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Csikos C, Czina P, Molnár S, Kovács AR, Garai I, Krasznai ZT. Predicting Complete Cytoreduction with Preoperative [ 18F]FDG PET/CT in Patients with Ovarian Cancer: A Systematic Review and Meta-Analysis. Diagnostics (Basel) 2024; 14:1740. [PMID: 39202228 PMCID: PMC11353955 DOI: 10.3390/diagnostics14161740] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2024] [Revised: 08/08/2024] [Accepted: 08/09/2024] [Indexed: 09/03/2024] Open
Abstract
The cornerstone of ovarian cancer treatment is complete surgical cytoreduction. The gold-standard option in the absence of extra-abdominal metastases and intra-abdominal inoperable circumstances is primary cytoreductive surgery (CRS). However, achieving complete cytoreduction is challenging, and only possible in a selected patient population. Preoperative imaging modalities such as [18F]FDG PET/CT could be useful in patient selection for cytoreductive surgery. In our systematic review and meta-analysis, we aimed to evaluate the role of preoperative [18F]FDG PET/CT in predicting complete cytoreduction in primary and secondary debulking surgeries. Publications were pooled from two databases (PubMed, Mendeley) with predefined keywords "(ovarian cancer) AND (FDG OR PET) AND (cytoreductive surgery)". The quality of the included studies was assessed with the Prediction model Risk Of Bias Assessment Tool (PROBAST). During statistical analysis, MetaDiSc 1.4 software and the DerSimonian-Laird method (random effects models) were used. Primary and secondary cytoreductive surgeries were evaluated. Pooled sensitivities, specificities, positive predictive values (PPVs), and negative predictive values (NPVs) were calculated and statistically analyzed. Results were presented in forest plot diagrams and summary receiver operating characteristic (SROC) curves. Overall, eight publications were included in our meta-analysis. Four publications presented results of primary, three presented results of secondary cytoreductions, and two presented data related to both primary and secondary surgery. Pooled sensitivities, specificities, and positive and negative predictive values were the following: in the case of primary surgeries: 0.65 (95% CI 0.60-0.71), 0.73 (95% CI 0.66-0.80), 0.82 (95% CI 0.77-0.87), 0.52 (95% CI 0.46-0.59); and in the case of secondary surgeries: 0.91 (95% CI 0.84-0.95), 0.48 (95% CI 0.30-0.67), 0.88 (95% CI 0.81-0.93), 0.56 (95% CI 0.35-0.75), respectively. The PPVs of [18F]FDG PET/CT proved to be higher in cases of secondary debulking surgeries; therefore, it can be a valuable predictor of complete successful secondary cytoreduction.
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Affiliation(s)
- Csaba Csikos
- Division of Nuclear Medicine and Translational Imaging, Department of Medical Imaging, Faculty of Medicine, University of Debrecen, H-4032 Debrecen, Hungary; (C.C.); (P.C.); (I.G.)
- Gyula Petrányi Doctoral School of Clinical Immunology and Allergology, Faculty of Medicine, University of Debrecen, H-4032 Debrecen, Hungary
| | - Péter Czina
- Division of Nuclear Medicine and Translational Imaging, Department of Medical Imaging, Faculty of Medicine, University of Debrecen, H-4032 Debrecen, Hungary; (C.C.); (P.C.); (I.G.)
| | - Szabolcs Molnár
- Department of Obstetrics and Gynaecology, Faculty of Medicine, University of Debrecen, H-4032 Debrecen, Hungary;
| | - Anna Rebeka Kovács
- Division of Nuclear Medicine and Translational Imaging, Department of Medical Imaging, Faculty of Medicine, University of Debrecen, H-4032 Debrecen, Hungary; (C.C.); (P.C.); (I.G.)
| | - Ildikó Garai
- Division of Nuclear Medicine and Translational Imaging, Department of Medical Imaging, Faculty of Medicine, University of Debrecen, H-4032 Debrecen, Hungary; (C.C.); (P.C.); (I.G.)
