1
|
Amroun K, Chaltiel R, Reyal F, Kianmanesh R, Savoye AM, Perrier M, Djerada Z, Bouché O. Dynamic Prediction of Resectability for Patients with Advanced Ovarian Cancer Undergoing Neo-Adjuvant Chemotherapy: Application of Joint Model for Longitudinal CA-125 Levels. Cancers (Basel) 2022; 15:cancers15010231. [PMID: 36612234 PMCID: PMC9818430 DOI: 10.3390/cancers15010231] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2022] [Revised: 12/23/2022] [Accepted: 12/27/2022] [Indexed: 01/04/2023] Open
Abstract
In patients with advanced ovarian cancer (AOC) receiving neoadjuvant chemotherapy (NAC), predicting the feasibility of complete interval cytoreductive surgery (ICRS) is helpful and may avoid unnecessary laparotomy. A joint model (JM) is a dynamic individual predictive model. The aim of this study was to develop a predictive JM combining CA-125 kinetics during NAC with patients' and clinical factors to predict resectability after NAC in patients with AOC. A retrospective study included 77 patients with AOC treated with NAC. A linear mixed effect (LME) sub-model was used to describe the evolution of CA-125 during NAC considering factors influencing the biomarker levels. A Cox sub-model screened the covariates associated with resectability. The JM combined the LME sub-model with the Cox sub-model. Using the LME sub-model, we observed that CA-125 levels were influenced by the number of NAC cycles and the performance of paracentesis. In the Cox sub-model, complete resectability was associated with Performance Status (HR = 0.57, [0.34-0.95], p = 0.03) and the presence of peritoneal carcinomatosis in the epigastric region (HR = 0.39, [0.19-0.80], p = 0.01). The JM accuracy to predict complete ICRS was 88% [82-100] with a predictive error of 2.24% [0-2.32]. Using a JM of a longitudinal CA-125 level during NAC could be a reliable predictor of complete ICRS.
Collapse
Affiliation(s)
- Koceila Amroun
- Department of Digestive and Endocrine Surgery, Université de Reims Champagne-Ardenne, VieFra, CHU Reims, 51100 Reims, France
- Correspondence:
| | - Raphael Chaltiel
- Department of Medical Oncology, Godinot Cancer Institute, 51100 Reims, France
| | - Fabien Reyal
- Department of Surgical Oncology, Godinot Cancer Institute, 51100 Reims, France
| | - Reza Kianmanesh
- Department of Digestive and Endocrine Surgery, Université de Reims Champagne-Ardenne, VieFra, CHU Reims, 51100 Reims, France
| | - Aude-Marie Savoye
- Department of Medical Oncology, Godinot Cancer Institute, 51100 Reims, France
| | - Marine Perrier
- Department of Gastroenterology and Digestive Oncology, Université de Reims Champagne-Ardenne, Robert Debré Hospital, CHU Reims, 51100 Reims, France
| | - Zoubir Djerada
- Department of Pharmacology and Toxicology, Université de Reims Champagne-Ardenne, HERVI, CHU Reims, 51100 Reims, France
| | - Olivier Bouché
- Department of Gastroenterology and Digestive Oncology, Université de Reims Champagne-Ardenne, Robert Debré Hospital, CHU Reims, 51100 Reims, France
| |
Collapse
|
2
|
Yi Q, Ran Y, Li C. The Effect of Delayed Chemotherapy on the Decrease of CA125 in Epithelial Ovarian Cancer During Coronavirus Disease Pandemic in 2020. Cancer Manag Res 2021; 13:515-520. [PMID: 33500665 PMCID: PMC7826069 DOI: 10.2147/cmar.s289773] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2020] [Accepted: 01/07/2021] [Indexed: 11/23/2022] Open
Abstract
Objective To investigate whether patients with epithelial ovarian cancer were affected by delayed chemotherapy during the coronavirus disease pandemic in 2020. Materials and Methods A delay of more than 21 days in the planned chemotherapy was defined as "delayed chemotherapy." Forty-five patients with epithelial ovarian, fallopian tube, and peritoneal cancer were delayed between January 1 and March 30, 2020 in the First Affiliated Hospital of Chongqing Medical University. Thirty-two cases were enrolled in this study. Neoadjuvant chemotherapy was used in 8 cases; palliative chemotherapy was used in 5 cases; and maintenance chemotherapy was used in 19 cases. Data included age, pathological type, surgical pathological stage, chemotherapy time and CA125 levels were collected. The half-life of CA125 and the decrease in CA125 levels before and after delayed chemotherapy were calculated. Results No patient got coronavirus disease. Compared with patients of ovarian cancer, fallopian tube epithelial cancer and peritoneal epithelial cancer in the same periods in 2019, the half-life of CA125 in neoadjuvant chemotherapy group and recurrence chemotherapy group were more than 20 days, but there was no significant difference. Only when the delayed chemotherapy took place before CA125 turned negative, accompanied by an interval of more than 60 days, the CA125 half-life and the decreased range of CA125 were totally affected. Conclusion There was no evidence to support that once chemotherapy was delayed it would influence the decrease of CA125, but whether it would affect the long-term effects such as recurrence and five-year survival rate remains to be further followed up.
