression free survival (PFS) were determined. The lowest HE4 and CA125 values during chemotherapy were compared to primary therapy outcome and PFS. The postoperative HE4 was associated to residual tumor after surgery (p = 0.0001), primary therapy outcome (p = 0.004) and PFS (p = 0.03) in all patients (n = 40). The postoperative CA125 was associated to PFS after IDS (n = 26, p = 0.006), but not after PDS. In multivariate analysis with FIGO stage (III/IV), residual tumor (0/>0) and postoperative CA125, the postoperative HE4 was the only statistically significant prognostic variable predicting PFS. Both HE4 and CA125 nadir corresponded to primary therapy outcome (HE4 p < 0.0001, CA125 p < 0.0001) and PFS (HE4 p = 0.009, CA125 p < 0.0001). HE4 is a promising candidate for EOC response monitoring. In our study, the performance of HE4 in response monitoring of first line chemotherapy was comparable to that of CA125. Of the postoperative values, only HE4 was statistically significantly associated to primary therapy outcome.
Collapse
Affiliation(s)
- Tuulia Vallius
- 1 Department of Obstetrics and Gynecology, Turku University Hospital, University of Turku, Turku, Finland
| | - Johanna Hynninen
- 1 Department of Obstetrics and Gynecology, Turku University Hospital, University of Turku, Turku, Finland
| | - Annika Auranen
- 2 Department of Obstetrics and Gynecology, Tampere University Hospital, Tampere, Finland
| | - Jaakko Matomäki
- 3 Turku Clinical Research Centre, Turku University Hospital, Turku, Finland
| | - Sinikka Oksa
- 4 Department of Obstetrics and Gynecology, Satakunta Central Hospital, Pori, Finland
| | - Pia Roering
- 5 Department of Pathology, Turku University Hospital, University of Turku, Turku, Finland
| | - Seija Grènman
- 1 Department of Obstetrics and Gynecology, Turku University Hospital, University of Turku, Turku, Finland
| |
Collapse
|
10
|
Serum CA125 and HE4 levels as predictors for optimal interval surgery and platinum sensitivity after neoadjuvant platinum-based chemotherapy in patients with advanced epithelial ovarian cancer. J Ovarian Res 2016; 9:61. [PMID: 27677313 PMCID: PMC5039904 DOI: 10.1186/s13048-016-0270-7] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2016] [Accepted: 09/19/2016] [Indexed: 01/30/2023] Open
Abstract
BACKGROUND The aim of this study is to evaluate a new tumour marker, HE4, and to compare it with CA125 in predicting optimal cytoreduction and response to chemotherapy. Thirty patients with advanced epithelial ovarian cancer and multiple sera harvested during neoadjuvant chemotherapy (NAC) were included. RESULTS Based on ROC curves analysis, CA125 ≤ 75 UI/ml and HE4 ≤ 252 pmol/L after the 3rd cycles of NAC, with a sensitivity of 93.7 % and a specificity of 92.3 % (PPV = 93.7 % and NPV = 92.3 %), offered the best combination for predicting optimal cytoreduction. In addition, the HE4 value of 115 pmol/L is the best cut-off level for identifying platinum-sensitive patients. CONCLUSIONS The introduction of HE4 as a new tool for predicting platinum-sensitivity and interval optimal cytoreduction is promising.
Collapse
|
11
|
Karlsen MA, Fagö-Olsen C, Høgdall E, Schnack TH, Christensen IJ, Nedergaard L, Lundvall L, Lydolph MC, Engelholm SA, Høgdall C. A novel index for preoperative, non-invasive prediction of macro-radical primary surgery in patients with stage IIIC-IV ovarian cancer-a part of the Danish prospective pelvic mass study. Tumour Biol 2016; 37:12619-12626. [PMID: 27440204 DOI: 10.1007/s13277-016-5166-z] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2016] [Accepted: 07/12/2016] [Indexed: 12/13/2022] Open
Abstract
The purpose of this study was to develop a novel index for preoperative, non-invasive prediction of complete primary cytoreduction in patients with FIGO stage IIIC-IV epithelial ovarian cancer. Prospectively collected clinical data was registered in the Danish Gynecologic Cancer Database. Blood samples were collected within 14 days of surgery and stored by the Danish CancerBiobank. Serum human epididymis protein 4 (HE4), serum cancer antigen 125 (CA125), age, performance status, and presence/absence of ascites at ultrasonography were evaluated individually and combined to predict complete tumor removal. One hundred fifty patients with advanced epithelial ovarian cancer were treated with primary debulking surgery (PDS). Complete PDS was achieved in 41 cases (27 %). The receiver operating characteristic curves demonstrated an area under the curve of 0.785 for HE4, 0.678 for CA125, and 0.688 for age. The multivariate model (Cancer Ovarii Non-invasive Assessment of Treatment Strategy (CONATS) index), consisting of HE4, age, and performance status, demonstrated an AUC of 0.853. According to the Danish indicator level, macro-radical PDS should be achieved in 60 % of patients admitted to primary surgery (positive predictive value of 60 %), resulting in a negative predictive value of 87.5 %, sensitivity of 68.3 %, specificity of 83.5 %, and cutoff of 0.63 for the CONATS index. Non-invasive prediction of complete PDS is possible with the CONATS index. The CONATS index is meant as a supplement to the standard preoperative evaluation of each patient. Evaluation of the CONATS index combined with radiological and/or laparoscopic findings may improve the assessment of the optimal treatment strategy in patients with advanced epithelial ovarian cancer.
Collapse
Affiliation(s)
- Mona Aarenstrup Karlsen
- Gynecologic Clinic, University Hospital of Copenhagen, Rigshospitalet, Blegdamsvej 9, DK-2100, Copenhagen, Denmark. .,Molecular Unit, Department of Pathology, Herlev University Hospital, Herlev Ringvej 75, DK-2730, Herlev, Denmark.
| | - Carsten Fagö-Olsen
- Gynecologic Clinic, University Hospital of Copenhagen, Rigshospitalet, Blegdamsvej 9, DK-2100, Copenhagen, Denmark
| | - Estrid Høgdall
- Molecular Unit, Department of Pathology, Herlev University Hospital, Herlev Ringvej 75, DK-2730, Herlev, Denmark
| | - Tine Henrichsen Schnack
- Gynecologic Clinic, University Hospital of Copenhagen, Rigshospitalet, Blegdamsvej 9, DK-2100, Copenhagen, Denmark
| | - Ib Jarle Christensen
- Molecular Unit, Department of Pathology, Herlev University Hospital, Herlev Ringvej 75, DK-2730, Herlev, Denmark
| | - Lotte Nedergaard
- Department of Pathology, University Hospital of Copenhagen, Rigshospitalet, Blegdamsvej 9, DK-2100, Copenhagen, Denmark
| | - Lene Lundvall
- Gynecologic Clinic, University Hospital of Copenhagen, Rigshospitalet, Blegdamsvej 9, DK-2100, Copenhagen, Denmark
| | - Magnus Christian Lydolph
- Department of Autoimmunology and Biomarkers, Statens Serum Institute, Artillerivej 5, DK-2300, Copenhagen, Denmark
| | - Svend Aage Engelholm
- Department of Radiation Oncology, University Hospital of Copenhagen, Rigshospitalet, Blegdamsvej 9, DK-2100, Copenhagen, Denmark
| | - Claus Høgdall
- Gynecologic Clinic, University Hospital of Copenhagen, Rigshospitalet, Blegdamsvej 9, DK-2100, Copenhagen, Denmark
| |
Collapse
|
12
|
Ji F, Chang X, Liu C, Meng L, Qu L, Wu J, Liu C, Cui H, Shou C. Prognostic value and characterization of the ovarian cancer-specific antigen CA166-9. Int J Oncol 2015; 47:1405-15. [PMID: 26251984 DOI: 10.3892/ijo.2015.3115] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2015] [Accepted: 03/09/2015] [Indexed: 11/05/2022] Open
Abstract
COC166-9 is an ovarian cancer-specific monoclonal antibody, and COC166-9-based immunotherapy has been shown to possess killing effects against ovarian cancer cells in vitro and in vivo. However the antigen recognized by COC166-9 (COC166-9-Ag, CA166-9) has not been identified and the clinical significance of CA166-9 expression remains unknown. We found that CA166-9 was positive in 53.1% of ovarian cancer tissues. Expression of CA166-9 was strongly correlated with the cancer recurrence (P<0.001). Patients with positive CA166-9 had substantially shorter overall survival (P=0.026) and disease-free survival (P=0.002). CA166-9 was also shown to be an independent predictive factor for overall survival (HR=2.454, P=0.016) and disease-free survival (HR=2.331, P=0.021). We identified CA166-9 as human immunoglobulin γ-1 heavy chain constant region (IGHG1). Purified IGHG1 promoted proliferation, migration, and invasion of CA166-9-negative ovarian cancer HOC1A cells, whereas it had minimal effects on the phenotypes of CA166-9-positive ovarian cancer CAOV-3 cells. In addition, overexpression of IGHG1 enhanced migration of ovarian cancer cells. On the contrary, COC166-9 inhibited proliferation, migration, and invasion of CAOV-3 cells, but had no effects on HOC1A cells. Therefore, IGHG1 similarly to CA166-9, could play an important role in ovarian cancer development and may serve as a potential prognostic marker and a therapeutical target for ovarian cancer.