- Gyula Petrányi Doctoral School of Clinical Immunology and Allergology, Faculty of Medicine, University of Debrecen, H-4032 Debrecen, Hungary
- Scanomed Ltd., H-4032 Debrecen, Hungary
| | - Zoárd Tibor Krasznai
- Department of Obstetrics and Gynaecology, Faculty of Medicine, University of Debrecen, H-4032 Debrecen, Hungary;
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Si Y, Song N, Ji Y. Construction of a nomogram model for predicting the outcome of debulking surgery for ovarian cancer on the basis of clinical indicators. Front Oncol 2024; 14:1421247. [PMID: 39050577 PMCID: PMC11266020 DOI: 10.3389/fonc.2024.1421247] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2024] [Accepted: 06/24/2024] [Indexed: 07/27/2024] Open
Abstract
Objective This study aimed to investigate the risk factors affecting satisfaction with debulking surgery for ovarian cancer and establish a preoperative clinical predictive model. Methods Clinical data from 131 patients who underwent ovarian cancer debulking surgery at Jiangnan University Affiliated Hospital between 2016 and 2022 were collected. Patients were randomly separated into an experimental group and a control group in a 7:3 ratio. On the basis of intraoperative outcomes, patients were grouped as either surgery-satisfactory or surgery-unsatisfactory. Clinical indicators were compared through single-factor analysis between groups. Significantly different factors (p < 0.1) were further analyzed through multivariate logistic regression. A predictive nomogram model was developed and validated by receiver operating characteristic (ROC), calibration, and clinical decision curves. Results Single-factor analysis revealed the significance of factors such as albumin levels, alkaline phosphatase (ALP), ECOG scores, CA125, HE4, and lymph node metastasis. Multivariate regression analysis identified albumin levels, ALP, ECOG scores, HE4, and lymph node metastasis as independent risk factors for satisfactory surgical outcomes in patients with ovarian cancer undergoing debulking surgery as (p < 0.05). A clinical predictive model was successfully constructed. ROC curves showed AUC values of 0.818 and 0.796 for the experimental and validation groups, respectively. Internal validation through the bootstrap method confirmed the model's fit in both groups. Meanwhile, the clinical decision curve demonstrated the model's high utility. Conclusion Independent risk factors associated with satisfactory tumor reduction in patients with ovarian cancer undergoing debulking surgery included decreased albumin levels, ALP > 137 U/L, ECOG = 1 score, HE4 > 140 pmol/L, and lymph node metastasis. Constructing a clinical predictive model through logistic regression analysis enables individualized testing and maximizes clinical benefits.
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Affiliation(s)
- Yuanyuan Si
- Department of Anesthesiology, Affiliated Hospital of Jiangnan University, Wuxi, China
- Wuxi Medical School, Jiangnan University, Wuxi, China
| | - Ningjia Song
- Wuxi Medical School, Jiangnan University, Wuxi, China
| | - Yong Ji
- Department of Anesthesiology, Affiliated Hospital of Jiangnan University, Wuxi, China
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Harutyunyan L, Manvelyan E, Karapetyan N, Bardakhchyan S, Jilavyan A, Tamamyan G, Avagyan A, Safaryan L, Zohrabyan D, Movsisyan N, Avinyan A, Galoyan A, Sargsyan M, Harutyunyan M, Nersoyan H, Stepanyan A, Galstyan A, Danielyan S, Muradyan A, Jilavyan G. A Survival Analysis of Patients with Recurrent Epithelial Ovarian Cancer Based on Relapse Type: A Multi-Institutional Retrospective Study in Armenia. Curr Oncol 2024; 31:1323-1334. [PMID: 38534933 PMCID: PMC10968888 DOI: 10.3390/curroncol31030100] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2023] [Revised: 02/11/2024] [Accepted: 02/27/2024] [Indexed: 05/26/2024] Open
Abstract
BACKGROUND Annually, approximately 200 new ovarian cancer cases are diagnosed in Armenia, which is considered an upper-middle-income country. This study aimed to summarize the survival outcomes of patients with relapsed ovarian cancer in Armenia based on the type of recurrence, risk factors, and choice of systemic treatment. METHODS This retrospective case-control study included 228 patients with relapsed ovarian cancer from three different institutions. RESULTS The median age of the patients was 55. The median follow-up times from relapse and primary diagnosis were 21 and 48 months, respectively. The incidence of platinum-sensitive relapse was 81.6% (186), while platinum-resistant relapse was observed in only 18.4% (42) of patients. The median post-progression survival of the platinum-sensitive group compared to the platinum-resistant group was 54 vs. 25 months (p < 0.001), respectively, while the median survival after relapse was 25 vs. 13 months, respectively; three- and five-year post-progression survival rates in these groups were 31.2% vs. 23.8%, and 15.1% vs. 9.5%, respectively (p = 0.113). CONCLUSIONS Overall, despite new therapeutic approaches, ovarian cancer continues to be one of the deadly malignant diseases affecting women, especially in developing countries with a lack of resources, where chemotherapy remains the primary available systemic treatment for the majority of patients. Low survival rates demonstrate the urgent need for more research focused on this group of patients with poor outcomes.
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Affiliation(s)
- Lilit Harutyunyan
- Department of General Oncology, Yerevan State Medical University after M. Heratsi, 2 Koryun St., Yerevan 0025, Armenia; (N.K.); (A.A.); (N.M.); (A.M.); (G.J.)