Collapse
Affiliation(s)
- Qiang Yi
- Department of Gynecology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, People's Republic of China
| | - Yu Ran
- Department of Gynecology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, People's Republic of China
| | - Cong Li
- Department of Gynecology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, People's Republic of China
| |
Collapse
|
3
|
The reduction of CA 125 serum levels in BRCA 1/2 mutation carriers after risk-reducing salpingo-oophorectomy is only partially associated with surgery: a prospective cohort, other biomarker controlled, study. Eur J Cancer Prev 2020; 29:350-356. [DOI: 10.1097/cej.0000000000000606] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
|
4
|
You B, Robelin P, Tod M, Louvet C, Lotz JP, Abadie-Lacourtoisie S, Fabbro M, Desauw C, Bonichon-Lamichhane N, Kurtz JE, Follana P, Leheurteur M, Piano FD, Ferron G, De Rauglaudre G, Ray-Coquard I, Combe P, Chevalier-Place A, Joly F, Leary A, Pujade-Lauraine E, Freyer G, Colomban O. CA-125 ELIMination Rate Constant K (KELIM) Is a Marker of Chemosensitivity in Patients with Ovarian Cancer: Results from the Phase II CHIVA Trial. Clin Cancer Res 2020; 26:4625-4632. [PMID: 32209570 DOI: 10.1158/1078-0432.ccr-20-0054] [Citation(s) in RCA: 46] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2020] [Revised: 02/26/2020] [Accepted: 03/20/2020] [Indexed: 11/16/2022]
Abstract
PURPOSE In patients with ovarian cancer receiving neoadjuvant chemotherapy, the first-line treatment success will depend on both the tumor-primary chemosensitivity and the completeness of interval debulking surgery (IDS). The modeled CA-125 ELIMination rate constant K (KELIM), calculated with the CA-125 longitudinal kinetics during the first 100 chemotherapy days, is a validated early marker of tumor chemosensitivity. The objective was to investigate the role of the chemosensitivity relative to the success of first-line medical-surgical treatment. EXPERIMENTAL DESIGN The CA-125 concentrations were prospectively measured in the randomized phase II trial CHIVA (NCT01583322, carboplatin-paclitaxel regimen ± nintedanib, and IDS, n = 188 patients). The KELIM predictive value regarding the tumor response rate, likelihood of complete IDS, risk of subsequent platinum-resistant relapse (PtRR), progression-free survival (PFS), and overall survival (OS) was assessed using univariate and multivariate tests. RESULTS The data from 134 patients were analyzed. KELIM was an independent and major predictor of subsequent PtRR risk, and of survivals. The final logistic regression model, including KELIM [OR = 0.13; 95% confidence interval (CI), 0.03-0.49] and complete IDS (no vs. yes, OR = 0.30; 95% CI, 0.11-0.76) highlights the preponderant role of chemosensitivity on the success of the first-line treatment. In patients with highly chemosensitive diseases, the patient prognosis was driven more by the chemotherapy-induced antitumor effects than by the surgery. CONCLUSIONS The tumor-primary chemosensitivity, assessed by the modeled CA-125 KELIM calculated during neoadjuvant chemotherapy (http://www.biomarker-kinetics.org/CA-125-neo), may be a major parameter to consider for decision-making regarding IDS attempt, and selecting patients for treatments meant to reverse the primary chemoresistance.See related commentary by May and Oza, p. 4432.
