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Ting WH, Chen HH, Wei MC, Sun HD, Hsiao SM. Intraperitoneal Chemotherapy without Bevacizumab versus Intravenous Chemotherapy with Bevacizumab as the Frontline Adjuvant Therapy in Advanced Ovarian Cancer. Cancers (Basel) 2024; 16:3382. [PMID: 39410004 PMCID: PMC11476050 DOI: 10.3390/cancers16193382] [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: 08/29/2024] [Revised: 09/27/2024] [Accepted: 10/01/2024] [Indexed: 10/20/2024] Open
Abstract
Objectives: To compare the clinical outcomes of intravenous carboplatin/paclitaxel chemotherapy plus bevacizumab versus intraperitoneal cisplatin/paclitaxel chemotherapy without bevacizumab as the frontline treatment in women with advanced ovarian, fallopian tube and primary peritoneal cancer. Methods: Between November 2012 and January 2024, medical records of all consecutive women with stage II~IV cancer treated with either frontline adjuvant intraperitoneal cisplatin/paclitaxel without bevacizumab (IP group), intravenous carboplatin/paclitaxel without bevacizumab (IV group) or intravenous carboplatin/paclitaxel with bevacizumab (IVB group) at a tertiary referral center were reviewed. Results: A total of 143 women (IP group, n = 57; IVB group, n = 23; IV group, n = 63) were reviewed. The IP group had greater progression-free survival compared to the IVB group (49.1 months, 95% confidence interval [CI] = 27.8 months to infinity, versus 11.9 months, 95% CI = 11.2 to 16.2 months; adjusted hazard ratio [HR] = 0.45, 95% CI = 0.24 to 0.87, p = 0.017). Additionally, the IP group also had a higher overall survival compared to the IVB group (not reached, 95% CI = 55.6 months to infinity, versus 38.9 months, 95% CI = 21.9 months to infinity; adjusted HR = 0.34, 95% CI = 0.15 to 0.79, p = 0.012). Conclusions: Intraperitoneal cisplatin/paclitaxel chemotherapy without bevacizumab seems to offer a survival advantage when compared with intravenous carboplatin/paclitaxel with bevacizumab in the frontline treatment of women with advanced ovarian cancer.
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Affiliation(s)
- Wan-Hua Ting
- Department of Obstetrics and Gynecology, Far Eastern Memorial Hospital, New Taipei 220216, Taiwan (M.-C.W.)
- Department of Electrical Engineering, Yuan Ze University, Taoyuan 320315, Taiwan
| | - Hui-Hua Chen
- Department of Obstetrics and Gynecology, Far Eastern Memorial Hospital, New Taipei 220216, Taiwan (M.-C.W.)
- Graduate Institute of Medicine, Yuan Ze University, Taoyuan 320315, Taiwan
| | - Ming-Chow Wei
- Department of Obstetrics and Gynecology, Far Eastern Memorial Hospital, New Taipei 220216, Taiwan (M.-C.W.)
| | - Hsu-Dong Sun
- Department of Obstetrics and Gynecology, Far Eastern Memorial Hospital, New Taipei 220216, Taiwan (M.-C.W.)
- Faculty of Medicine, School of Medicine, National Yang Ming Chiao Tung University, Taipei 112304, Taiwan
| | - Sheng-Mou Hsiao
- Department of Obstetrics and Gynecology, Far Eastern Memorial Hospital, New Taipei 220216, Taiwan (M.-C.W.)