- Oncology Clinic, Mikaelyan Institute of Surgery, Ezras Hasratian 9, Yerevan 0052, Armenia; (A.A.); (A.G.); (M.S.)
| | - Evelina Manvelyan
- Department of Reproductive Biology, University Hospitals Cleveland Medical Center, Case Western Reserve University School of Medicine, Cleveland, OH 44106, USA;
| | - Nune Karapetyan
- Department of General Oncology, Yerevan State Medical University after M. Heratsi, 2 Koryun St., Yerevan 0025, Armenia; (N.K.); (A.A.); (N.M.); (A.M.); (G.J.)
- Clinic of Adults’ Oncology and Chemotherapy at Yeolyan Hematology and Oncology Center, 7 Nersisyan St., Yerevan 0014, Armenia; (S.B.); (L.S.); (D.Z.); (M.H.)
- Immune Oncology Research Institute, 7 Nersisyan St., Yerevan 0014, Armenia;
- Yeolyan Hematology and Oncology Center, 7 Nersisyan St., Yerevan 0014, Armenia;
| | - Samvel Bardakhchyan
- Clinic of Adults’ Oncology and Chemotherapy at Yeolyan Hematology and Oncology Center, 7 Nersisyan St., Yerevan 0014, Armenia; (S.B.); (L.S.); (D.Z.); (M.H.)
- Immune Oncology Research Institute, 7 Nersisyan St., Yerevan 0014, Armenia;
- Yeolyan Hematology and Oncology Center, 7 Nersisyan St., Yerevan 0014, Armenia;
| | - Aram Jilavyan
- National Center of Oncology of Armenia, 76 Fanarjyan St., Yerevan 0052, Armenia; (A.J.); (H.N.); (A.S.); (A.G.)
- Department of Gynecologic Oncology, National Center of Oncology of Armenia, 76 Fanarjyan St., Yerevan 0052, Armenia
| | - Gevorg Tamamyan
- Immune Oncology Research Institute, 7 Nersisyan St., Yerevan 0014, Armenia;
- Yeolyan Hematology and Oncology Center, 7 Nersisyan St., Yerevan 0014, Armenia;
- Pediatric Cancer and Blood Disorders Center of Armenia, 7 Nersisyan St., Yerevan 0014, Armenia
- Pediatric Oncology and Hematology Department, Yerevan State Medical University after M. Heratsi, 2 Koryun St., Yerevan 0025, Armenia
| | - Armen Avagyan
- Department of General Oncology, Yerevan State Medical University after M. Heratsi, 2 Koryun St., Yerevan 0025, Armenia; (N.K.); (A.A.); (N.M.); (A.M.); (G.J.)
- Oncology Clinic, Mikaelyan Institute of Surgery, Ezras Hasratian 9, Yerevan 0052, Armenia; (A.A.); (A.G.); (M.S.)
| | - Liana Safaryan
- Clinic of Adults’ Oncology and Chemotherapy at Yeolyan Hematology and Oncology Center, 7 Nersisyan St., Yerevan 0014, Armenia; (S.B.); (L.S.); (D.Z.); (M.H.)
- Yeolyan Hematology and Oncology Center, 7 Nersisyan St., Yerevan 0014, Armenia;
| | - Davit Zohrabyan
- Clinic of Adults’ Oncology and Chemotherapy at Yeolyan Hematology and Oncology Center, 7 Nersisyan St., Yerevan 0014, Armenia; (S.B.); (L.S.); (D.Z.); (M.H.)
- Yeolyan Hematology and Oncology Center, 7 Nersisyan St., Yerevan 0014, Armenia;
| | - Narine Movsisyan
- Department of General Oncology, Yerevan State Medical University after M. Heratsi, 2 Koryun St., Yerevan 0025, Armenia; (N.K.); (A.A.); (N.M.); (A.M.); (G.J.)
- Oncology Clinic, Mikaelyan Institute of Surgery, Ezras Hasratian 9, Yerevan 0052, Armenia; (A.A.); (A.G.); (M.S.)
- Anesthesiology and Intensive Care Department, Yerevan State Medical University after M. Heratsi, 2 Koryun St., Yerevan 0025, Armenia
- Armenian Association for the Study of Pain, 12 Kievyan Str. Apt. 20, Yerevan 0028, Armenia
| | - Anna Avinyan
- Oncology Clinic, Mikaelyan Institute of Surgery, Ezras Hasratian 9, Yerevan 0052, Armenia; (A.A.); (A.G.); (M.S.)
| | - Arevik Galoyan
- Oncology Clinic, Mikaelyan Institute of Surgery, Ezras Hasratian 9, Yerevan 0052, Armenia; (A.A.); (A.G.); (M.S.)
| | - Mariam Sargsyan
- Oncology Clinic, Mikaelyan Institute of Surgery, Ezras Hasratian 9, Yerevan 0052, Armenia; (A.A.); (A.G.); (M.S.)