Collapse
Affiliation(s)
- Benoit You
- Univ Lyon, Université Claude Bernard Lyon 1, Faculté de médecine Lyon-Sud, Lyon, France. .,Medical Oncology, Institut de Cancérologie des Hospices Civils de Lyon (IC-HCL), CITOHL, Centre Hospitalier Lyon-Sud, GINECO, GINEGEPS, Lyon, France
| | - Patrick Robelin
- Univ Lyon, Université Claude Bernard Lyon 1, Faculté de médecine Lyon-Sud, Lyon, France.,Medical Oncology, Institut de Cancérologie des Hospices Civils de Lyon (IC-HCL), CITOHL, Centre Hospitalier Lyon-Sud, GINECO, GINEGEPS, Lyon, France
| | - Michel Tod
- Univ Lyon, Université Claude Bernard Lyon 1, Faculté de médecine Lyon-Sud, Lyon, France.,Hospices Civils de Lyon, Pharmacie, Hôpital de la Croix Rousse, Lyon, France
| | - Christophe Louvet
- L'Institut Mutualiste Montsouris, Service d'oncologie, GINECO, Paris, France
| | | | - Sophie Abadie-Lacourtoisie
- Institut de Cancérologie de l'Ouest - ICO - Site Paul Papin, Oncologie médicale gynécologique, Angers, GINECO, Paris, France
| | - Michel Fabbro
- ICM Val d'Aurelle Parc Euromedecine, Oncologie médicale, Montpellier, GINECO, Paris, France
| | - Christophe Desauw
- Centre Hospitalier Régional Universitaire de Lille, Oncologie médicale, Lille Cedex, GINECO, Paris, France
| | | | - Jean-Emmanuel Kurtz
- Hôpitaux Universitaires de Strasbourg, Service d'Oncologie et d'Hématologie, Strasbourg, France
| | - Philippe Follana
- CLCC Antoine Lacassagne, Département d'Hématologie - Oncologie médicale, NICE CEDEX 2, GINECO, Paris, France
| | | | - Francesco Del Piano
- Hôpitaux de LEMAN, Chirurgie Gynécologique, THONON LES BAINS, GINECO, Paris, France
| | - Gwénael Ferron
- Institut Claudius Regaud, Département de Chirurgie Oncologique, TOULOUSE, France
| | - Gaëtan De Rauglaudre
- Institut Sainte-Catherine, Oncologie radiothérapie, Avignon, GINECO, Paris, France
| | - Isabelle Ray-Coquard
- Centre Léon Bérard, 28 Prom. Léa et Napoléon Bullukian, & Université Claude Bernard Lyon, Lyon, GINECO, Paris, France
| | - Pierre Combe
- Hôpital Européen Georges Pompidou, Oncologie Médicale, GINECO, Paris, France
| | | | - Florence Joly
- Centre François Baclesse, Oncologie Médicale, GINECO, Paris, France
| | | | | | - Gilles Freyer
- Univ Lyon, Université Claude Bernard Lyon 1, Faculté de médecine Lyon-Sud, Lyon, France.,Medical Oncology, Institut de Cancérologie des Hospices Civils de Lyon (IC-HCL), CITOHL, Centre Hospitalier Lyon-Sud, GINECO, GINEGEPS, Lyon, France
| | - Olivier Colomban
- Univ Lyon, Université Claude Bernard Lyon 1, Faculté de médecine Lyon-Sud, Lyon, France
| |
Collapse
|
5
|
Association of expression of p53, livin, ERCC1, BRCA1 and PARP1 in epithelial ovarian cancer tissue with drug resistance and prognosis. Pathol Res Pract 2020; 216:152794. [DOI: 10.1016/j.prp.2019.152794] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2018] [Revised: 11/28/2019] [Accepted: 12/12/2019] [Indexed: 01/01/2023]
|
6
|
Sun C, Guo E, Zhou B, Shan W, Huang J, Weng D, Wu P, Wang C, Wang S, Zhang W, Gao Q, Xu X, Wang B, Hu J, Ma D, Chen G. A reactive oxygen species scoring system predicts cisplatin sensitivity and prognosis in ovarian cancer patients. BMC Cancer 2019; 19:1061. [PMID: 31703584 PMCID: PMC6839150 DOI: 10.1186/s12885-019-6288-7] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2019] [Accepted: 10/24/2019] [Indexed: 12/11/2022] Open
Abstract
Background To reveal roles of reactive oxygen species (ROS) status in chemotherapy resistance and to develop a ROS scoring system for prognosis prediction in ovarian cancer. Methods We tested the sensitizing effects of ROS elevating drugs to cisplatin (cDDP) in ovarian cancer both in vitro and in vivo. A ROS scoring system was developed using The Cancer Genome Atlas (TCGA) database of ovarian cancer. The associations between ROS scores and overall survival (OS) were analyzed in TCGA, Tothill dataset, and our in-house dataset (TJ dataset). Results ROS-inducing drugs increased cisplatin-induced ovarian cancer cell injury in vitro and in vivo. ROS scoring system was established using 25 ROS-related genes. Patients were divided into low (scores 0–12) and high (scores 13–25) score groups. Improved patient survival was associated with higher scores (TCGA dataset hazard ratio (HR) = 0.43, P < 0.001; Tothill dataset HR = 0.65, P = 0.022; TJ dataset HR = 0.40, P = 0.003). The score was also significantly associated with OS in multiple datasets (TCGA dataset r2 = 0.574, P = 0.032; Thothill dataset r2 = 0.266, P = 0.049; TJ dataset r2 = 0.632, P = 0.001) and with cisplatin sensitivity in ovarian cancer cell lines (r2 = 0.799, P = 0.016) when used as a continuous variable. The scoring system showed better prognostic performance than other clinical factors by receiver operating characteristic (ROC) curves (TCGA dataset area under the curve (AUC) = 0.71 v.s. 0.65, Tothill dataset AUC = 0.73 v.s. 0.67, TJ dataset AUC = 0.74 v.s. 0.66). Conclusions ROS status is associated with chemotherapy resistance. ROS score system might be a prognostic biomarker in predicting the survival benefit from ovarian cancer patients.