- Department of Obstetrics and Gynecology, National Taiwan University College of Medicine, National Taiwan University Hospital, Taipei 100226, Taiwan
- Graduate School of Biotechnology and Bioengineering, Yuan Ze University, Taoyuan 320315, Taiwan
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Saffarieh E, Nassiri S, Mirmohammadkhani M. Predicting value of HE4 and CA125 markers for optimal cytoreductive surgery in ovarian cancer patients. Eur J Transl Myol 2022; 32. [PMID: 35916763 PMCID: PMC9580533 DOI: 10.4081/ejtm.2022.10671] [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: 06/13/2022] [Accepted: 06/26/2022] [Indexed: 12/04/2022] Open
Abstract
We conducted a cross-sectional study to evaluate the role of serum levels of CA125 and HE4 in predicting optimal cytoreductive surgery. Eligible women who had been diagnosed with ovarian cancer based on both clinical and imaging criteria were enrolled in this study. Serum levels of CA 125 and HE4 were checked before surgery and all patients underwent complete surgical staging. After completion of the pathological evaluation, data were entered in SPSS version 23. One hundred and ten individuals were enrolled in our study. We divided cases between two groups: stage I to Ш b and stage Шc to IV. Serum level of HE4 >170 pmol/L can predict optimal cytoreductive surgery before operation. (sensitivity:80% and specificity 70%) and serum level of CA 125 > 320 UI/mL can predict optimal cytoreductive surgery before operation. (sensitivity:80% and specificity 70%). Our data demonstrated a negative predictive value of about 80% for both HE4 and CA125. Based on these cut-off, unnecessary surgery can be avoided in many cases, however, it is unwise to ignore clinical performance and radiological findings. Nevertheless, we can say the evaluation of tumor markers is feasible and helpful in predicting optimal surgery.
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Affiliation(s)
- Elham Saffarieh
- Abnormal Uterine Bleeding Research Center, Semnan University of Medical Science, Semnan.
| | - Setare Nassiri
- Endometriosis Research Center, Iran University of Medical Sciences, Tehran.
| | - Majid Mirmohammadkhani
- Social Determinants of Health Research Center, Semnan University of Medical Sciences, Semnan.
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The role of computed tomography in the assessment of tumour extent and the risk of residual disease after upfront surgery in advanced ovarian cancer (AOC). Arch Gynecol Obstet 2022; 306:1235-1243. [PMID: 35235024 PMCID: PMC9470643 DOI: 10.1007/s00404-022-06466-8] [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: 05/05/2021] [Accepted: 02/15/2022] [Indexed: 11/28/2022]
Abstract
Purpose Epithelial ovarian cancer is usually diagnosed in the advanced stages. To choose the best therapeutic approach, an accurate preoperative assessment of the tumour extent is crucial. This study aimed to determine whether the peritoneal cancer index (PCI), the amount of ascites, and the presence of cardiophrenic nodes (CPLNs) visualized by computed tomography (CT) can assess the tumour extent (S-PCI) and residual disease (RD) for advanced ovarian cancer (AOC) patients treated with upfront surgery. Methods In total, 118 AOC cases were included between January 2016 and December 2018 at Skåne University Hospital, Lund, Sweden. Linear regression and interclass correlation (ICC) analyses were used to determine the relationship between CT-PCI and S-PCI. The patients were stratified in complete cytoreductive surgery (CCS) with no RD or to non-CCS with RD of any size. The amount of ascites on CT (CT-ascites), CA-125 and the presence of radiological enlarged CPLNs (CT-CPLN) were analysed to evaluate their impact on estimating RD. Results CT-PCI correlated well with S-PCI (0.397; 95% CI 0.252–0.541; p < 0.001). The risk of RD was also related to CT-PCI (OR 1.069 (1.009–1.131), p < 0.023) with a cut-off of 21 for CT-PCI (0.715, p = 0.000). The sensitivity, specificity, positive predictive value and negative predictive value were 58.5, 70.3, 52.2 and 75.4%, respectively. CT-ascites above 1000 ml predicted RD (OR 3.510 (1.298–9.491) p < 0.013). Conclusion CT is a reliable tool to assess the extent of the disease in advanced ovarian cancer. Higher CT-PCI scores and large volumes of ascites estimated on CT predicted RD of any size.