- Immune Oncology Research Institute, 7 Nersisyan St., Yerevan 0014, Armenia;
| | - Martin Harutyunyan
- Clinic of Adults’ Oncology and Chemotherapy at Yeolyan Hematology and Oncology Center, 7 Nersisyan St., Yerevan 0014, Armenia; (S.B.); (L.S.); (D.Z.); (M.H.)
- Yeolyan Hematology and Oncology Center, 7 Nersisyan St., Yerevan 0014, Armenia;
| | - Hasmik Nersoyan
- National Center of Oncology of Armenia, 76 Fanarjyan St., Yerevan 0052, Armenia; (A.J.); (H.N.); (A.S.); (A.G.)
- Clinical Research and Cancer Registry Department, National Center of Oncology after V.A. Fanarjian, 76 Fanarjyan St., Yerevan 0052, Armenia
| | - Arevik Stepanyan
- National Center of Oncology of Armenia, 76 Fanarjyan St., Yerevan 0052, Armenia; (A.J.); (H.N.); (A.S.); (A.G.)
- Clinical Research and Cancer Registry Department, National Center of Oncology after V.A. Fanarjian, 76 Fanarjyan St., Yerevan 0052, Armenia
| | - Armenuhi Galstyan
- National Center of Oncology of Armenia, 76 Fanarjyan St., Yerevan 0052, Armenia; (A.J.); (H.N.); (A.S.); (A.G.)
- Diagnostic Service of the National Center of Oncology, 76 Fanarjyan St., Yerevan 0052, Armenia
| | - Samvel Danielyan
- Yeolyan Hematology and Oncology Center, 7 Nersisyan St., Yerevan 0014, Armenia;
| | - Armen Muradyan
- Department of General Oncology, Yerevan State Medical University after M. Heratsi, 2 Koryun St., Yerevan 0025, Armenia; (N.K.); (A.A.); (N.M.); (A.M.); (G.J.)
| | - Gagik Jilavyan
- Department of General Oncology, Yerevan State Medical University after M. Heratsi, 2 Koryun St., Yerevan 0025, Armenia; (N.K.); (A.A.); (N.M.); (A.M.); (G.J.)
- National Center of Oncology of Armenia, 76 Fanarjyan St., Yerevan 0052, Armenia; (A.J.); (H.N.); (A.S.); (A.G.)
- Department of Gynecologic Oncology, National Center of Oncology of Armenia, 76 Fanarjyan St., Yerevan 0052, Armenia
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Muhammad S, Azwan RJ, Rita RS, Susanti R, Yusrawati. The Role of Interleukin 6 (IL6), Cancer Antigen-125 (CA-125), and Human Epididymis Protein 4 (HE4) to predict tumor resectability in the advanced epithelial ovarian cancer patients. PLoS One 2023; 18:e0292282. [PMID: 37792745 PMCID: PMC10550129 DOI: 10.1371/journal.pone.0292282] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2023] [Accepted: 09/17/2023] [Indexed: 10/06/2023] Open
Abstract
INTRODUCTION A study of tumor resectability in pre-operative patients with advanced epithelial ovarian cancer is required to predict primary surgical benefits accurately. This study aims to investigate IL6, CA-125 and HE4 to predict tumor resectability in the pre-operative patients with advanced epithelial ovarian cancer. METHODS This cross-sectional study was conducted in the polyclinic, oncology and gynecology inpatient room of Dr. M. Jamil Padang Hospital from June until December 2022. Advanced epithelial ovarian cancer stage based on histology result from FIGO stages IIIB-IVA. IL6, CA-125, and HE4 were measured using ECLIA (electrochemiluminescence immunoassay). Categorical data were assessed using Chi-square and Mann-Whitney tests. Numerical variable correlations were analyzed using Pearson Correlation tests. While the correlation between numerical and nominal variables was analyzed using the Eta correlation test. A p-value of <0,05 was considered a significant correlation. The cut-off value of serum IL6, CA-125, and HE4 was determined with a ROC curve. The sensitivity and specificity of each clinical parameter were calculated. RESULTS There was a significant difference in IL-6 (1328 vs 752 pg/ml; p<0,001), CA-125 (1260,5 vs 819,5 U/ml; p<0,001), and HE4 levels (1320 vs 760 pmol/L; p<0,001) between patients with tumor resectability of > 1 cm (suboptimal) vs < 1 cm (optimal). There was a correlation between IL6 (r = 0,832), CA-125 (r = 0,716), and HE4 (r = 0,716) with tumor resectability. CONCLUSION Measuring IL6, CA-125, and HE4 levels is useful for clinicians to predict tumor resectability in pre-operative patients with advanced epithelial ovarian cancer.