Collapse
Affiliation(s)
- Chaoyang Sun
- Cancer Biology Research Center (Key laboratory of Chinese Ministry of Education), Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, People's Republic of China.,Department of Gynecology and Obstetrics, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, People's Republic of China
| | - Ensong Guo
- Cancer Biology Research Center (Key laboratory of Chinese Ministry of Education), Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, People's Republic of China.,Department of Gynecology and Obstetrics, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, People's Republic of China
| | - Bo Zhou
- Cancer Biology Research Center (Key laboratory of Chinese Ministry of Education), Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, People's Republic of China.,Department of Gynecology and Obstetrics, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, People's Republic of China
| | - Wanying Shan
- Cancer Biology Research Center (Key laboratory of Chinese Ministry of Education), Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, People's Republic of China.,Department of Gynecology and Obstetrics, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, People's Republic of China
| | - Jia Huang
- Cancer Biology Research Center (Key laboratory of Chinese Ministry of Education), Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, People's Republic of China.,Department of Gynecology and Obstetrics, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, People's Republic of China
| | - Danhui Weng
- Cancer Biology Research Center (Key laboratory of Chinese Ministry of Education), Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, People's Republic of China.,Department of Gynecology and Obstetrics, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, People's Republic of China
| | - Peng Wu
- Cancer Biology Research Center (Key laboratory of Chinese Ministry of Education), Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, People's Republic of China.,Department of Gynecology and Obstetrics, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, People's Republic of China
| | - Changyu Wang
- Cancer Biology Research Center (Key laboratory of Chinese Ministry of Education), Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, People's Republic of China.,Department of Gynecology and Obstetrics, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, People's Republic of China
| | - Shixuan Wang
- Cancer Biology Research Center (Key laboratory of Chinese Ministry of Education), Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, People's Republic of China.,Department of Gynecology and Obstetrics, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, People's Republic of China
| | - Wei Zhang
- Cancer Biology Research Center (Key laboratory of Chinese Ministry of Education), Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, People's Republic of China.,Department of Gynecology and Obstetrics, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, People's Republic of China
| | - Qinglei Gao
- Cancer Biology Research Center (Key laboratory of Chinese Ministry of Education), Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, People's Republic of China.,Department of Gynecology and Obstetrics, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, People's Republic of China
| | - Xiaoyan Xu
- Cancer Biology Research Center (Key laboratory of Chinese Ministry of Education), Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, People's Republic of China.,Department of Gynecology and Obstetrics, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, People's Republic of China
| | - Beibei Wang
- Cancer Biology Research Center (Key laboratory of Chinese Ministry of Education), Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, People's Republic of China.,Department of Gynecology and Obstetrics, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, People's Republic of China
| | - Junbo Hu
- Cancer Biology Research Center (Key laboratory of Chinese Ministry of Education), Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, People's Republic of China.,Department of Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, People's Republic of China
| | - Ding Ma
- Cancer Biology Research Center (Key laboratory of Chinese Ministry of Education), Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, People's Republic of China.,Department of Gynecology and Obstetrics, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, People's Republic of China
| | - Gang Chen
- Cancer Biology Research Center (Key laboratory of Chinese Ministry of Education), Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, People's Republic of China. .,Department of Gynecology and Obstetrics, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, People's Republic of China.