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Lymphovascular space invasion as a prognostic factor of epithelial ovarian cancer: a multicenter study by the FRANCOGYN group. Arch Gynecol Obstet 2021; 304:1577-1585. [PMID: 34184114 DOI: 10.1007/s00404-021-06110-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2020] [Accepted: 05/28/2021] [Indexed: 12/24/2022]
Abstract
BACKGROUND The presence of lymphovascular space invasion (LVSI) is not yet included in international recommendations neither as a prognostic factor nor as a parameter for the decision to use adjuvant chemotherapy in FIGO stage I/IIa ovarian cancer (OC). OBJECTIVE This study set out to evaluate the impact of LVSI on Overall Survival (OS) and Recurrence-Free Survival (RFS) in patients managed for epithelial OC. DESIGN Retrospective multicenter study by the research group FRANCOGYN between January 2001 and December 2018. All patients managed for epithelial OC surgery and for whom histological slides for the review of LVSI were available, were included. The characteristics of patients with LVSI (LVSI group) were compared to those without LVSI (No-LVSI group). A Cox analysis for OS and RFS analysis was performed in all the populations. SETTING French multicenter tertiary care centers RESULTS: Over the study period, 852 patients were included in the 13 institutions. Among them, 289 patients had LVSI (33.9%). There was a significant difference in the distribution of LVSI between early and advanced stages (p < 0.001). LVSI was an independent predictive factor for poorer Overall and Recurrence-Free Survival. LVSI affected OS (p < 0.001) and RFS (p < 0.001), LVSI affected OS and RFS for early stages (p = 0.001; p = 0.001, respectively) and also for advanced stages (p = 0.01; p = 0.009, respectively). CONCLUSION The presence of LVSI in epithelial ovarian epithelial tumors has an impact on OS and RFS and should be included in the routine pathology examination to adapt therapeutic management, especially for women in the early stages of the disease.
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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: 0.4] [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.
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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
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Rema P, John ER, Samabasivan S, Prahladan A, George P, Ranjith JS, Thomas S. Evaluation of Computed Tomography Scan and CA 125 Response in Predicting Operability in Advanced Ovarian Cancer and Assessing Survival Outcome in Interval Cytoreductive Surgery. Indian J Surg Oncol 2019; 10:426-434. [PMID: 31496584 DOI: 10.1007/s13193-018-0868-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2018] [Revised: 12/06/2018] [Accepted: 12/18/2018] [Indexed: 11/26/2022] Open
Abstract
The study aims at the prediction of optimal cytoreduction (OCR) in patients undergoing interval cytoreduction (ICR) in advanced epithelial ovarian cancer (AEOC) based on CT imaging and CA 125 values and assessing the survival pattern of these patients after ICR. This is a prospective observational study of patients with stage III C ovarian cancer who underwent ICR in our institution after neoadjuvant chemotherapy (NACT). All consecutive patients operated from April 2016 to October 2017 were included in the study. From their medical records, their demographic details and clinical variables were recorded. The CA 125 value and CT scan findings before and after chemotherapy were documented. A Bristow's predictive score (BS) was calculated based on the radiological parameters. After ICR, the outcome of the surgery was documented. Optimal cytoreduction (OCR) was defined as no gross residual disease after surgery. The surgical outcome was correlated with the CA 125 difference pre and post chemotherapy and Bristow's predictive score pre and post chemotherapy. The patients were followed up and their survival at 6 and 12 months was assessed. Univariate and multivariate analysis was done to identify factors predicting OCR. 51 patients were included in the study. Age group of the women ranged from 31 to 74 years with a mean of 52 years. Majority of the patients (70.6%) were postmenopausal. Of the 51 women, OCR could be achieved in 31 patients (60.8%). Post-chemotherapy, 36 patients had elevated CA125 above baseline of which 50% attained OCR. Forty six patients had CA 125 response post chemotherapy of which 67.4% attained OCR. Forty five patients had reduction in Bristow Score compared to the pre chemo values of which 64.4% attained OCR which was not found to be statistically significant. Overall survival was 100% survival at 6 months and 92.8% at 12 months in those who achieved OCR. Those with residual disease 0.1-1 cm had survival of 74.1% at 6 and 12 months. Those with residual disease > 1 cm had a survival of 50% at 6 and 12 months. CA125 response has a significant role in predicting OCR while CT evaluation using the BS was not useful in predicting OCR during ICR for AEOC.