Collapse
Affiliation(s)
- Fangxing Ji
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Department of Biochemistry and Molecular Biology, Peking University Cancer Hospital and Institute, Beijing 100142, P.R. China
| | - Xiaohong Chang
- Gynecological Oncology Center, Peking University People's Hospital, Beijing 100044, P.R. China
| | - Caiyun Liu
- Gynecological Oncology Center, Peking University People's Hospital, Beijing 100044, P.R. China
| | - Lin Meng
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Department of Biochemistry and Molecular Biology, Peking University Cancer Hospital and Institute, Beijing 100142, P.R. China
| | - Like Qu
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Department of Biochemistry and Molecular Biology, Peking University Cancer Hospital and Institute, Beijing 100142, P.R. China
| | - Jian Wu
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Department of Biochemistry and Molecular Biology, Peking University Cancer Hospital and Institute, Beijing 100142, P.R. China
| | - Chanzhen Liu
- Gynecological Oncology Center, Peking University People's Hospital, Beijing 100044, P.R. China
| | - Heng Cui
- Gynecological Oncology Center, Peking University People's Hospital, Beijing 100044, P.R. China
| | - Chengchao Shou
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Department of Biochemistry and Molecular Biology, Peking University Cancer Hospital and Institute, Beijing 100142, P.R. China
| |
Collapse
|
13
|
Surgical outcome prediction in patients with advanced ovarian cancer using computed tomography scans and intraoperative findings. Taiwan J Obstet Gynecol 2015; 53:343-7. [PMID: 25286788 DOI: 10.1016/j.tjog.2013.10.041] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/23/2013] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVE This study aimed to identify features on preoperative computed tomography (CT) scans that are predictive of suboptimal primary cytoreduction and to evaluate the correlation between CT findings and intraoperative findings in advanced ovarian cancer. MATERIALS AND METHODS We retrospectively reviewed preoperative CT scans and operative findings from patients with stage III/IV epithelial ovarian cancer who underwent primary cytoreduction between 2003 and 2006. Fourteen criteria were assessed. Clinical data were extracted from medical records. Residual tumors measuring ≥1 cm were considered suboptimal. RESULTS We retrospectively identified 118 patients who met the study inclusion criteria. The rate of optimal cytoreduction (≤1 cm residual disease) was 40%. On preoperative CT scans, omental extension to the stomach or spleen and inguinal or pelvic lymph nodes >2 cm were predictors of suboptimal cytoreduction on univariate (p = 0.016 and p = 0.028, respectively) and multivariate analysis (p = 0.042 and p = 0.029, respectively). Involvement of both omental extension and inguinal or pelvic lymph nodes had a positive predictive value (PPV) of 100%, a specificity of 100%, and an accuracy of 45.8% in predicting suboptimal cytoreduction. We correlated the preoperative CT findings with the intraoperative findings. There were significant correlations between CT and intraoperative findings of omental extension (p = 0.007), inguinal or pelvic lymph nodes >2 cm (p < 0.001), and large bowel mesentery implants >2 cm (p = 0.001). CONCLUSION The combination of omental extension to the stomach or spleen and involvement of inguinal or pelvic lymph nodes in preoperative CT scans is considered predictive of suboptimal cytoreduction. These patients may be more appropriately treated with neoadjuvant chemotherapy followed by surgical cytoreduction.
Collapse
|
14
|
Does a standardized preoperative algorithm of clinical data improve outcomes in patients with ovarian cancer? A quality improvement project. Int J Gynecol Cancer 2015; 25:798-801. [PMID: 25950127 DOI: 10.1097/igc.0000000000000433] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
OBJECTIVE To evaluate the potential impact of a standardized preoperative algorithm on outcomes of patients with suspected ovarian cancer. METHODS From January 1 to December 31, 2013, patients with suspected ovarian cancer were triaged to primary debulking surgery or neoadjuvant chemotherapy/interval debulking surgery (NACT/IDS) based on a comprehensive review of preoperative clinical data as part of a quality improvement project. Demographics, surgical, and postoperative data were collected. RESULTS A total of 110 patients with newly diagnosed ovarian cancer were identified: 68 (62%) underwent PDS with an 85% optimal debulking rate. The 30-day readmission rate was 14.7% with a 2.9% 60-day mortality rate. Forty-two patients (38%) underwent NACT. Two patients (4.8%) died before receiving NACT. Thirty-five patients have undergone IDS with an 89% optimal debulking rate. The 30-day readmission rate was 8.5% with a 5.7% 60-day mortality rate after IDS. CONCLUSIONS Although it is difficult to predict which patients will undergo optimal debulking at the time of PDS, surgical morbidity and mortality can be decreased by using NACT in select patients. The initiation of a quality improvement project has contributed to an improvement in patient outcomes at our institution.
Collapse
|
15
|
Nick AM, Coleman RL, Ramirez PT, Sood AK. A framework for a personalized surgical approach to ovarian cancer. Nat Rev Clin Oncol 2015; 12:239-45. [PMID: 25707631 PMCID: PMC4528308 DOI: 10.1038/nrclinonc.2015.26] [Citation(s) in RCA: 101] [Impact Index Per Article: 11.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
The standard approach for the treatment of advanced-stage ovarian cancer is upfront cytoreductive surgery followed by a combination of platinum-based and taxane-based chemotherapy. The extent of residual disease following upfront cytoreductive surgery correlates with objective response to adjuvant chemotherapy, rate of pathological complete response at second-look assessment operations, and progression-free survival and overall survival. Contemporary data and meta-analyses indicate a correlation between volume of residual disease and patient outcome, with those patients undergoing complete gross resection having the best outcomes. Thus, attention has focused on surgical efforts to remove as much disease as possible with the metric of 'optimal' cytoreduction being R0 disease. Because patients with R0 resection seem to have the best overall outcomes, preoperative or intraoperative assessment to avoid unnecessary primary debulking surgery has become common. The use of serum CA-125 levels, physical examination and CT imaging have lacked accuracy in determining if disease can be optimally debulked. Therefore, an algorithm that identifies patients in whom complete gross resection at primary surgery is likely to be achieved would be expected to improve patient survival. We discuss contemporary definitions of 'optimal' residual disease, and opportunities to personalize surgical therapy and improve the quality of surgical care.
Collapse
Affiliation(s)
- Alpa M. Nick
- Department of Gynecologic Oncology, The University of Texas M.D. Anderson Cancer Center, Houston, Texas
| | - Robert L. Coleman
- Department of Gynecologic Oncology, The University of Texas M.D. Anderson Cancer Center, Houston, Texas
| | - Pedro T. Ramirez
- Department of Gynecologic Oncology, The University of Texas M.D. Anderson Cancer Center, Houston, Texas
| | - Anil K. Sood
- Department of Gynecologic Oncology, The University of Texas M.D. Anderson Cancer Center, Houston, Texas
- Department of Cancer Biology, The University of Texas M.D. Anderson Cancer Center, Houston, Texas
- Department of Center for RNA Interference and Non-Coding RNAs, The University of Texas M.D. Anderson Cancer Center, Houston, Texas
| |
Collapse
|
16
|
Kumar L, Pramanik R, Kumar S, Bhatla N, Malik S. Neoadjuvant chemotherapy in gynaecological cancers - Implications for staging. Best Pract Res Clin Obstet Gynaecol 2015; 29:790-801. [PMID: 25840650 DOI: 10.1016/j.bpobgyn.2015.02.008] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2015] [Revised: 02/12/2015] [Accepted: 02/13/2015] [Indexed: 10/23/2022]
Abstract
The management of advanced gynaecological cancers remains a therapeutic challenge. Neoadjuvant chemotherapy has been used to reduce tumour size, thus facilitating subsequent local treatment in the form of surgery or radiation. For advanced epithelial ovarian cancer, data from several non-randomized and one randomized studies indicate that neoadjuvant chemotherapy followed by interval debulking surgery is a reasonable approach in patients deemed inoperable. Such an approach results in optimum debulking (no visible tumour) in approximately 40% of the patients with reduced operative morbidity. Overall and progression free-survival is comparable to the group treated with primary debulking surgery followed by chemotherapy. Neoadjuvant chemotherapy followed by surgery is associated with improved survival for women with stage IB2-IIA cervix cancer. There is a resurgence of interest for using short-course neoadjuvant chemotherapy prior to concurrent chemo-radiation. Currently, this is being tested in randomized trials.
Collapse
Affiliation(s)
- Lalit Kumar
- Department of Medical Oncology, Institute Rotary Cancer Hospital, All India Institute of Medical Sciences, New Delhi 110029, India.
| | - Raja Pramanik
- Department of Medical Oncology, Institute Rotary Cancer Hospital, All India Institute of Medical Sciences, New Delhi 110029, India
| | - Sunesh Kumar
- Department of Obstetrics and Gynecology, All India Institute of Medical Sciences, New Delhi 110029, India
| | - Neerja Bhatla
- Department of Obstetrics and Gynecology, All India Institute of Medical Sciences, New Delhi 110029, India
| | - Shilpa Malik
- Department of Medical Oncology, Institute Rotary Cancer Hospital, All India Institute of Medical Sciences, New Delhi 110029, India
| |
Collapse
|
17
|
Menczer J, Ben-Shem E, Golan A, Levy T. The Significance of Normal Pretreatment Levels of CA125 (<35 U/mL) in Epithelial Ovarian Carcinoma. Rambam Maimonides Med J 2015; 6:e0005. [PMID: 25717387 PMCID: PMC4327321 DOI: 10.5041/rmmj.10180] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/14/2023] Open
Abstract
OBJECTIVE To assess the association between normal CA125 levels at diagnosis of epithelial ovarian carcinoma (EOC) with prognostic factors and with outcome. METHODS The study group consisted of histologically confirmed EOC patients with normal pretreatment CA125 levels, and the controls consisted of EOC patients with elevated (≥35 U/mL) pretreatment CA125 levels, diagnosed and treated between 1995 and 2112. Study and control group patients fulfilled the following criteria: 1) their pretreatment CA125 levels were assessed; 2) they had full standard primary treatment, i.e. cytoreductive surgery and cisplatin-based chemotherapy; and 3) they were followed every 2-4 months during the first two years and every 4-6 months thereafter. RESULTS Of 114 EOC patients who fulfilled the inclusion criteria, 22 (19.3%) had normal pretreatment CA125 levels. The control group consisted of the remaining 92 patients with ≥35 U/mL serum CA125 levels pretreatment. The proportion of patients with early-stage and low-grade disease, with optimal cytoreduction, and with platin-sensitive tumors was significantly higher in the study group than in the control group. The progression-free survival (PFS) and overall survival (OS) were significantly higher in the study group than in the control group on univariate analysis but not on multivariate analysis. CONCLUSION It seems that a normal CA125 level at diagnosis in EOC may also be of prognostic significance for the individual patient.