| |
Collapse
|
7
|
Colomban O, Tod M, Leary A, Ray-Coquard I, Lortholary A, Hardy-Bessard AC, Pfisterer J, Du Bois A, Kurzeder C, Burges A, Péron J, Freyer G, You B. Early Modeled Longitudinal CA-125 Kinetics and Survival of Ovarian Cancer Patients: A GINECO AGO MRC CTU Study. Clin Cancer Res 2019; 25:5342-5350. [DOI: 10.1158/1078-0432.ccr-18-3335] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2018] [Revised: 01/03/2019] [Accepted: 03/28/2019] [Indexed: 11/16/2022]
|
8
|
Fu A, Chang HR, Zhang ZF. Integrated multiomic predictors for ovarian cancer survival. Carcinogenesis 2019; 39:860-868. [PMID: 29897425 DOI: 10.1093/carcin/bgy055] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2017] [Accepted: 04/13/2018] [Indexed: 02/03/2023] Open
Abstract
Increasingly affordable high-throughput molecular profiling technologies have made feasible the measurement of omics-wide interindividual variations for the purposes of predicting cancer prognosis. While multiple types of genetic, epigenetic and expression changes have been implicated in ovarian cancer, existing prognostic biomarker strategies are constrained to analyzing a single class of molecular variations. The extra predictive power afforded by the integration of multiple omics types remains largely unexplored. In this study, we performed integrative analysis on tumor-based exome-, transcriptome- and methylome-wide molecular profiles from The Cancer Genome Atlas (TCGA) for variations in cancer-relevant genes to construct robust, cross-validated multiomic predictors for ovarian cancer survival. These integrated polygenic survival scores (PSSs) were able to predict 5-year overall (OS) and progression-free survival in the Caucasian subsample with high accuracy (AUROC = 0.87 and 0.81, respectively). These findings suggest that the PSSs are able to predict long-term OS in TCGA patients with accuracy beyond that of previously proposed protein-based biomarker strategies. Our findings reveal the promise of an integrated omics-based approach in enhancing existing prognostic strategies. Future investigations should be aimed toward prospective external validation, strategies for standardizing application and the integration of germline variants.
Collapse
Affiliation(s)
- Alan Fu
- Department of Epidemiology, UCLA Fielding School of Public Health, CHS, Charles E. Young Dr. South, Los Angeles, CA, USA
| | - Helena R Chang
- Department of Surgery, Revlon/UCLA Breast Center, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Zuo-Feng Zhang
- Department of Epidemiology, UCLA Fielding School of Public Health, CHS, Charles E. Young Dr. South, Los Angeles, CA, USA
| |
Collapse
|
9
|
Inoue LYT, Lin DW, Newcomb LF, Leonardson AS, Ankerst D, Gulati R, Carter HB, Trock BJ, Carroll PR, Cooperberg MR, Cowan JE, Klotz LH, Mamedov A, Penson DF, Etzioni R. Comparative Analysis of Biopsy Upgrading in Four Prostate Cancer Active Surveillance Cohorts. Ann Intern Med 2018; 168:1-9. [PMID: 29181514 PMCID: PMC5752581 DOI: 10.7326/m17-0548] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Active surveillance (AS) is increasingly accepted for managing low-risk prostate cancer, yet there is no consensus about implementation. This lack of consensus is due in part to uncertainty about risks for disease progression, which have not been systematically compared or integrated across AS studies with variable surveillance protocols and dropout to active treatment. OBJECTIVE To compare risks for upgrading from a Gleason score (GS) of 6 or less to 7 or more across AS studies after accounting for differences in surveillance intervals and competing treatments and to evaluate tradeoffs of more versus less frequent biopsies. DESIGN Joint statistical model of longitudinal prostate-specific antigen (PSA) levels and risks for biopsy upgrading. SETTING Johns Hopkins University (JHU); Canary Prostate Active Surveillance Study (PASS); University of California, San Francisco (UCSF); and University of Toronto (UT) AS studies. PATIENTS 2576 men aged 40 to 80 years with a GS between 2 and 6 and clinical stage T1 or T2 prostate cancer enrolled between 1995 and 2014. MEASUREMENTS PSA levels and biopsy GSs. RESULTS After variable surveillance intervals and competing treatments were accounted for, estimated risks for biopsy upgrading were similar in the PASS and UT studies but higher in UCSF and lower in JHU studies. All cohorts had a delay of 3 to 5 months in detecting upgrading with biennial biopsies starting after a first confirmatory biopsy versus annual biopsies. LIMITATION The model does not account for possible misclassification of biopsy GS. CONCLUSION Men in different AS studies have different risks for biopsy upgrading after variable surveillance protocols and competing treatments are accounted for. Despite these differences, the consequences of more versus less frequent biopsies seem to be similar across cohorts. Biennial biopsies seem to be an acceptable alternative to annual biopsies. PRIMARY FUNDING SOURCE National Cancer Institute.