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Affiliation(s)
- P Rema
- 1Department of Surgical Oncology, Regional Cancer Centre, Thiruvanathapuram, Kerala India
| | - Elizabeth Reshmi John
- Department of Obstetrics and Gynecology, Azeezia Medical College Hospital, Meeyannoor, Kollam 37, Kerala, India
- Thiruvananthapuram, India
| | - Suchetha Samabasivan
- 1Department of Surgical Oncology, Regional Cancer Centre, Thiruvanathapuram, Kerala India
| | - Anil Prahladan
- 3Department of Radiodiagnosis, Regional Cancer Centre, Thiruvanathapuram, Kerala India
| | - Preethi George
- 4Department of Biostatistics, Regional Cancer Centre, Thiruvanathapuram, Kerala India
| | - J Siva Ranjith
- 1Department of Surgical Oncology, Regional Cancer Centre, Thiruvanathapuram, Kerala India
| | - Shaji Thomas
- 1Department of Surgical Oncology, Regional Cancer Centre, Thiruvanathapuram, Kerala India
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Bendifallah S, Body G, Daraï E, Ouldamer L. [Diagnostic and prognostic value of tumor markers, scores (clinical and biological) algorithms, in front of an ovarian mass suspected of an epithelial ovarian cancer: Article drafted from the French Guidelines in oncology entitled "Initial management of patients with epithelial ovarian cancer" developed by FRANCOGYN, CNGOF, SFOG, GINECO-ARCAGY under the aegis of CNGOF and endorsed by INCa]. ACTA ACUST UNITED AC 2019; 47:134-154. [PMID: 30733191 DOI: 10.1016/j.gofs.2018.12.013] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2018] [Indexed: 11/26/2022]
Abstract
OBJECTIVES To evaluate the diagnostic value of serum/urinary biomarkers and the operability diagnosis strategy to make management recommendations. METHODS Bibliographical search in French and English languages by consultation of Pubmed, Cochrane and Embase databases. RESULTS For the diagnosis of a suspicious adnexal mass on imaging: Serum CA125 antigen is recommended (grade A). Serum CAE is not recommended (grade C). The low evidence in literature concerning diagnostic value of CA19.9 does not allow any recommendation concerning its use. Serum Human epididymis protein 4 (HE4) is recommended (grade A). Comparison of data concerning diagnosis value of CA125 and HE4 show similar results for the prediction of malignancy in case of a suspicious adnexal mass on imaging (NP1). Urinary HE4 is not recommended (grade A). The use of circulating tumor DNA is not recommended (grade A). Tumor associated antigen-antibodies (AAbs) is not recommended (grade B). The use of ROMA score (Risk of Ovarian Malignancy Algorithm) is recommended (grade A). The use of Copenhagen index (CPH-I), R-OPS score, OVA500 is not recommended (grade C). For the prediction of resectability of an ovarian cancer with peritoneal carcinomatosis in the context of a primary debulking surgery: It is not recommendend to use serum CA125 (grade A). The low evidence in literature concerning diagnostic value of HE4 does not allow any recommendation concerning its use in this context. No recommendation can be given concerning CA19.9 and CAE. For the prediction of resectability of an ovarian cancer with peritoneal carcinomatosis in the context of surgery after neoadjuvant chemotherapy: the low evidence in literature concerning diagnostic value of serum markers in this context does not allow any recommendation concerning their use in this context. Place of laparoscopy for the prediction of resectability in case of upfront surgery of an ovarian cancer with peritoneal carcinomatosis robust data shows that the use of laparoscopy significantly reduce futile laparotomies (LE1). Laparoscopy is recommended in this context (grade A). Fagotti score is a reproducible tool (LE1) permitting the evaluation of feasibility of an optimal upfront debulking (NP4), its use is recommended (grade C). A Fagotti score≥8 is correlated to a low probability of complete or optimal debulking surgery (LE4) (grade C). There is no sufficient evidence to recommend the use of the modified Fagotti score or any other laparoscopic score (LE4). In case of laparotomy for an ovarian cancer with peritoneal carcinomatosis, the use of Peritoneal Cancer Index (PCI) is recommended (grade C). For the prediction of overall survival, disease free survival and the prediction of postoperative complications, the clinical and statistical of actually available tools do not allow any recommendation.