Collapse
Affiliation(s)
- Joseph Menczer
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, E. Wolfson Medical Center, Holon, Tel Aviv University, Sackler Faculty of Medicine, Tel Aviv, Israel
| | - Erez Ben-Shem
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, E. Wolfson Medical Center, Holon, Tel Aviv University, Sackler Faculty of Medicine, Tel Aviv, Israel
| | - Abraham Golan
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, E. Wolfson Medical Center, Holon, Tel Aviv University, Sackler Faculty of Medicine, Tel Aviv, Israel
| | - Tally Levy
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, E. Wolfson Medical Center, Holon, Tel Aviv University, Sackler Faculty of Medicine, Tel Aviv, Israel
| |
Collapse
|
18
|
Suidan RS, Ramirez PT, Sarasohn DM, Teitcher JB, Mironov S, Iyer RB, Zhou Q, Iasonos A, Paul H, Hosaka M, Aghajanian CA, Leitao MM, Gardner GJ, Abu-Rustum NR, Sonoda Y, Levine DA, Hricak H, Chi DS. A multicenter prospective trial evaluating the ability of preoperative computed tomography scan and serum CA-125 to predict suboptimal cytoreduction at primary debulking surgery for advanced ovarian, fallopian tube, and peritoneal cancer. Gynecol Oncol 2014; 134:455-61. [PMID: 25019568 DOI: 10.1016/j.ygyno.2014.07.002] [Citation(s) in RCA: 160] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2014] [Revised: 07/01/2014] [Accepted: 07/04/2014] [Indexed: 12/30/2022]
Abstract
OBJECTIVE To assess the ability of preoperative computed tomography (CT) scan of the abdomen/pelvis and serum CA-125 to predict suboptimal (>1cm residual disease) primary cytoreduction in advanced ovarian, fallopian tube, and peritoneal cancer. METHODS This was a prospective, non-randomized, multicenter trial of patients who underwent primary cytoreduction for stage III-IV ovarian, fallopian tube, and peritoneal cancer. A CT scan of the abdomen/pelvis and serum CA-125 were obtained within 35 and 14 days before surgery, respectively. Four clinical and 20 radiologic criteria were assessed. RESULTS From 7/2001 to 12/2012, 669 patients were enrolled; 350 met eligibility criteria. The optimal debulking rate was 75%. On multivariate analysis, three clinical and six radiologic criteria were significantly associated with suboptimal debulking: age ≥ 60 years (p=0.01); CA-125 ≥ 500 U/mL (p<0.001); ASA 3-4 (p<0.001); suprarenal retroperitoneal lymph nodes >1cm (p<0.001); diffuse small bowel adhesions/thickening (p<0.001); and lesions >1cm in the small bowel mesentery (p=0.03), root of the superior mesenteric artery (p=0.003), perisplenic area (p<0.001), and lesser sac (p<0.001). A 'predictive value score' was assigned for each criterion, and the suboptimal debulking rates of patients who had a total score of 0, 1-2, 3-4, 5-6, 7-8, and ≥ 9 were 5%, 10%, 17%, 34%, 52%, and 74%, respectively. A prognostic model combining these nine factors had a predictive accuracy of 0.758. CONCLUSIONS We identified nine criteria associated with suboptimal cytoreduction, and developed a predictive model in which the suboptimal rate was directly proportional to a predictive value score. These results may be helpful in pretreatment patient assessment.
Collapse
Affiliation(s)
- Rudy S Suidan
- Gynecology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center (MSKCC), New York, NY, USA
| | - Pedro T Ramirez
- Department of Gynecologic Oncology, MD Anderson Cancer Center (MDACC), Houston, TX, USA
| | | | | | | | | | - Qin Zhou
- Department of Epidemiology and Biostatistics, MSKCC, New York, NY, USA
| | - Alexia Iasonos
- Department of Epidemiology and Biostatistics, MSKCC, New York, NY, USA
| | - Harold Paul
- Gynecology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center (MSKCC), New York, NY, USA
| | - Masayoshi Hosaka
- Department of Gynecologic Oncology, MD Anderson Cancer Center (MDACC), Houston, TX, USA
| | - Carol A Aghajanian
- Gynecologic Medical Oncology Service, Department of Medicine, MSKCC, New York, NY, USA; Weill Cornell Medical College, New York, NY, USA
| | - Mario M Leitao
- Gynecology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center (MSKCC), New York, NY, USA; Weill Cornell Medical College, New York, NY, USA
| | - Ginger J Gardner
- Gynecology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center (MSKCC), New York, NY, USA; Weill Cornell Medical College, New York, NY, USA
| | - Nadeem R Abu-Rustum
- Gynecology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center (MSKCC), New York, NY, USA; Weill Cornell Medical College, New York, NY, USA
| | - Yukio Sonoda
- Gynecology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center (MSKCC), New York, NY, USA; Weill Cornell Medical College, New York, NY, USA
| | - Douglas A Levine
- Gynecology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center (MSKCC), New York, NY, USA; Weill Cornell Medical College, New York, NY, USA
| | | | - Dennis S Chi
- Gynecology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center (MSKCC), New York, NY, USA; Weill Cornell Medical College, New York, NY, USA.
| |
Collapse
|
19
|
Tangjitgamol S, Hanprasertpong J, Cubelli M, Zamagni C. Neoadjuvant chemotherapy and cytoreductive surgery in epithelial ovarian cancer. World J Obstet Gynecol 2013; 2:153-166. [DOI: 10.5317/wjog.v2.i4.153] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2012] [Accepted: 02/06/2013] [Indexed: 02/05/2023] Open
Abstract
Ovarian cancer is one of the leading causes of death among gynecological cancers. This is because the majority of patients present with advanced stage disease. Primary debulking surgery (PDS) followed by adjuvant chemotherapy is still a mainstay of treatment. An optimal surgery, which is currently defined by leaving no gross residual tumor, is the goal of PDS. The extent of disease as well as the operative setting, including the surgeon’s skill, influences the likelihood of successful debulking. With extensive disease and a poor chance of optimal surgery or high morbidity anticipated, neoadjuvant chemotherapy (NACT) prior to primary surgery is an option. Secondary surgery after induction chemotherapy is termed interval debulking surgery (IDS). Delayed PDS or IDS is offered to patients who show some clinical response and are without progressive disease. NACT or IDS has become more established in clinical practice and there are numerous publications regarding its advantages and disadvantages. However, data on survival are limited and inconsistent. Only one large randomized trial could demonstrate that NACT was not inferior to PDS while the few randomized trials on IDS had inconsistent results. Without a definite benefit of NACT prior to surgery over PDS, one must carefully weigh the chances of safe and successful PDS against the morbidity and risks of suboptimal surgery. Appropriate selection of a patient to undergo PDS followed by chemotherapy or, preferably, to have NACT prior to surgery is very important. Some clinical characteristics from physical examination, serum tumor markers and/or findings from imaging studies may be predictive of resectability. However, no specific features have been consistently identified in the literature. This article will address the clinical data on prediction of surgical outcomes, the role of NACT, and the role of IDS.
Collapse
|
20
|
The use of CT findings to predict extent of tumor at primary surgery for ovarian cancer. Gynecol Oncol 2013; 130:280-3. [PMID: 23672930 DOI: 10.1016/j.ygyno.2013.05.007] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2013] [Revised: 04/26/2013] [Accepted: 05/05/2013] [Indexed: 11/21/2022]
Abstract
BACKGROUND High tumor dissemination (HTD) is a major risk factor for serious morbidity after primary ovarian cancer (OC) surgery, particularly in medically compromised patients. We performed a pilot study of whether CT findings could predict extent of disease and surgical complexity necessary in advanced OC. METHODS Preoperative CT images for patients with advanced OC from 1997-2003 were evaluated for rigorously defined disease-related findings and compared to both the findings at exploration and the required surgical procedures. Associations were assessed by the chi-square test. RESULTS Forty-six cases met inclusion criteria. Mean age was 66.4y, and 76% had residual disease (RD) 1cm or less. CT and surgical findings correlated (sensitivity/specificity) as follows: diaphragm disease (48%/100%); surface liver (100%/93%); omental cake (72%/65%); any sigmoid involvement (54%/100%); ascites (44%/100%); extra-pelvic large bowel involvement (29%/91%). When diaphragm disease and omental cake were present, HTD was found in all cases (positive predictive value and specificity=100%, sensitivity 48%). For CT findings of liver, large bowel and spleen involvement there was a strong trend toward resection (P=0.001, P=0.06 and P=0.06, respectively). CONCLUSIONS The findings of diaphragm disease and omental cake on CT scan are highly predictive for high tumor dissemination (HTD) and thus likelihood of extensive surgery required to achieve low residual disease. In addition, multiple CT findings correlate strongly with the need for higher surgical complexity which should facilitate preoperative planning and/or triage to specialized centers. These preliminary data suggest specific CT findings can be used to optimize treatment planning.
Collapse
|
21
|
Espada M, Garcia-Flores JR, Jimenez M, Alvarez-Moreno E, De Haro M, Gonzalez-Cortijo L, Hernandez-Cortes G, Martinez-Vega V, Sainz De La Cuesta R. Diffusion-weighted magnetic resonance imaging evaluation of intra-abdominal sites of implants to predict likelihood of suboptimal cytoreductive surgery in patients with ovarian carcinoma. Eur Radiol 2013; 23:2636-42. [PMID: 23604800 DOI: 10.1007/s00330-013-2837-7] [Citation(s) in RCA: 52] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2013] [Revised: 02/09/2013] [Accepted: 02/21/2013] [Indexed: 02/07/2023]
Abstract
OBJECTIVES To analyse the diagnostic accuracy and to establish a predictive score based on diffusion-weighted magnetic resonance imaging (DWMRI) compared to exploratory laparotomy (EL) for predicting suboptimal cytoreductive surgery for different intra-abdominal sites of implants in patients with ovarian cancer. METHODS Thirty-four patients with advanced ovarian carcinoma were studied. Preoperative DWMRI of the abdomen and pelvis was performed. DWMRI findings were compared with EL. Ten anatomical sites were selected for inclusion in the score. Sensitivity, specificity, positive predictive value, negative predictive value and accuracy for suboptimal cytoreduction were calculated for both DWMRI and EL. Receiver operating characteristic (ROC) curve analysis was used to assess the ability to predict suboptimal cytoreduction. RESULTS Using predictive score, ROC curves were generated with an area under the curve of 0.938 for DWMRI and 0.947 for EL (P < 0.0001). For DWMRI, a score ≥6 had the highest overall accuracy at 91.1 % and identified patients with unnecessary EL with a sensitivity of 75 %. For EL, a score ≥4 had the highest overall accuracy at 88.2 % and was able to identify patients with unnecessary EL with a sensitivity of 87.5 %. CONCLUSIONS DWMRI is an emerging technique that may be useful to predict suboptimal cytoreduction in ovarian cancer. KEY POINTS • DWMRI is increasingly used in ovarian cancer. • DWMRI is an accurate technique for depicting intra-abdominal sites of implants • DWMRI is useful for predicting optimal cytoreductive surgical outcome. • We report a high predictive value similar to exploratory laparotomy.