Collapse
Affiliation(s)
- Lurdes Y T Inoue
- From University of Washington, Seattle, Washington; Fred Hutchinson Cancer Research Center, Seattle, Washington; Technical University of Munich, Garching, Germany; The James Buchanan Urological Institute, Johns Hopkins Medical Institutions, Baltimore, Maryland; University of California, San Francisco, San Francisco, California; University of Toronto, Toronto, Ontario, Canada; and Vanderbilt University, Nashville, Tennessee
| | - Daniel W Lin
- From University of Washington, Seattle, Washington; Fred Hutchinson Cancer Research Center, Seattle, Washington; Technical University of Munich, Garching, Germany; The James Buchanan Urological Institute, Johns Hopkins Medical Institutions, Baltimore, Maryland; University of California, San Francisco, San Francisco, California; University of Toronto, Toronto, Ontario, Canada; and Vanderbilt University, Nashville, Tennessee
| | - Lisa F Newcomb
- From University of Washington, Seattle, Washington; Fred Hutchinson Cancer Research Center, Seattle, Washington; Technical University of Munich, Garching, Germany; The James Buchanan Urological Institute, Johns Hopkins Medical Institutions, Baltimore, Maryland; University of California, San Francisco, San Francisco, California; University of Toronto, Toronto, Ontario, Canada; and Vanderbilt University, Nashville, Tennessee
| | - Amy S Leonardson
- From University of Washington, Seattle, Washington; Fred Hutchinson Cancer Research Center, Seattle, Washington; Technical University of Munich, Garching, Germany; The James Buchanan Urological Institute, Johns Hopkins Medical Institutions, Baltimore, Maryland; University of California, San Francisco, San Francisco, California; University of Toronto, Toronto, Ontario, Canada; and Vanderbilt University, Nashville, Tennessee
| | - Donna Ankerst
- From University of Washington, Seattle, Washington; Fred Hutchinson Cancer Research Center, Seattle, Washington; Technical University of Munich, Garching, Germany; The James Buchanan Urological Institute, Johns Hopkins Medical Institutions, Baltimore, Maryland; University of California, San Francisco, San Francisco, California; University of Toronto, Toronto, Ontario, Canada; and Vanderbilt University, Nashville, Tennessee
| | - Roman Gulati
- From University of Washington, Seattle, Washington; Fred Hutchinson Cancer Research Center, Seattle, Washington; Technical University of Munich, Garching, Germany; The James Buchanan Urological Institute, Johns Hopkins Medical Institutions, Baltimore, Maryland; University of California, San Francisco, San Francisco, California; University of Toronto, Toronto, Ontario, Canada; and Vanderbilt University, Nashville, Tennessee
| | - H Ballentine Carter
- From University of Washington, Seattle, Washington; Fred Hutchinson Cancer Research Center, Seattle, Washington; Technical University of Munich, Garching, Germany; The James Buchanan Urological Institute, Johns Hopkins Medical Institutions, Baltimore, Maryland; University of California, San Francisco, San Francisco, California; University of Toronto, Toronto, Ontario, Canada; and Vanderbilt University, Nashville, Tennessee
| | - Bruce J Trock
- From University of Washington, Seattle, Washington; Fred Hutchinson Cancer Research Center, Seattle, Washington; Technical University of Munich, Garching, Germany; The James Buchanan Urological Institute, Johns Hopkins Medical Institutions, Baltimore, Maryland; University of California, San Francisco, San Francisco, California; University of Toronto, Toronto, Ontario, Canada; and Vanderbilt University, Nashville, Tennessee
| | - Peter R Carroll
- From University of Washington, Seattle, Washington; Fred Hutchinson Cancer Research Center, Seattle, Washington; Technical University of Munich, Garching, Germany; The James Buchanan Urological Institute, Johns Hopkins Medical Institutions, Baltimore, Maryland; University of California, San Francisco, San Francisco, California; University of Toronto, Toronto, Ontario, Canada; and Vanderbilt University, Nashville, Tennessee
| | - Matthew R Cooperberg
- From University of Washington, Seattle, Washington; Fred Hutchinson Cancer Research Center, Seattle, Washington; Technical University of Munich, Garching, Germany; The James Buchanan Urological Institute, Johns Hopkins Medical Institutions, Baltimore, Maryland; University of California, San Francisco, San Francisco, California; University of Toronto, Toronto, Ontario, Canada; and Vanderbilt University, Nashville, Tennessee