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Affiliation(s)
- S Bendifallah
- Département de gynécologie-obstétrique, hôpital Tenon, Assistance publique des Hôpitaux de Paris (AP-HP), 4, rue de la Chine, 75020 Paris, France; UMR_S938, université de Sorbonne, 75000 Paris, France
| | - G Body
- Département de gynécologie, centre hospitalier universitaire de Tours, 2, boulevard Tonnellé, 37044 Tours, France; Inserm U1069, université François-Rabelais, 37044 Tours, France
| | - E Daraï
- Département de gynécologie-obstétrique, hôpital Tenon, Assistance publique des Hôpitaux de Paris (AP-HP), 4, rue de la Chine, 75020 Paris, France; Inserm UMR S 938, université Pierre-et-Marie-Curie, 75000 Paris, France
| | - L Ouldamer
- Département de gynécologie, centre hospitalier universitaire de Tours, 2, boulevard Tonnellé, 37044 Tours, France; Inserm U1069, université François-Rabelais, 37044 Tours, France.
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Qin L, Huang H, Chen M, Liang Y, Wang H. Clinical study of a CT evaluation model combined with serum CA125 in predicting the treatment of newly diagnosed advanced epithelial ovarian cancer. J Ovarian Res 2018; 11:49. [PMID: 29914567 PMCID: PMC6006670 DOI: 10.1186/s13048-018-0422-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2018] [Accepted: 05/23/2018] [Indexed: 01/20/2023] Open
Abstract
Background The treatment of newly diagnosed advanced epithelial ovarian cancer (EOC) was predicted by an ovarian cancer computed tomography (CT) evaluation model combined with serum CA125. Methods Clinical data for 194 patients with advanced EOC treated with neoadjuvant chemotherapy (NACT) combined with interval debulking surgery (IDS) or primary debulking surgery (PDS) were retrospectively analyzed, and the appropriate treatment was predicted by comparing the subgroup differences in intraoperative situations, postoperative situations and survival rates. Results There were no significant differences with respect to operation time, intraoperative blood loss, ideal tumor cytoreductive rate or postoperative complication rate between the NACT + IDS group and the PDS group with scores less than 5 (score < 5) (p = 0.764, p = 0.504, p = 0.906, p = 0.176). However, there was a statistically significant difference in overall survival rate between the two groups (p = 0.029), with better survival in the PDS group than in the NACT + IDS group. There were significant differences between the NACT + IDS group and the PDS group with scores greater than or equal to 5 (score ≥ 5). The former was better than the latter in terms of operation time, intraoperative blood loss, ideal tumor cytoreductive rate, and postoperative complication rate (p = 0.002, p = 0.040, p = 0.014, p = 0.021). However, there was no significant difference in overall survival rate between the two groups (p = 0.383). Conclusions According to the new evaluation system, for a score < 5, we suggest that patients with newly diagnosed advanced EOC undergo PDS; for a score ≥ 5, we recommend NACT + IDS.
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Affiliation(s)
- Lu Qin
- Department of Gynecologic Oncology, Affiliated Tumor Hospital of Guangxi Medical University, 71 Hedi Road, Qingxiu District, Nanning, Guangxi, 530021, People's Republic of China
| | - Huming Huang
- Department of Gynecologic Oncology, Affiliated Tumor Hospital of Guangxi Medical University, 71 Hedi Road, Qingxiu District, Nanning, Guangxi, 530021, People's Republic of China
| | - Mengjie Chen
- Department of Gynecologic Oncology, Affiliated Tumor Hospital of Guangxi Medical University, 71 Hedi Road, Qingxiu District, Nanning, Guangxi, 530021, People's Republic of China
| | - Yuejuan Liang
- Department of Gynecologic Oncology, Affiliated Tumor Hospital of Guangxi Medical University, 71 Hedi Road, Qingxiu District, Nanning, Guangxi, 530021, People's Republic of China
| | - He Wang
- Department of Gynecologic Oncology, Affiliated Tumor Hospital of Guangxi Medical University, 71 Hedi Road, Qingxiu District, Nanning, Guangxi, 530021, People's Republic of China.