Collapse
Affiliation(s)
- Mercedes Espada
- Obstetrics and Gynecology Department, Hospital Universitario Quiron Madrid, Calle Diego de Velazquez, 1. 28223. Pozuelo de Alarcon, Madrid, Spain.
| | | | | | | | | | | | | | | | | |
Collapse
|
22
|
Diagnostic accuracy of hand-assisted laparoscopy in predicting resectability of peritoneal carcinomatosis from gynecological malignancies. Eur J Surg Oncol 2013; 39:774-9. [PMID: 23597496 DOI: 10.1016/j.ejso.2013.03.022] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2012] [Revised: 10/06/2012] [Accepted: 03/25/2013] [Indexed: 12/31/2022] Open
Abstract
OBJECTIVES Residual disease after excision surgery is the main prognostic factor in advanced ovarian cancer. Open surgery can delay neoadjuvant chemotherapy initiation. Therefore, a minimally invasive method for evaluating resectability would be of great interest. Aim of our study is to evaluate a new technique for assessing the extent of peritoneal carcinomatosis, combining manual palpation and standard laparoscopy. METHODS Prospective single-center study from October 2008 to January 2010. Patients with peritoneal carcinomatosis from gynecological malignancies were investigated by standard laparoscopy followed by laparoscopy plus manual palpation using Lapdisc(®) (Ethicon Inc.), at 43 abdominopelvic sites. When both techniques indicated resectability, standard cytoreduction surgery was performed via a midline laparotomy. The Fagotti, modified Fagotti, and Sugarbaker scores were computed. The diagnostic performance of each evaluation criterion was assessed by computing sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and area under the receiver-operating characteristic curves (ROC-AUCs). RESULTS Of the 29 included patients, 18 (62.1%) were considered to have resectable disease. Fourteen (14/18, 77.8%) had macroscopically complete cytoreduction. With Lapdisc(®), sensitivity was 100%, specificity 73.3%, PPV 77.8%, NPV 100%, and ROC-AUC 0.87. Corresponding values were as follows: laparoscopy, 100%, 40%, 60.9%, 100%, and 0.70; Fagotti and modified Fagotti scores, 100%, 46.7%, 63.6%, 100%, and 0.73; Sugarbaker score, 64.3%, 93.3%, 90%, 73.7%, and 0.79. The ROC-AUCs showed significantly better performance of Lapdisc(®) than of standard laparoscopy (P = 0.008). CONCLUSION Hand-assisted laparoscopy may perform better than laparoscopy alone for predicting the resectability of peritoneal carcinomatosis by increasing the number of sites evaluated.
Collapse
|
23
|
Furukawa N, Sasaki Y, Shigemitsu A, Akasaka J, Kanayama S, Kawaguchi R, Kobayashi H. CA-125 cut-off value as a predictor for complete interval debulking surgery after neoadjuvant chemotherapy in patients with advanced ovarian cancer. J Gynecol Oncol 2013; 24:141-5. [PMID: 23653831 PMCID: PMC3644690 DOI: 10.3802/jgo.2013.24.2.141] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2012] [Revised: 10/29/2012] [Accepted: 10/30/2012] [Indexed: 11/30/2022] Open
Abstract
Objective In the present study, we evaluated changes in CA-125 cut-off values predictive of complete interval debulking surgery (IDS) after neoadjuvant chemotherapy (NAC) using receiver operating characteristic (ROC) analysis. Methods This retrospective single-institution study included patients with International Federation of Gynecology and Obstetrics (FIGO) stage III epithelial ovarian cancer and a pre-NAC serum CA-125 level of greater than 40 U/mL who were treated with neoadjuvant platinum-based chemotherapy followed by IDS between 1994 and 2009. Logistic regression analysis was used to evaluate univariate and independent multivariate associations with the effect of clinical, pathological, and CA-125 parameters on complete IDS, and ROC analysis was used to determine potential cut-off values of CA-125 for prediction of the possibility of complete IDS. Results Seventy-five patients were identified. Complete IDS was achieved in 46 (61.3%) patients and non-complete IDS was observed 29 (38.7%). Median pre-NAC CA-125 level was 639 U/mL (range, 57 to 6,539 U/mL) in the complete IDS group and 1,427 U/mL (range, 45 to 10,989 U/mL) in the non-complete IDS group. Median pre-IDS CA-125 level was 15 U/mL (range, 2 to 60 U/mL) in the complete IDS group and 53 U/mL (range, 5 to 980 U/mL) in the non-complete IDS group (p<0.001). Multivariate analyses performed with complete IDS as the endpoint revealed only pre-IDS CA-125 as an independent predictor. The odds ratio of non-complete IDS was 10.861 when the pre-IDS CA-125 level was greater than 20 U/mL. Conclusion The present data suggest that in the setting of IDS after platinum-based NAC for advanced ovarian cancer, a pre-IDS CA-125 level less than 20 U/mL is an independent predictor of complete IDS.
Collapse
Affiliation(s)
- Naoto Furukawa
- Department of Obstetrics and Gynecology, Nara Medical University, Nara, Japan
| | | | | | | | | | | | | |
Collapse
|
24
|
Angioli R, Plotti F, Capriglione S, Aloisi A, Montera R, Luvero D, Miranda A, Cafà EV, Damiani P, Benedetti-Panici P. Can the preoperative HE4 level predict optimal cytoreduction in patients with advanced ovarian carcinoma? Gynecol Oncol 2012; 128:579-83. [PMID: 23220563 DOI: 10.1016/j.ygyno.2012.11.040] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2012] [Revised: 11/28/2012] [Accepted: 11/29/2012] [Indexed: 11/16/2022]
Abstract
OBJECTIVE Optimal surgical outcome has been proved to be one of the most powerful survival determinants in the management of ovarian cancer patients. Actually, for ovarian cancer patients there is no general consensus on the preoperatively establishment of cytoreducibility. METHODS Between January 2011 and June 2012 patients affected by suspicious advanced ovarian cancer, referred to the Department of Gynecology of Campus Biomedico of Rome were enrolled in the study. All patients had serum CA125 and HE4 measured preoperatively. After a complete laparoscopy to assess the possibility of optimal debulking surgery defined as no visible residual tumor after cytoreduction (RT=0), patients were submitted to primary cytoreductive surgery (Group A) or addressed to neoadjuvant chemotherapy (Group B). RESULTS After diagnostic open laparoscopy, 36 patients underwent optimal primary cytoreductive surgery (Group A) and 21 patients were addressed to neoadjuvant chemotherapy (Group B). In our population, based on ROC curve, the HE4 value of 262pmol/L is the best cut-off to identify patients candidates to optimal cytoreduction with a sensitivity of 86.1% and a specificity of 89.5% (PPV=93.9% and NPV=77%). In addition, CA125 has a sensitivity of 58.3% and a specificity of 84% at cut-off of 414 UI/mL (AUC is 0.68, 95% C.I.=0.620 to 0.861). CONCLUSION Our data indicate that preoperative HE4 is a better predictor for optimal cytoreduction compared to CA125. The best combination in predicting cytoreduction is HE4≤262 pmol/L and ascites <500mL with a sensitivity of 100% and a specificity of 89.5% (PPV=94% and NPV=100%).
Collapse
Affiliation(s)
- Roberto Angioli
- Department of Obstetrics and Gynaecology Campus Bio Medico University of Rome, Italy.
| | | | | | | | | | | | | | | | | | | |
Collapse
|
25
|
Preoperative HE4 expression in plasma predicts surgical outcome in primary ovarian cancer patients: results from the OVCAD study. Gynecol Oncol 2012. [PMID: 23178313 DOI: 10.1016/j.ygyno.2012.11.023] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
OBJECTIVES Epithelial ovarian cancer (EOC) is the major cause of death due to gynecological malignancies. The most important prognostic factors are residual tumor mass after surgery and platinum-response. No predictive biomarkers are available to identify patients who will benefit from standard treatment. The aim of our study was to analyze the role of HE4 in predicting surgical and clinical outcome in primary EOC. METHODS In the European multicentric project "OVCAD", 275 consecutive patients with primary EOC were enrolled. Patients were eligible if radical cytoreductive surgery was performed and platinum-based chemotherapy was applied. Plasma and ascites samples were collected before or during surgery. The concentrations of HE4 and CA125 was determined using ELISA and Luminex technique, respectively. RESULTS Median age at first diagnosis was 58 years (range 18-85 years). Most patients presented with advanced stage disease, FIGO III or IV (94.6%), grades II-III (96%) and serous histology (86.2%). In most cases a complete cytoreduction to no residual tumor mass was achieved (68.4%). Higher plasma HE4 levels correlated with poor surgery outcome in terms of macroscopically residual tumor mass (p<0.001) and platinum-resistance (p=0.009). Plasma CA125 and the risk index (HE4 and CA125) were independent predictive factors for surgical outcome (p=0.001, OR=3.37, 95% CI=1.61-7.06 and p<0.001, OR=6,041, 95% CI=2.33-15.65, respectively). FIGO stage III was an independent predictive factor for platinum response (p=0.039, OR=0.436, 95% CI=0.198-0.960). CONCLUSIONS The presented data are showing that the combination of HE4 and CA125 expression in plasma might predict the surgical outcome in EOC and by this may have a prognostic impact on PFS and OS.