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Affiliation(s)
- Syamel Muhammad
- Obstetrics and Gynecology Department, Medical Faculty of Andalas University, Padang, West Sumatera, Indonesia
| | - Reyhan Julio Azwan
- Obstetrics and Gynecology Department, Medical Faculty of Andalas University, Padang, West Sumatera, Indonesia
| | - Rauza Sukma Rita
- Biomedical Science Department, Medical Faculty of Andalas University, Padang, West Sumatera, Indonesia
| | - Restu Susanti
- Nephrology Department, Medical Faculty of Andalas University, Padang, West Sumatera, Indonesia
| | - Yusrawati
- Fetomaternal Division, Obstetrics and Gynecology Department, Medical Faculty of Andalas University, Padang, West Sumatera, Indonesia
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Lawson AB, Kim J, Johnson C, Ratnapradipa KL, Alberg AJ, Akonde M, Hastert T, Bandera EV, Terry P, Mandle H, Cote ML, Bondy M, Marks J, Peres LC, Schildkraut J, Peters ES. The Association between Mediated Deprivation and Ovarian Cancer Survival among African American Women. Cancers (Basel) 2023; 15:4848. [PMID: 37835542 PMCID: PMC10571563 DOI: 10.3390/cancers15194848] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2023] [Revised: 09/25/2023] [Accepted: 10/02/2023] [Indexed: 10/15/2023] Open
Abstract
BACKGROUND Deprivation indices are often used to adjust for socio-economic disparities in health studies. Their role has been partially evaluated for certain population-level cancer outcomes, but examination of their role in ovarian cancer is limited. In this study, we evaluated a range of well-recognized deprivation indices in relation to cancer survival in a cohort of self-identified Black women diagnosed with ovarian cancer. This study aimed to determine if clinical or diagnostic characteristics lie on a mediating pathway between socioeconomic status (SES) and deprivation and ovarian cancer survival in a minority population that experiences worse survival from ovarian cancer. METHODS We used mediation analysis to look at the direct and indirect causal effects of deprivation indices with main mediators of the SEER stage at diagnosis and residual disease. The analysis employed Bayesian structural equation models with variable selection. We applied a joint Bayesian structural model for the mediator, including a Weibull mixed model for the vital outcome with deprivation as exposure. We selected modifiers via a Monte Carlo model selection procedure. RESULTS The results suggest that high SES-related indices, such as Yost, Kolak urbanicity (URB), mobility (MOB) and SES dimensions, and concentrated disadvantage index (CDI), all have a significant impact on improved survival. In contrast, area deprivation index (ADI)/Singh, and area level poverty (POV) did not have a major impact. In some cases, the indirect effects have very wide credible intervals, so the total effect is not well estimated despite the estimation of the direct effect. CONCLUSIONS First, it is clear that commonly used indices such as Yost, or CDI both significantly impact the survival experience of Black women diagnosed with epithelial ovarian cancer. In addition, the Kolak dimension indices (URB, MOB, mixed immigrant: MICA and SES) also demonstrate a significant association, depending on the mediator. Mediation effects differ according to the mediator chosen.
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Affiliation(s)
- Andrew B. Lawson
- Department of Public Health Sciences, College of Medicine, Medical University of South Carolina, Charleston, SC 29425, USA
- Usher Institute, School of Medicine, University of Edinburgh, Edinburgh EH16 4UX, UK
| | - Joanne Kim
- Department of Biomedical Informatics, College of Medicine, Ohio State University, Columbus, OH 43210, USA;
| | - Courtney Johnson
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA 30322, USA; (C.J.)
| | - Kendra L. Ratnapradipa
- Department of Epidemiology, College of Public Health, University of Nebraska Medical Center, Omaha, NE 68198, USA
| | - Anthony J. Alberg
- Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, SC 29208, USA
| | - Maxwell Akonde
- Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, SC 29208, USA
| | - Theresa Hastert
- Department of Oncology, Wayne State University School of Medicine, Population Studies and Disparities Research Program, Karmanos Cancer Institute, Detroit, MI 48201, USA
| | - Elisa V. Bandera
- Cancer Epidemiology and Health Outcomes, Rutgers Cancer Institute of New Jersey, New Brunswick, NJ 08625, USA
| | - Paul Terry
- Department of Medicine, University of Tennessee Medical Center-Knoxville, Knoxville, TN 37920, USA
| | - Hannah Mandle
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA 30322, USA; (C.J.)
| | - Michele L. Cote
- Bren Simon Comprehensive Cancer Center, Indiana University Melvin, Inidianapolis, IN 46202, USA;
| | - Melissa Bondy
- Department of Epidemiology and Population Health, College of Medicine, Stanford University, Stanford, CA 94305, USA
| | - Jeffrey Marks
- Department of Surgery, Duke University School of Medicine, Durham, NC 27710, USA;
| | - Lauren C. Peres
- Department of Cancer Epidemiology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL 33612, USA;
| | - Joellen Schildkraut
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA 30322, USA; (C.J.)