| | - Janet E Cowan
- From University of Washington, Seattle, Washington; Fred Hutchinson Cancer Research Center, Seattle, Washington; Technical University of Munich, Garching, Germany; The James Buchanan Urological Institute, Johns Hopkins Medical Institutions, Baltimore, Maryland; University of California, San Francisco, San Francisco, California; University of Toronto, Toronto, Ontario, Canada; and Vanderbilt University, Nashville, Tennessee
| | - Laurence H Klotz
- From University of Washington, Seattle, Washington; Fred Hutchinson Cancer Research Center, Seattle, Washington; Technical University of Munich, Garching, Germany; The James Buchanan Urological Institute, Johns Hopkins Medical Institutions, Baltimore, Maryland; University of California, San Francisco, San Francisco, California; University of Toronto, Toronto, Ontario, Canada; and Vanderbilt University, Nashville, Tennessee
| | - Alexandre Mamedov
- From University of Washington, Seattle, Washington; Fred Hutchinson Cancer Research Center, Seattle, Washington; Technical University of Munich, Garching, Germany; The James Buchanan Urological Institute, Johns Hopkins Medical Institutions, Baltimore, Maryland; University of California, San Francisco, San Francisco, California; University of Toronto, Toronto, Ontario, Canada; and Vanderbilt University, Nashville, Tennessee
| | - David F Penson
- From University of Washington, Seattle, Washington; Fred Hutchinson Cancer Research Center, Seattle, Washington; Technical University of Munich, Garching, Germany; The James Buchanan Urological Institute, Johns Hopkins Medical Institutions, Baltimore, Maryland; University of California, San Francisco, San Francisco, California; University of Toronto, Toronto, Ontario, Canada; and Vanderbilt University, Nashville, Tennessee
| | - Ruth Etzioni
- From University of Washington, Seattle, Washington; Fred Hutchinson Cancer Research Center, Seattle, Washington; Technical University of Munich, Garching, Germany; The James Buchanan Urological Institute, Johns Hopkins Medical Institutions, Baltimore, Maryland; University of California, San Francisco, San Francisco, California; University of Toronto, Toronto, Ontario, Canada; and Vanderbilt University, Nashville, Tennessee
| |
Collapse
|
10
|
Dynamic Prediction of Outcome for Patients With Ovarian Cancer: Application of a Joint Model for Longitudinal Cancer Antigen 125 Values. Int J Gynecol Cancer 2018; 28:85-91. [DOI: 10.1097/igc.0000000000001134] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
ObjectiveIn clinical practice, gynecologic oncologists are interested in predicting the prognosis of patients through information from different sources. Recently, the overall survival (OS) of ovarian cancer patients has been widely and intensively researched, and a large number of risk factors have been determined, including the biomarker of cancer antigen 125 (CA-125). For newly diagnosed patients, it is critical to construct effective prognostic models to predict prognosis dynamically by combining their CA-125 values with adjusted clinical factors.Methods/MaterialsA total of 227 ovarian cancer participants entered this study. A 4-step method was used to construct a joint model to examine the association between longitudinal CA-125 measurements and OS time, to explore time-independent predictive factors influencing OS, and to obtain an accurate and credible dynamic prediction of OS for specific subjects.ResultsWe found that CA-125 values were greatly affected by observation time, menarche, Federation International of Gynecology and Obstetrics stage, and ascites at baseline. Similarly, CA-125 values, menopause, Federation International of Gynecology and Obstetrics stage, and surgery state at baseline were selected from the best Cox proportion hazard model and showed a strong correlation with OS. In addition, the analyses presented by the joint model depict that, as time goes by, increasing CA-125 was deemed to be a significant predictor of death.ConclusionsTogether, our results show that a joint model could be highly efficient in clinical consultation and diagnosis for patients newly diagnosed as having ovarian cancer. Longitudinal CA-125 values, which are measured over time, can be used to credibly predict OS after taking all adjusted covariates into account.