Collapse
|
26
|
Tropé CG, Elstrand MB, Sandstad B, Davidson B, Oksefjell H. Neoadjuvant chemotherapy, interval debulking surgery or primary surgery in ovarian carcinoma FIGO stage IV? Eur J Cancer 2012; 48:2146-54. [DOI: 10.1016/j.ejca.2012.01.031] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2012] [Accepted: 01/29/2012] [Indexed: 11/27/2022]
|
27
|
Surgical risk score predicts suboptimal debulking or a major perioperative complication in patients with advanced epithelial ovarian, fallopian tube, or primary peritoneal cancer. Int J Gynecol Cancer 2012; 21:1422-7. [PMID: 21997170 DOI: 10.1097/igc.0b013e31822c7704] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Patients who present with an advanced ovarian cancer are typically treated with primary debulking surgery (PDS) or neoadjuvant chemotherapy (NAC) followed by interval debulking surgery. The accurate pretreatment identification of patients best suited for PDS versus NAC is challenging. A paradigm for selecting one approach over the other could improve patient outcomes. In this study, we developed a prediction model for "successful surgery" (defined as optimal residual disease and no major perioperative complication) in patients who underwent PDS. PATIENTS Preoperative clinical characteristics, laboratory values, computed tomography findings, and surgical outcomes of 106 consecutive medically fit patients with advanced ovarian, tubal, or peritoneal cancer were reviewed. Preoperative predictors of suboptimal residual disease and major perioperative complications were determined using regression analysis. A surgical risk score (SRS) that minimized the false-negative rate (ie, likelihood of incorrectly predicting successful surgery) was constructed. RESULTS Sixty (57%) of the 106 patients were optimally cytoreduced. Fifty-six "radical procedures" were performed, and there were a total of 24 major perioperative complications. Diffuse peritoneal studding (P < 0.0001), para-aortic lymphadenopathy (P < 0.0001), and mesenteric involvement (Mes, P = 0.006) were associated with suboptimal (>1 cm) residual disease. Low albumin (P = 0.04) and splenic disease (spleen, P = 0.02) were the only 2 parameters associated with a higher risk of a major perioperative complication. The median SRSs of patients who had successful and "unsuccessful surgery" were 1 (0-4) and 3 (0-6), respectively. The false-negative rate of the SRS was only 7%. CONCLUSIONS We developed a model that incorporated complications, in addition to residual disease status, into predicting surgical outcome for medically fit patients with advanced ovarian cancer. The SRS might be useful in determining the initial treatment strategy (ie, PDS vs NAC) for these patients. The accuracy of the SRS needs to be validated in a prospective manner.
Collapse
|
28
|
Díaz-Padilla I, Razak ARA, Minig L, Bernardini MQ, del Campo JM. Prognostic and predictive value of CA-125 in the primary treatment of epithelial ovarian cancer: potentials and pitfalls. Clin Transl Oncol 2012; 14:15-20. [DOI: 10.1007/s12094-012-0756-8] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
|
29
|
Elstrand MB, Sandstad B, Oksefjell H, Davidson B, Tropé CG. Prognostic significance of residual tumor in patients with epithelial ovarian carcinoma stage IV in a 20 year perspective. Acta Obstet Gynecol Scand 2012; 91:308-17. [PMID: 22050605 DOI: 10.1111/j.1600-0412.2011.01316.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
OBJECTIVE We aimed to evaluate prognostic factors impacting on overall survival during a 20 year period with substantial changes in surgical approach and chemotherapy management of patients with epithelial ovarian carcinoma stage IV. DESIGN A retrospective population-based study. SETTING The Norwegian Radium Hospital during 1985-2005. POPULATION Three hundred and ninety-four patients with epithelial ovarian carcinoma stage IV treated at the Norwegian Radium Hospital. METHODS The cohort was divided into two groups (1985-1995 and 1996-2005), and clinical and pathological characteristics were compared. Univariate and multivariate analyses were performed to identify prognostic factors during 1985-1995, 1996-2005 and 1985-2005. MAIN OUTCOME MEASURES Prognostic factors and overall survival in the three periods. RESULTS Median overall survival improved from 1985-1995 to 1996-2005 (from 1.3 to 2.1 years). More patients had macroscopic radical surgery (28 vs. 11%), received neoadjuvant chemotherapy and were treated with platinum-taxane combination therapy from 1996-2005 compared to 1985-1995. Patients with primary surgery had improved median overall survival from 1996-2005 compared to 1985-1995. In multivariate analyses, surgical approach was not a prognostic factor for overall survival, but chemotherapy was during 1985-2005. Postoperative residual tumor was a prognostic factor for overall survival in all periods. CONCLUSIONS Macroscopic radical surgery is a strong prognostic factor for overall survival and is achievable in a subset of patients with epithelial ovarian carcinoma stage IV. Improved selection criteria for what treatment algorithm to choose for patients with epithelial ovarian carcinoma stage IV are warranted.
Collapse
Affiliation(s)
- Mari B Elstrand
- Department of Obstetrics and Gynecology, Baerum Hospital, Norway
| | | | | | | | | |
Collapse
|
30
|
[Interest of CA 125 level in management of ovarian cancer]. ACTA ACUST UNITED AC 2011; 39:296-301. [PMID: 21515085 DOI: 10.1016/j.gyobfe.2010.10.018] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2010] [Accepted: 10/07/2010] [Indexed: 11/24/2022]
Abstract
CA 125 is the most sensitive and the most used marker in the management of ovarian cancer at various stages of the disease. CA 125 is used at the time of diagnosis of the disease, to evaluate the possibility of complete resection during surgery, to estimate sensibility for adjuvant or neo-adjuvant chemotherapy and for diagnosis of recurrences. CA 125 has a diagnostic and therapeutic value and could be of help during therapeutic evaluation. CA 125 has been the topic of many studies for optimizing the management of epithelial ovarian cancers. Mandatory before any ovarian surgery, serum CA 125 levels is a help for the determination of the appropriate surgery. It appears to be a help in choosing therapeutic strategy, to predict optimal surgery and also global and progression-free survival. Low preoperative rates, half-life and fast normalization of CA 125 during the adjuvant chemotherapy are correlated with an optimal surgery and a better global and progression-free survival. The normal range of CA 125 is a strong predictive factor for disease recurrence even if its role in survival has not yet been determined. The dosage of CA 125 and its dynamic interpretation is an indispensable approach to the diagnosis, therapeutics and follow-up of ovarian cancer. Simple serum CA 125 concentration is a very important prognostic and predictive factor for a personalized care.
Collapse
|
31
|
Usefulness of computed tomography in predicting cytoreductive surgical outcomes for ovarian cancer. Arch Gynecol Obstet 2011; 284:1501-7. [PMID: 21347681 DOI: 10.1007/s00404-011-1864-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2010] [Accepted: 02/09/2011] [Indexed: 01/08/2023]
Abstract
PURPOSE The objective of this study was to identify features of preoperative computed tomography (CT) scans that can best predict outcomes of primary cytoreductive surgery in ovarian cancer patients. METHODS Preoperative CT scans of 98 patients were evaluated retrospectively. Multiple logistic regression analysis was used to develop two models. RESULTS Although optimal surgical reduction was attempted in 98 patients, 12 had suboptimal results. Having tumor implants on the small or large bowel mesenteries (any size) or at other sites (cutoff index: ≥ 1 cm) was found to be significant (p < 0.001) for predicting a suboptimal cytoreduction outcome. Two predictive models were created using multiple logistic regression analysis; both consider diffuse peritoneal thickening (DPT), infrarenal para-aortic or pelvic lymph node involvement, a bowel encasement tumor (≥ 2 cm), and any tumor implants in the cul-de-sac as significant. Model 1 adds consideration to any tumors in the pelvic or retroperitoneum and has an accuracy of 90.8% for predicting a suboptimal surgery. Model 2 (accuracy of 93.9%) adds to the core of predictors the presence of tumor implants on the bowel mesenteries (≥ 2 cm), omental caking (≥ 2 cm), and ascites fluid. CONCLUSION Using specific CT findings from patients with ovarian cancer, we have devised two predictive models that have an accuracy of greater than 90% for predicting whether cytoreductive surgery will completely remove all tumor tissue, which should greatly aid in the differential decision-making as to whether to attempt cytoreductive surgery first, or to advance directly to neoadjuvant chemotherapy.
Collapse
|
32
|
Fotopoulou C, Richter R, Braicu E, Schmidt SC, Lichtenegger W, Sehouli J. Can complete tumor resection be predicted in advanced primary epithelial ovarian cancer? A systematic evaluation of 360 consecutive patients. Eur J Surg Oncol 2010; 36:1202-10. [DOI: 10.1016/j.ejso.2010.09.008] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2009] [Revised: 07/16/2010] [Accepted: 09/06/2010] [Indexed: 01/08/2023] Open
|
33
|
Distinctive DNA methylation patterns of cell-free plasma DNA in women with malignant ovarian tumors. Gynecol Oncol 2010; 120:113-20. [PMID: 21056906 DOI: 10.1016/j.ygyno.2010.09.019] [Citation(s) in RCA: 89] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2010] [Revised: 08/09/2010] [Accepted: 09/28/2010] [Indexed: 12/17/2022]
Abstract
OBJECTIVE Epithelial ovarian carcinoma (OvCa) is rarely detected early, and it is also difficult to determine whether an adnexal mass is benign or malignant. Previously, we noted differences in methylation patterns of cell-free plasma DNA (cfpDNA) in women without disease compared to patients with OvCa. In this work, we investigated whether methylation patterns of cfpDNA can differentiate between benign and malignant tumors. METHODS Methylation patterns in cfpDNA were determined in three cohorts (30 samples each) using a microarray-based assay (MethDet 56). Principal component analysis, supervised clustering, linear discrimination analysis, and 25 rounds of 5-fold cross-validation were used to determine informative genes and assess the sensitivity and specificity of differentiating between OvCa vs. healthy control (HC), benign ovarian disease (mostly serous cystadenoma, BOD) vs. HC, and OvCa vs. BOD samples. RESULTS Differential methylation of three promoters (RASSF1A, CALCA, and EP300) differentiated between OvCa vs. HC with a sensitivity of 90.0% and a specificity of 86.7%. Three different promoters (BRCA1, CALCA, and CDKN1C) were informative for differentiating between BOD vs. HC, with a sensitivity of 90.0% and a specificity of 76.7%. Finally, two promoters (RASSF1A and PGR-PROX) were informative for differentiating between OvCa vs. BOD, with a sensitivity of 80.0% and a specificity of 73.3%. CONCLUSIONS This proof-of-principle data show that differential methylation of promoters in cfpDNA may be a useful biomarker to differentiate between certain benign and malignant ovarian tumors.