| | - Edward S. Peters
- Department of Epidemiology, College of Public Health, University of Nebraska Medical Center, Omaha, NE 68198, USA
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Chandra R, Kumari S, Bhatla N, Kumar R, Tiwari A, Sachani H, Kumar L. Role of Positron Emission Tomography/Computed Tomography in Epithelial Ovarian Cancer. Indian J Nucl Med 2023; 38:366-375. [PMID: 38390547 PMCID: PMC10880854 DOI: 10.4103/ijnm.ijnm_42_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2022] [Revised: 05/03/2022] [Accepted: 05/19/2022] [Indexed: 02/24/2024] Open
Abstract
Ovarian cancer (OC) is the most lethal gynecological malignancy with majority of cases diagnosed in advanced stages and associated with high morbidity and mortality. Positron emission tomography/computed tomography (PET/CT) has emerged as an integral part of the management of several nongynecological cancers. We used PubMed search engine using MeSH words "ovarian cancer" and "PET/CT" and reviewed the current status of PET/CT in epithelial OC. Its application related to ovarian tumor including adnexal mass evaluation, baseline staging, as a triaging tool for upfront surgery or neoadjuvant chemotherapy, for response assessment and prognostication, and for relapse detection and treatment planning has been highlighted. we highlight the current guidelines and newer upcoming PET modalities and radiotracers.
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Affiliation(s)
- Rudrika Chandra
- Department of Obstetrics and Gynaecology, Division of Gynaecologic Oncology, All India Institute of Medical Sciences, New Delhi, India
| | - Sarita Kumari
- Department of Obstetrics and Gynaecology, Division of Gynaecologic Oncology, All India Institute of Medical Sciences, New Delhi, India
| | - Neerja Bhatla
- Department of Obstetrics and Gynaecology, All India Institute of Medical Sciences, New Delhi, India
| | - Rakesh Kumar
- Department of Nuclear Medicine, Division of Diagnostic Nuclear Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Abhinav Tiwari
- Department of Medicine, Base Hospital, Delhi Cantt, India
| | - Hemant Sachani
- Department of Nuclear Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Lalit Kumar
- Department of Medical Oncology, BRA IRCH, All India Institute of Medical Sciences, New Delhi, India
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Kovács AR, Sulina A, Kovács KS, Lukács L, Török P, Lampé R. Prognostic Significance of Preoperative NLR, MLR, and PLR Values in Predicting the Outcome of Primary Cytoreductive Surgery in Serous Epithelial Ovarian Cancer. Diagnostics (Basel) 2023; 13:2268. [PMID: 37443662 DOI: 10.3390/diagnostics13132268] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2023] [Revised: 06/29/2023] [Accepted: 06/30/2023] [Indexed: 07/15/2023] Open
Abstract
(1) The degree of cytoreduction achieved during primary debulking surgery (PDS) is an important prognostic factor for the survival of patients with epithelial ovarian cancer (EOC). Our aim was to investigate the prognostic value of preoperative laboratory parameters for the outcome of PDS. (2) We analyzed the preoperative laboratory parameters of 150 serous EOC patients who underwent PDS between 2006 and 2013. Receiver operating characteristic (ROC) curve analysis was used to determine the optimal cut-off values of the variables for predicting the PDS outcome. We used binary logistic regression to examine the independent predictive value of the factors for incomplete cytoreduction. (3) Among the parameters, we established optimal cut-off values for cancer antigen (Ca)-125, neutrophil-to-lymphocyte ratio (NLR), monocyte-to-lymphocyte ratio (MLR), and platelet-to-lymphocyte ratio (PLR) to predict the outcome of PDS. The results of binary logistic regression showed that stage (FIGO III-IV), MLR (>0.305), and Ca-125 (>169.15 kU/L) were independent significant predictors of the degree of tumor reduction achieved during PDS. (4) In the future, MLR, especially in combination with other parameters, may be useful in determining prognosis and selecting the best treatment option (PDS or neoadjuvant chemotherapy + interval debulking surgery) for ovarian cancer patients.