Collapse
|
11
|
Trial-level analysis of progression-free survival and response rate as end points of trials of first-line chemotherapy in advanced ovarian cancer. Med Oncol 2017; 34:87. [DOI: 10.1007/s12032-017-0939-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2017] [Accepted: 03/28/2017] [Indexed: 10/19/2022]
|
12
|
Chang C, Chiang AJ, Chen WA, Chang HW, Chen J. A joint model based on longitudinal CA125 in ovarian cancer to predict recurrence. Biomark Med 2015; 10:53-61. [PMID: 26565119 DOI: 10.2217/bmm.15.110] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
AIMS To develop a new package of joint model to fit longitudinal CA125 in epithelial ovarian cancer relapse. PATIENTS & METHODS Included were 305 epithelial ovarian cancer patients who reached complete remission after cytoreductive surgery and first-line chemotherapy. Univariate and multivariate analysis with a joint model was performed to select independent risk factors, which were subsequently combined to predict recurrence. RESULTS Independent factors were longitudinal CA125, age, stage and residual tumor size (p < 0.05). Prediction of recurrence with these factors had an average of 80.7% accuracy, 5.6-10.7% better than kinetic factors. CONCLUSION The new package of joint model fits longitudinal CA125 well. Potential application can be extended to other biomarkers.
Collapse
Affiliation(s)
- Chung Chang
- Department of Applied Mathematics, National Sun Yat-sen University, Kaohsiung, Taiwan, Republic of China
| | - An Jen Chiang
- Department of Obstetrics & Gynecology, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan, Republic of China.,Department of Biological Sciences, National Sun Yat-sen University, Kaohsiung, Taiwan, Republic of China.,Department of Pharmacy & Graduate Institute of Pharmaceutical Technology, Tajen University, Pingtung, Taiwan, Republic of China
| | - Wei-An Chen
- Department of Applied Mathematics, National Sun Yat-sen University, Kaohsiung, Taiwan, Republic of China
| | - Hsueh-Wen Chang
- Department of Biological Sciences, National Sun Yat-sen University, Kaohsiung, Taiwan, Republic of China
| | - Jiabin Chen
- Multidisciplinary Science Research Center, National Sun Yat-sen University, Kaohsiung, Taiwan, Republic of China.,Da-Yeh University, Changhua, Taiwan, Republic of China
| |
Collapse
|
13
|
CA125-related tumor cell kinetics variables after chemotherapy in advanced ovarian cancer: a systematic review. Clin Transl Oncol 2015; 18:813-24. [PMID: 26546024 DOI: 10.1007/s12094-015-1441-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2015] [Accepted: 10/26/2015] [Indexed: 12/13/2022]
Abstract
Various kinetic parameters, based on a minimum of two time points, have been built with CA125 determinations. The aim of this study is to review studies about the clinical application of CA125-related tumor cell kinetics variables in patients with advanced ovarian cancer (AOC) receiving chemotherapy. A literature search for studies about CA125-related variables in patients with AOC was undertaken on three databases, by predefined search criteria, and a selection of studies was performed. Sixty-two studies were selected. CA125-related variables were summarized in three groups: response-related, time-to-event, and other CA125-related tumor cell kinetics variables. Even though CA125 changes and half-life after chemotherapy were the most studied, other variables and two models have been well defined, and often showed an interesting power to predict survival. These kinetics variables are related to the CA125 regression curve, pre- and post-chemotherapy kinetics, or are variables inferred from a population model of CA125 kinetics.
Collapse
|
14
|
Chang C, Chiang AJ, Wang HC, Chen WA, Chen J. Evaluation of the Time-Varying Effect of Prognostic Factors on Survival in Ovarian Cancer. Ann Surg Oncol 2015; 22:3976-80. [DOI: 10.1245/s10434-015-4493-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2014] [Indexed: 11/18/2022]
|