Collapse
|
34
|
Aletti GD, Eisenhauer EL, Santillan A, Axtell A, Aletti G, Holschneider C, Chi DS, Bristow RE, Cliby WA. Identification of patient groups at highest risk from traditional approach to ovarian cancer treatment. Gynecol Oncol 2010; 120:23-8. [PMID: 20933255 DOI: 10.1016/j.ygyno.2010.09.010] [Citation(s) in RCA: 168] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2010] [Revised: 09/08/2010] [Accepted: 09/15/2010] [Indexed: 12/22/2022]
Abstract
OBJECTIVE Define subgroups of patients at highest risk for major morbidity and mortality after a traditional approach of maximal surgical efforts followed by chemotherapy for advanced ovarian cancer (AOC). METHODS Preoperative health, intra-operative findings and outcomes were assessed in consecutive patients with primary AOC from 4 centers. Initial tumor dissemination was stratified into 3 groups based on volume of disease. Surgery was categorized using a previously described surgical complexity score (SCS). Statistical analysis was directed toward validating a multivariable risk-adjusted model. RESULTS 576 patients with stage IIIC (N=447, 77.6%) or IV AOC (N=129, 22.4%) were analyzed. Age (HR (per year): 1.02; 95%CI: 1.01-1.03), high tumor dissemination (HTD) (HR: 1.73; 95%CI: 1.19-2.56), residual disease (RD) >1 cm (HR: 2.46; 95%CI: 1.74-3.53), and stage IV (HR: 1.93; 95% CI: 1.51-2.45), independently correlated with OS. We identified a small subgroup of patients who comprised a high-risk group (N=38, 6.6%) characterized by all of the following characteristics: high initial tumor dissemination (HTD) or stage IV plus poor performance or nutritional status plus age ≥ 75. In this group, high SCS to achieve low RD was associated with morbidity of 63.6% and limited survival benefit. CONCLUSIONS Optimal management of AOC requires accurate, risk-adjusted predictors of outcomes allowing a tailored approach starting with primary therapy. Complex surgical procedures to render low RD improve survival, and in the majority of cases, the benefits of such surgery appear to outweigh the morbidity. However careful analysis identifies a subgroup of patients in whom an alternative approach may be the better strategy.
Collapse
Affiliation(s)
- Giovanni D Aletti
- Department of Gynecologic Surgery, Mayo Clinic, Rochester, MN 55905, USA
| | | | | | | | | | | | | | | | | |
Collapse
|
35
|
Mousavi AS, Mazhari MM, Guilani MM, Ghaemmaghami F, Behtash N, Akhavan S. Can primary optimal cytoreduction be predicted in advanced epithelial ovarian cancer preoperatively? World J Surg Oncol 2010; 8:11. [PMID: 20170515 PMCID: PMC2844392 DOI: 10.1186/1477-7819-8-11] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2009] [Accepted: 02/19/2010] [Indexed: 12/15/2022] Open
Abstract
Introduction Prediction of optimal cytoreduction in patients with advanced epithelial ovarian caner preoperatively. Methods Patients with advanced epithelial ovarian cancer who underwent surgery for the first time from Jan. to June 2008 at gynecologic oncology ward of TUMS (Tehran University of Medical Sciences) were eligible for this study. The possibility of predicting primary optimal cytoreduction considering multiple variables was evaluated. Variables were peritoneal carcinomatosis, serum CA125, ascites, pleural effusion, physical status and imaging findings. Univariate comparisons of patients underwent suboptimal cytoreduction carried out using Fisher's exact test for each of the potential predictors. The wilcoxon rank sum test was used to compare variables between patients with optimal versus suboptimal cytoreduction. Results 41 patients met study inclusion criteria. Statistically significant association was noted between peritoneal carcinomatosis and suboptimal cytoreduction. There were no statistically significant differences between physical status, pleural effusion, imaging findings, serum CA125 and ascites of individuals with optimal cytoreduction compared to those with suboptimal cytoreduction. Conclusions Because of small populations in our study the results are not reproducible in alternate populations. Only the patient who is most unlikely to undergo optimal cytoreduction should be offered neoadjuvant chemotherapy, unless her medical condition renders her unsuitable for primary surgery.
Collapse
Affiliation(s)
- Azam-Sadat Mousavi
- Department of Gynecology Oncology, vali-e-asr hospital, Tehran University of Medical Sciences, Keshavarz Blvd, Tehran, 1419733141, Iran
| | | | | | | | | | | |
Collapse
|
36
|
Kang S, Kim TJ, Nam BH, Seo SS, Kim BG, Bae DS, Park SY. Preoperative serum CA-125 levels and risk of suboptimal cytoreduction in ovarian cancer: a meta-analysis. J Surg Oncol 2010; 101:13-7. [PMID: 20025071 DOI: 10.1002/jso.21398] [Citation(s) in RCA: 56] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
BACKGROUND This meta-analysis was designed to determine the ability of pretreatment CA-125 level to predict optimal cytoreduction in advanced ovarian cancer (OC). METHODS Through literature search, 14 studies were identified. In addition, we retrospectively reviewed the data of 154 patients with OC. Using the bi-variate model, diagnostic performance of CA-125 was assessed at the various cut-off levels. An overall odds ratio was obtained using random effects model. RESULTS A total of 2,192 patients were included in the analysis. The pooled optimal cytoreduction rate and the mean of median CA-125 levels were 53.7% and 580 U/ml, respectively. At the cut-off of 500 U/ml, overall sensitivity and specificity were 68.9% (95% confidence interval [CI] 62.0-75.1%) and 63.2% (95% CI 53.7-71.7%), respectively. Positive and negative likelihood ratios were 1.87 (95% CI 1.40-2.50) and 0.49 (95% CI 0.37-0.66). The CA-125 >500 U/ml showed strong association with a risk of suboptimal cytoreduction with an odds ratio of 3.69 (95% CI 2.02-6.73). CONCLUSIONS The current analysis indicates that CA-125 is a strong risk factor of suboptimal cytoreduction and it may be applied in preoperative counseling and treatment planning. However, it also shows that CA-125 lacks the ability to predict optimal cytoreduction accurately.
Collapse
Affiliation(s)
- Sokbom Kang
- Center for Uterine Cancer, Research Institute and Hospital, National Cancer Center, Ilsan-gu Madu-dong, Goyang, Republic of Korea.
| | | | | | | | | | | | | |
Collapse
|
37
|
Ibeanu OA, Bristow RE. Predicting the Outcome of Cytoreductive Surgery for Advanced Ovarian Cancer. Int J Gynecol Cancer 2010; 20 Suppl 1:S1-11. [DOI: 10.1111/igc.0b013e3181cff38b] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
|
38
|
Martinek IE, Kehoe S. When should surgical cytoreduction in advanced ovarian cancer take place? JOURNAL OF ONCOLOGY 2009; 2010:852028. [PMID: 19859583 PMCID: PMC2766504 DOI: 10.1155/2010/852028] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/29/2009] [Accepted: 09/13/2009] [Indexed: 11/17/2022]
Abstract
Initial surgical management is commonly accepted to date as paramount in the treatment of women presenting with epithelial ovarian cancer and permits the assessment of the disease (staging), the histological confirmation of disease type and grade, and the practice of maximal debulking preceding platinum-based chemotherapy. Many studies have shown that the volume of residual disease after initial surgical cytoreduction inversely correlates with survival. Thus, women with optimal debulking performed by a trained specialist have improved median survival. In this review, we will focus on the answers gleaned from clinical trials on primary and interval surgery, which prompts the question on the timing of surgery in respect to chemotherapy. Interval debulking surgery (IDS) is secondary cytoreduction following primary debulking and is carried out in between the courses of chemotherapy. The major clinical trials and the latest systematic reviews seem unable to give any definitive guidance or recommendation for clinical practice. The choice of aggressive primary cytoreduction or upfront chemotherapy followed by second line surgical cytoreduction seems among others to have to be individualized according to tumour load, prediction of its resectability, and response to chemotherapy. The role of tumour biology must also be kept in mind. Finally, concrete answers are awaited on the timing of surgery from the ongoing prospective randomized control trials (CHORUS and EORTC 55971) though preliminary data from the latter have already been presented at major meetings (IGCS 2008; SGO 2009) and ignited strong debate.