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Affiliation(s)
- Anna Rebeka Kovács
- Department of Obstetrics and Gynecology, Faculty of Medicine, University of Debrecen, 98. Nagyerdei krt., 4032 Debrecen, Hungary
| | - Anita Sulina
- Department of Obstetrics and Gynecology, Faculty of Medicine, University of Debrecen, 98. Nagyerdei krt., 4032 Debrecen, Hungary
| | - Kincső Sára Kovács
- Department of Obstetrics and Gynecology, Faculty of Medicine, University of Debrecen, 98. Nagyerdei krt., 4032 Debrecen, Hungary
| | - Luca Lukács
- Department of Obstetrics and Gynecology, Faculty of Medicine, University of Debrecen, 98. Nagyerdei krt., 4032 Debrecen, Hungary
| | - Péter Török
- Department of Obstetrics and Gynecology, Faculty of Medicine, University of Debrecen, 98. Nagyerdei krt., 4032 Debrecen, Hungary
| | - Rudolf Lampé
- Department of Obstetrics and Gynecology, Faculty of Medicine, University of Debrecen, 98. Nagyerdei krt., 4032 Debrecen, Hungary
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Li Q, Deng Y, Wei W, Yang F, Lin A, Yao D, Zhu X, Li J. Development and External Validation of a Novel Model for Predicting Postsurgical Recurrence and Overall Survival After Cytoreductive R0 Resection of Epithelial Ovarian Cancer. Front Oncol 2022; 12:859409. [PMID: 35402239 PMCID: PMC8984120 DOI: 10.3389/fonc.2022.859409] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2022] [Accepted: 02/28/2022] [Indexed: 11/13/2022] Open
Abstract
PurposeTreatment of epithelial ovarian cancer is evolving towards personalization and precision, which require patient-specific estimates of overall survival (OS) and progression-free survival (PFS).Patients and MethodsMedical records of 1173 patients who underwent debulking surgery in our center were comprehensively reviewed and randomly allocated into a derivation cohort of 879 patients and an internal validation cohort of 294 patients. Five hundred and seventy-seven patients from the other three cancer centers served as the external validation cohort. A novel nomogram model for PFS and OS was constructed based on independent predictors identified by multivariable Cox regression analysis. The predictive accuracy and discriminative ability of the model were measured using Harrell’s concordance index (C-index) and calibration curve.ResultsThe C-index values were 0.82 (95% CI: 0.76–0.88) and 0.84 (95% CI: 0.78–0.90) for the PFS and OS models, respectively, substantially higher than those obtained with the FIGO staging system and most nomograms reported for use in epithelial ovarian cancer. The nomogram score could clearly classify the patients into subgroups with different risks of recurrence or postoperative mortality. The online versions of our nomograms are available at https://eocnomogram.shinyapps.io/eocpfs/ and https://eocnomogram.shinyapps.io/eocos/.ConclusionA externally validated nomogram predicting OS and PFS in patients after R0 reduction surgery was established using a propensity score matching model. This nomogram may be useful in estimating individual recurrence risk and guiding personalized surveillance programs for patients after surgery, and it could potentially aid clinical decision-making or stratification for clinical trials.
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Affiliation(s)
- Qiaqia Li
- Department of Gynecologic Oncology, Sun Yat-sen University Cancer Center, Guangzhou, China
- State Key Laboratory of Oncology in South China, Collaborative Innovation Centre for Cancer Medicine, Guangzhou, China
| | - Yinghong Deng
- Department of General Surgery, Hunan Provincial People’s Hospital, The First Affiliated Hospital of Hunan Normal University, Changsha, China
| | - Wei Wei
- Department of Gynecologic Oncology, Sun Yat-sen University Cancer Center, Guangzhou, China
- State Key Laboratory of Oncology in South China, Collaborative Innovation Centre for Cancer Medicine, Guangzhou, China
| | - Fan Yang
- Department of Gynecologic Oncology, Sun Yat-sen University Cancer Center, Guangzhou, China
- State Key Laboratory of Oncology in South China, Collaborative Innovation Centre for Cancer Medicine, Guangzhou, China
| | - An Lin
- Department of Gynecology, Fujian Medical University Cancer Hospital, Fujian Cancer Hospital, Fuzhou, China
| | - Desheng Yao
- Department of Gynecologic Oncology, The Affiliated Tumor Hospital of Guangxi Medical University, Nanning, China
| | - Xiaofeng Zhu
- State Key Laboratory of Oncology in South China, Collaborative Innovation Centre for Cancer Medicine, Guangzhou, China
- *Correspondence: Jundong Li, ; Xiaofeng Zhu,
| | - Jundong Li
- Department of Gynecologic Oncology, Sun Yat-sen University Cancer Center, Guangzhou, China
- State Key Laboratory of Oncology in South China, Collaborative Innovation Centre for Cancer Medicine, Guangzhou, China
- *Correspondence: Jundong Li, ; Xiaofeng Zhu,
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Gagliardi T, Adejolu M, deSouza NM. Diffusion-Weighted Magnetic Resonance Imaging in Ovarian Cancer: Exploiting Strengths and Understanding Limitations. J Clin Med 2022; 11:1524. [PMID: 35329850 PMCID: PMC8949455 DOI: 10.3390/jcm11061524] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2022] [Revised: 03/05/2022] [Accepted: 03/08/2022] [Indexed: 02/06/2023] Open
Abstract
Detection, characterization, staging, and response assessment are key steps in the imaging pathway of ovarian cancer. The most common type, high grade serous ovarian cancer, often presents late, so that accurate disease staging and response assessment are required through imaging in order to improve patient management. Currently, computerized tomography (CT) is the most common method for these tasks, but due to its poor soft-tissue contrast, it is unable to quantify early response within lesions before shrinkage is observed by size criteria. Therefore, quantifiable techniques, such as diffusion-weighted magnetic resonance imaging (DW-MRI), which generates high contrast between tumor and healthy tissue, are increasingly being explored. This article discusses the basis of diffusion-weighted contrast and the technical issues that must be addressed in order to achieve optimal implementation and robust quantifiable diffusion-weighted metrics in the abdomen and pelvis. The role of DW-MRI in characterizing adnexal masses in order to distinguish benign from malignant disease, and to differentiate borderline from frankly invasive malignancy is discussed, emphasizing the importance of morphological imaging over diffusion-weighted metrics in this regard. Its key role in disease staging and predicting resectability in comparison to CT is addressed, including its valuable use as a biomarker for following response within individual lesions, where early changes in the apparent diffusion coefficient in peritoneal metastases may be detected. Finally, the task of implementing DW-MRI into clinical trials in order to validate this biomarker for clinical use are discussed, along with the trials that include it within their protocols.