Collapse
Affiliation(s)
- Igor E. Martinek
- Oxford Gynaecological Cancer Centre Surgery and Diagnostics, Level 0, Churchill Hospital, Oxford OX3 7JL, UK
| | - Sean Kehoe
- Oxford Gynaecological Cancer Centre Surgery and Diagnostics, Level 0, Churchill Hospital, Oxford OX3 7JL, UK
| |
Collapse
|
39
|
A multicenter validation of computerized tomography models as predictors of non- optimal primary cytoreduction of advanced epithelial ovarian cancer. Eur J Surg Oncol 2009; 35:1109-12. [DOI: 10.1016/j.ejso.2009.03.002] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2008] [Revised: 11/27/2008] [Accepted: 03/05/2009] [Indexed: 11/30/2022] Open
|
40
|
Role of CT scan-based and clinical evaluation in the preoperative prediction of optimal cytoreduction in advanced ovarian cancer: a prospective trial. Br J Cancer 2009; 101:1066-73. [PMID: 19738608 PMCID: PMC2768100 DOI: 10.1038/sj.bjc.6605292] [Citation(s) in RCA: 69] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND In advanced ovarian cancer, maximal efforts have to be attemptedto achieve optimal cytoreduction, as this represents the keystone in the therapeutic management. This large, prospective study aims at investigating the role of computed tomography (CT) scan in predicting the feasibility of optimal cytoreduction in ovarian cancer. METHODS A total of 195 consecutive patients with clinical/radiographic suspicion of advanced ovarian/peritoneal cancer were enrolled at the Gynecologic Oncology Unit, Catholic University of Rome and Campobasso, Italy. Preoperative CT scans were performed with a high-speed scanner (CT Hi Speed Nx/i Pro; 2-slice; GE Medical System). All patients underwent standard laparotomy, and maximal surgical effort was attempted. The following CT parameters were used: peritoneal thickening, peritoneal implants >2 cm, bowel mesentery involvement, omental cake, pelvic sidewall involvement and/or hydroureter, suprarenal aortic lymph nodes >1 cm, infrarenal aortic lymph nodes >2 cm, superficial liver metastases >2 cm and/or intraparenchimal liver metastases any size, large volume ascites (>500 ml). Clinical data included were age, Ca125 serum levels, and ECOG-PS. Radiographic and clinical features exhibiting a specificity >75%, a positive and negative predictive value >50%, an accuracy >60% in predicting surgical outcome were assigned a point value of 2. With this scoring system, a predictive index (PI) was calculated for each patient. RESULTS The PI scores ranged from 0 to 6, and from 0 to 8, in Model 1 (including only radiographic parameters) and in Model 2 (including radiographic and clinical data). The AUC was 0.78+0.035 in Model 1, and 0.81+0.031 in Model 2. Therefore, the addition of ECOG-PS data led to the improvement of the diagnostic performances (z=2.41, P-value <0.05). CONCLUSIONS Computed scan still represents a valid tool to predict ovarian cancer optimal cytoreduction; the predictive ability of a CT scan-based model is improved by integrating ECOG-PS data.
Collapse
|
41
|
A contemporary analysis of the ability of preoperative serum CA-125 to predict primary cytoreductive outcome in patients with advanced ovarian, tubal and peritoneal carcinoma. Gynecol Oncol 2009; 112:6-10. [PMID: 19100916 DOI: 10.1016/j.ygyno.2008.10.010] [Citation(s) in RCA: 59] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2008] [Revised: 10/07/2008] [Accepted: 10/12/2008] [Indexed: 01/08/2023]
Abstract
OBJECTIVE We previously reported that preoperative CA-125 may predict primary cytoreductive outcome in patients with stage III ovarian carcinoma (OC). The objective of this study was to perform a contemporary analysis of the ability of CA-125 to predict cytoreductive outcome in advanced OC since our programmatic change in surgical approach that currently incorporates the utilization of extensive upper abdominal procedures, as needed, to achieve maximal cytoreduction. METHODS We reviewed the records of all patients with advanced ovarian, tubal or peritoneal carcinoma who underwent primary cytoreduction at our institution between 1/01 and 4/05. RESULTS The study cohort included 277 patients. Primary disease sites were: ovary, 232 (84%); tubal, 9 (3%); and peritoneum, 36 (13%). Stages were: IIIA, 6 (2%); IIIB, 12 (4%); IIIC, 215 (78%); and IV, 44 (16%). Tumor grades were: grade 1, 6 (2%); grade 2, 30 (11%); grade 3, 233 (84%), and undifferentiated, 8 (3%). Cytoreductive outcomes were: no gross residual disease (RD), 68 (25%); <or=1 cm RD, 153 (55%); and >cm RD, 56 (20%). There was no threshold CA-125 level that accurately predicted cytoreductive outcome. However, with CA-125 values >500 U/mL, 50% (57/113) of patients required extensive upper abdominal surgery to achieve RD <or=1 cm, compared to 27% (25/93) for those with CA-125 <500 U/mL (P=0.001). CONCLUSION Following our change in surgical paradigm that the incorporated extensive upper abdominal procedures to attain optimal debulking, preoperative CA-125 did not predict the primary cytoreductive outcome of patients with advanced ovarian, tubal, or peritoneal carcinoma. However, with a preoperative CA-125 >500 U/mL, extensive upper abdominal procedures were necessary in 50% of cases to achieve residual disease <or=1 cm. These data may be useful as part of preoperative surgical counseling and planning.
Collapse
|
42
|
Can the preoperative Ca-125 level predict optimal cytoreduction in patients with advanced ovarian carcinoma? A single institution cohort study. Gynecol Oncol 2009; 112:11-5. [PMID: 19119502 DOI: 10.1016/j.ygyno.2008.09.020] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
BACKGROUND Preoperative Ca-125 level has been used as a predictor of optimal cytoreduction in advanced ovarian carcinoma. Yet, controversy exists regarding the ability of the tumor marker to predict optimal debulking and moreover of the proper cut-off limit to do so. METHODS The preoperative Ca-125 levels of 426 patients with Stage III/IV ovarian carcinoma from a single institution were correlated with surgical outcome. Optimal was considered the cytoreduction if the largest residual tumor was < or equal to 1 cm in diameter. Receiver operation characteristic (ROC) curve data were combined with interval likelihood ratios at various Ca-125 levels to determine the cut-off level with the maximum prognostic power. Sensitivity, specificity, positive and negative predictive values and accuracy were also calculated. RESULTS Preoperative Ca-125 proved to be a reliable predictor for optimal cytoreduction. The area under curve of the ROC curve was 0.89, 98% C.I.=[0.828-0.952], indicating very good discriminating capability. The level of 500 IU/ml was found to have the most predictive power. The sensitivity of Ca-125 at that level was 78.5%, the specificity 89.6%, the positive predictive value 84.2%, the negative predictive value 85.4% and its accuracy 85%. Furthermore, the likelihood ratio for correct discrimination between optimal and sub-optimal cytoreduction, dropped sharply from 6.33, 95% C.I. [5.19-10.91] at the level of 500 IU/ml to 0.58, 95% C.I. [0.21-1.63] at the level of 600 IU/ml. CONCLUSIONS Our data indicate that preoperative Ca-125 is a good predictor for optimal cytoreduction. the best threshold for this prediction proved to be 500 IU/ml. These patients may be candidates for neo-adjuvant chemotherapy treatment. Nevertheless, all clinical and radiological findings must be co-evaluated.
Collapse
|
43
|
Fagotti A, Ferrandina G, Fanfani F, Garganese G, Vizzielli G, Carone V, Salerno MG, Scambia G. Prospective validation of a laparoscopic predictive model for optimal cytoreduction in advanced ovarian carcinoma. Am J Obstet Gynecol 2008; 199:642.e1-6. [PMID: 18801470 DOI: 10.1016/j.ajog.2008.06.052] [Citation(s) in RCA: 185] [Impact Index Per Article: 11.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2007] [Revised: 02/17/2008] [Accepted: 06/21/2008] [Indexed: 02/07/2023]
Abstract
OBJECTIVE The purpose of this study was to validate the performance of a laparoscopy-based model to predict optimal cytoreduction in advanced ovarian cancer patients. STUDY DESIGN In a consecutive prospective series of 113 advanced ovarian cancer patients, the presence of omental cake, peritoneal and diaphragmatic extensive carcinosis, mesenteric retraction, bowel and stomach infiltration, spleen and/or liver superficial metastasis were investigated by laparoscopy. By summing the scores relative to all parameters, a laparoscopic assessment for each patient (total predictive index value = PIV) has been calculated. Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and accuracy have been calculated for each PIV. RESULTS The overall accuracy rate of the laparoscopic procedure ranged between 77.3 and 100%. At a PIV >/= 8 the probability of optimally resecting the disease at laparotomy is equal to 0, and the rate of unnecessary exploratory laparotomy is 40.5%. CONCLUSION The proposed laparoscopic model appears a reliable and flexible tool to predict optimal cytoreduction in advanced ovarian cancer.
Collapse
|
44
|
Helm CW, Bristow RE, Kusamura S, Baratti D, Deraco M. Hyperthermic intraperitoneal chemotherapy with and without cytoreductive surgery for epithelial ovarian cancer. J Surg Oncol 2008; 98:283-90. [PMID: 18726895 DOI: 10.1002/jso.21083] [Citation(s) in RCA: 56] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
Women with epithelial ovarian cancer (EOC) usually present with advanced disease and overall only just over half survive 5 years. Even following a complete response to front-line treatment two-thirds will recur, with a resultant dismal prognosis. We review and discuss the role of surgery and hyperthermic intraperitoneal chemotherapy (HIPEC) in EOC and present the results of the ovary consensus panel (OCP) convened for the 5th International Workshop on Peritoneal Surface Malignancy.
Collapse
Affiliation(s)
- C William Helm
- Division of Gynecologic Oncology, James Graham Brown Cancer Center, University of Louisville, Kentucky 40207, USA.
| | | | | | | | | |
Collapse
|
45
|
Colombo PE, Mourregot A, Fabbro M, Gutowski M, Saint-Aubert B, Quenet F, Gourgou S, Rouanet P. Aggressive surgical strategies in advanced ovarian cancer: a monocentric study of 203 stage IIIC and IV patients. Eur J Surg Oncol 2008; 35:135-43. [PMID: 18289825 DOI: 10.1016/j.ejso.2008.01.005] [Citation(s) in RCA: 79] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2007] [Accepted: 01/08/2008] [Indexed: 01/13/2023] Open
Abstract
AIMS The standard treatment for advanced ovarian cancer consists of cytoreductive surgery associated with a platinum/paclitaxel-based chemotherapy. Nevertheless, there is still the question as to the extent and timing of the surgical debulking. The aim of this study was to evaluate the place of surgery in the therapeutic sequence. PATIENTS AND METHODS We reviewed data from all consecutive patients with stage IIIC and IV epithelial ovarian cancer, operated on at our institution between 1990 and 2005. Patients were divided into 2 groups, according to the position of surgery in the therapeutic sequence. Patients in group 1 received initial debulking surgery. Group 2 consisted of patients having received their first debulking after initial chemotherapy. RESULTS Two hundred and three patients were identified and frequently underwent aggressive surgery, in particular, digestive surgery with bowel resections. Perioperative mortality and morbidity rates were low (2% and 14%, respectively) and there was no difference between the groups. Overall survival in group 1 for patients with complete cytoreduction (residual disease (RD)=0), optimal surgery (RD<1cm) or sub-optimal surgery (RD>1cm) was 50%, 30% and 14%, respectively. In group 2, overall survival following complete surgery was 30%, and no long-term survival was observed when surgery was not complete at the time of interval surgery. Survival was worse for patients who had received more than 4 cycles of neoadjuvant chemotherapy. CONCLUSION This study confirms the importance of surgery in the prognosis of advanced ovarian cancer. Only the patient subgroup that underwent complete initial or interval surgery was associated with a prolonged remission. Optimal surgery with a controlled morbidity can be achieved in many cases, even if bowel resection is needed, at the time of primary debulking. In the interval cytoreductive surgery subgroup, the response to initial chemotherapy and surgery was found to be essential for prognosis.
Collapse
Affiliation(s)
- P-E Colombo
- Department of Surgical Oncology, CRLC Val d'Aurelle, Montpellier Cedex, France.
| | | | | | | | | | | | | | | |
Collapse
|
46
|
Chimiothérapie néoadjuvante dans les cancers ovariens avancés: impact sur la qualitéde la chirurgie d’intervalle et sur la survie sans rechute. ONCOLOGIE 2008. [DOI: 10.1007/s10269-007-0826-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
|
47
|
Winter WE, Maxwell GL, Tian C, Sundborg MJ, Rose GS, Rose PG, Rubin SC, Muggia F, McGuire WP. Tumor residual after surgical cytoreduction in prediction of clinical outcome in stage IV epithelial ovarian cancer: a Gynecologic Oncology Group Study. J Clin Oncol 2007; 26:83-9. [PMID: 18025437 DOI: 10.1200/jco.2007.13.1953] [Citation(s) in RCA: 264] [Impact Index Per Article: 15.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
PURPOSE To identify factors predictive of poor prognosis in a similarly treated population of women with stage IV epithelial ovarian cancer (EOC). PATIENTS AND METHODS A retrospective review of 360 patients with International Federation of Gynecology and Obstetrics stage IV EOC who underwent primary surgery followed by six cycles of intravenous platinum/paclitaxel was performed. A proportional hazards model was used to assess the association of potential prognostic factors with progression-free survival (PFS) and overall survival (OS). RESULTS The median PFS and OS for this group of stage IV ovarian cancer patients was 12 and 29 months, respectively. Multivariate regression analysis revealed that histology, malignant pleural effusion, intraparenchymal liver metastasis, and residual tumor size were significant prognostic variables. Whereas patients with microscopic residual disease had the best outcome, patients with 0.1 to 1.0 cm residual disease and patients with 1.1 to 5.0 cm residual disease had similar PFS and OS. Patients with a residual size more than 5 cm had a diminished PFS and OS when compared with all other groups. Median OS for microscopic, 0.1 to 5.0 cm, and more than 5.0 cm residual disease was 64, 30, and 19 months, respectively. CONCLUSION Patients with more than 5 cm residual disease have the shortest PFS and OS, whereas patients with 0.1 to 1.0 and 1.1 to 5.0 cm have similar outcome. These findings suggest that ultraradical cytoreductive procedures might be targeted for selected patients in whom microscopic residual disease is achievable. Patients with less than 5.0 cm of disease initially and significant disease and/or comorbidities precluding microscopic cytoreduction may be considered for alternative therapeutic options other than primary cytoreduction.
Collapse
Affiliation(s)
- William E Winter
- Department of Obstetrics and Gynecology, Gynecologic Oncology, Brooke Army Medical Center, Ft Sam Houston, TX, USA
| | | | | | | | | | | | | | | | | | | |
Collapse
|
48
|
The impact of bulky upper abdominal disease cephalad to the greater omentum on surgical outcome for stage IIIC epithelial ovarian, fallopian tube, and primary peritoneal cancer. Gynecol Oncol 2007; 108:287-92. [PMID: 17996927 DOI: 10.1016/j.ygyno.2007.10.001] [Citation(s) in RCA: 85] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2007] [Revised: 09/25/2007] [Accepted: 10/01/2007] [Indexed: 12/14/2022]
Abstract
OBJECTIVE To analyze the impact of bulky upper abdominal disease (UAD) cephalad to the greater omentum on surgical outcomes for patients with stage IIIC epithelial ovarian, fallopian tube, and primary peritoneal carcinoma. METHODS All patients with stage IIIC epithelial ovarian, fallopian tube, and primary peritoneal carcinoma who underwent primary cytoreductive surgery at our institution from 1989 to 2005 were eligible for the study. UAD cephalad to the greater omentum was defined as cancerous lesions involving the diaphragm, liver, porta hepatis, spleen, pancreas, stomach, and lesser sac. The study group was divided into three groups based on the presence and size of UAD cephalad to the greater omentum at the beginning of surgery-group 1, no disease; group 2, < or = 1 cm disease; and group 3, bulky disease > 1 cm. These three groups were further divided into two subsets based on the routine use of extensive upper abdominal surgery after January 1, 2001. Standard statistical analyses were utilized. RESULTS We identified 490 patients who met study inclusion criteria. Their median age was 61 years (range, 25-88). UAD status was recorded in 474 patients as follows: group 1 (no UAD), 116 (24%); group 2 (< or = 1 cm UAD), 161 (34%); and group 3 (bulky UAD > 1 cm), 197 (42%). Bulky UAD was associated with ascites volume (P<0.001). Among the patients with ascites volumes > 500 ml, 54% had bulky UAD cephalad to the greater omentum, 37% had minimal UAD, and 9% had no evidence of UAD. Optimal surgical outcome (< or = 1 cm residual disease) was achieved in 81%, 63%, and 39% of patients in groups 1, 2, and 3, respectively (P<0.001). A significant increase in optimal cytoreduction was observed after 2001 (40% before 2001 vs. 78% after 2001; P<0.001). This effect was more pronounced in patients with bulky UAD (11%, before 2001 vs. 70% after 2001) than in patients with no or minimal UAD (P<0.001). CONCLUSION The upper abdomen cephalad to the greater omentum is frequently involved in patients with stage IIIC ovarian, tubal, and peritoneal carcinoma. This disease site is significantly associated with large-volume ascites and suboptimal cytoreduction. Over the course of 17 years, however, the significant improvement in optimal cytoreduction rates has been most apparent in patients with bulky UAD. These findings emphasize the importance of comprehensive training, preparation, and referral when appropriate to centers that specialize in the surgical management of patients with advanced ovarian, tubal, and peritoneal carcinoma.
Collapse
|
49
|
Arits AHMM, Stoot JEGM, Botterweck AAM, Roumen FJME, Voogd AC. Preoperative serum CA125 levels do not predict suboptimal cytoreductive surgery in epithelial ovarian cancer. Int J Gynecol Cancer 2007; 18:621-8. [PMID: 17868339 DOI: 10.1111/j.1525-1438.2007.01064.x] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
The objective is to assess the ability of preoperative serum CA125 levels to identify patients at high risk of suboptimal cytoreductive surgery for epithelial ovarian cancer (EOC). One hundred and thirty-two women diagnosed with EOC between 1998 and 2004, who had serum CA125 levels measured preoperatively and received primary cytoreductive surgery, were retrospectively evaluated. The value of CA125 and patient and disease characteristics to predict suboptimal cytoreduction were determined, and a prognostic scoring system, based on statistically significant variables, was created. Optimal cytoreduction was achieved in 42.7% of the women with FIGO stage III/IV EOC. The optimal cutoff point of preoperative CA125 to predict surgical outcome in this group was 330 U/mL (sensitivity 80.0%; specificity 41.5%). The area under the receiver-operating characteristic curve (AUC) for preoperative CA125 predicting suboptimal surgery in FIGO stage III/IV was 0.576 (P = 0.617). Preoperative radiologic amount of ascites and weight loss (ie, >or=10% in the last 6 months before diagnosis) were independent prognostic factors for suboptimal cytoreduction, showing an AUC of 0.76 (P < 0.001) in women with FIGO stage III/IV. A prognostic scoring system showed that the chance of suboptimal surgery was 84.6% in FIGO stage III/IV when both these factors are present preoperatively. The role of CA125 levels predicting suboptimal cytoreduction seems questionable. Instead, women with considerable weight loss and a gross amount of ascites have a higher risk of suboptimal cytoreduction. These patients may be candidates for neoadjuvant chemotherapy.
Collapse
Affiliation(s)
- A H M M Arits
- Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands
| | | | | | | | | |
Collapse
|
50
|
Abstract
Surgery plays a critical role in the optimal management of all stages of ovarian carcinoma. In apparent early-stage ovarian cancer, a comprehensive surgical evaluation allows stratification of patients into low- and high-risk categories. Low-risk patients may be candidates for fertility-sparing surgery and can safely avoid chemotherapy and be observed. Treatment of patients with high-risk early- or advanced-stage ovarian cancer usually requires a combined modality approach. Although it is well known that epithelial ovarian cancer is moderately chemosensitive, what distinguishes it most from other metastatic solid tumors is that surgical cytoreduction of tumor volume is highly correlated with prolongation of patient survival. Procedures such as radical pelvic surgery, bowel resection, and aggressive upper abdominal surgery are commonly required to achieve optimal cytoreduction. Women who develop recurrent disease may be eligible for a secondary cytoreductive surgery or may require a surgical intervention to palliate disease-related symptoms. For women at high risk of ovarian cancer, prophylactic bilateral salpingo-oophorectomy significantly reduces the incidence of this disease. The purpose of this article is to provide a comprehensive review of the surgical management of ovarian carcinoma. The roles of primary, interval, and secondary cytoreductive surgeries; second-look procedures; and palliative surgery are reviewed. The indications for fertility-sparing and minimally invasive surgery as well as the current guidelines for prophylactic surgery in high-risk mutation carriers are also discussed.
Collapse
|