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Affiliation(s)
- Tanja Gagliardi
- Department of Imaging, The Royal Marsden NHS Foundation Trust, London SW3 6JJ, UK; (T.G.); (M.A.)
| | - Margaret Adejolu
- Department of Imaging, The Royal Marsden NHS Foundation Trust, London SW3 6JJ, UK; (T.G.); (M.A.)
| | - Nandita M. deSouza
- Department of Imaging, The Royal Marsden NHS Foundation Trust, London SW3 6JJ, UK; (T.G.); (M.A.)
- Division of Radiotherapy and Imaging, The Institute of Cancer Research, London SW7 3RP, UK
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10
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Tanabe S, Sugino S, Ichida K, Niiya K, Morishima S. A Case of Ovarian Metastasis of Pancreatic Cancer Causing Ovarian Torsion. Cureus 2022; 14:e21352. [PMID: 35070584 PMCID: PMC8765578 DOI: 10.7759/cureus.21352] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/17/2022] [Indexed: 11/20/2022] Open
Abstract
A 55-year-old female who had been diagnosed with stage 4 pancreatic cancer visited the emergency department of our hospital owing to sudden lower abdominal pain and was found to have an ovarian tumor. An urgent laparoscopic resection of the right adnexa was performed with a diagnosis of ovarian tumor stalk torsion. Postoperative pathological diagnosis revealed ovarian metastasis of pancreatic cancer. Our case report demonstrates that an ovarian tumor on one side in a patient with advanced pancreatic cancer may represent ovarian metastasis of the primary tumor.
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Guo M, Shang X, Guo D. Metformin Use and Mortality in Women with Ovarian Cancer: An Updated Meta-Analysis. Int J Clin Pract 2022; 2022:9592969. [PMID: 35685604 PMCID: PMC9159224 DOI: 10.1155/2022/9592969] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2021] [Accepted: 01/05/2022] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Previous observational studies and meta-analysis suggested a possible association between metformin use and reduced mortality in women with ovarian cancer (OC). However, clinical factors that may influence the relationship remain poorly evaluated. We performed an updated meta-analysis to systematically evaluate the above association and to observe the potential influences of study characteristics on the association. METHODS Relevant studies reporting the association between metformin use and mortality in women with OC in the multivariate adjusted model were identified by search of electronic databases that included PubMed, Embase, and Web of Science. The random-effects model was adopted to combine the results. RESULTS Nine studies including 10030 women with OC were included. Overall, metformin use was independently associated with reduced overall mortality (hazard ratio (HR): 0.72, 95% confidence interval (CI): 0.55-0.93, P=0.01; I 2 = 62%). Consistent results were observed for studies comparing metformin users with nondiabetic women and studies comparing metformin users with diabetic women who did not use metformin (P for subgroup analysis = 0.70). Further subgroup analyses showed consistent results in studies with metformin use before or after the diagnosis of OC, with or without adjustment of body mass index (BMI) and with or without adjustment of concurrent medications (P for subgroup analyses all >0.10). CONCLUSION Metformin use is associated with reduced mortality in women with OC, which may be independent of the diabetic status of the controls, timing of metformin use, or adjustment of BMI and concurrent medications. Clinical trials are needed to validate the potential benefits of metformin on survival of OC.
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Affiliation(s)
- Mingchuan Guo
- Department of Gynecology, Longgang District People's Hospital of Shenzhen, Shenzhen 518172, China
| | - Xiaofei Shang
- Department of Physical Examination, Cancer Hospital of Chinese Academy of Medical Sciences, Shenzhen Center, Shenzhen 518116, China
| | - Duanying Guo
- Department of Gynecology, Longgang District People's Hospital of Shenzhen, Shenzhen 518172, China
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