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Arab M, Jamdar F, Sadat Hosseini M, Ghodssi- Ghasemabadi R, Farzaneh F, Ashrafganjoei T. Model for Prediction of Optimal Debulking of Epithelial Ovarian Cancer. Asian Pac J Cancer Prev 2018; 19:1319-1324. [PMID: 29802693 PMCID: PMC6031811 DOI: 10.22034/apjcp.2018.19.5.1319] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2017] [Accepted: 01/16/2018] [Indexed: 12/01/2022] Open
Abstract
Background: Primary cytoreduction surgery followed by chemotherapy is the cornerstone treatment for epithelial ovarian cancer (EOC). In patients with a low probability of optimal primary surgical debulking, neoadjuvant chemotherapy (NACT) followed by interval debulking increases the chance of optimal surgery. The aim of this study was to develop a model to identify preoperative predictors for suboptimal cytoreduction. Methods: Medical records of patients with EOC who underwent primary cytoreductive surgery in a referral tertiary gyneco-oncology center were reviewed from 2007 to 2017. Data were collected on a range of characteristics including demographic features, comorbidities, serum tumor markers, hematologic markers, preoperative imaging, surgical procedures, and pathologic reports. Univariate and multivariate analyses were performed to clarify the ability of preoperative factors to predict suboptimal primary surgery. Results: The majority of patients (71.3%) who underwent primary cytoreductive surgery were optimally debulked. Based on the Youden index, the best cut-off point for the serum CA125 level to distinguish suboptimal debulking was 420U/ml with 0.730 (95%CI:0.559 to 0.862) sensitivity and 0.783 (0.684 to 0.862) specificity. Multiple logistic regression results showed that serum CA125 level >420 U/ ml (p value <0.001), the presence of liver metastasis on preoperative imaging (p value: 0.041) and ascites (p value: 0.032) or massive ascites (p value:0.010) significantly increased the risk of suboptimal debulking (logit p = 2.36 CA125 level +1.85 Liverinvolvement +1.68 presence of Ascites+ 2.28 Massive Ascites). Conclusion:The present study suggests that a serum CA125 level >420 U/ml, the presence of ascites or massive ascites and liver metastasis are strong predictors of suboptimal primary surgery in cases of EOC. Based on the constructed model, with any of these 4 factors, the probability of suboptimal debulking in EOC is more than 80%.
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Affiliation(s)
- Maliheh Arab
- Cancer Research Center, ShahidBeheshti University of Medical Science, Tehran, Iran.
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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: 1.4] [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.
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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
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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: 18] [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.
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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: 18] [Impact Index Per Article: 2.0] [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.
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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
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Yamamoto M, Tsujikawa T, Fujita Y, Chino Y, Kurokawa T, Kiyono Y, Okazawa H, Yoshida Y. Metabolic tumor burden predicts prognosis of ovarian cancer patients who receive platinum-based adjuvant chemotherapy. Cancer Sci 2016; 107:478-85. [PMID: 26789906 PMCID: PMC4832857 DOI: 10.1111/cas.12890] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2015] [Revised: 01/07/2016] [Accepted: 01/12/2016] [Indexed: 01/21/2023] Open
Abstract
Volumetric parameters of positron emission tomography–computed tomography using 18F‐fludeoxyglucose (18F‐FDG PET/CT) that comprehensively reflect both metabolic activity and tumor burden are capable of predicting survival in several cancers. The aim of this study was to investigate the predictive performance of metabolic tumor burden measured by 18F‐FDG PET/CT in ovarian cancer patients who received platinum‐based adjuvant chemotherapy after cytoreductive surgery. Included in this study were 37 epithelial ovarian cancer patients. Metabolic tumor burden in terms of metabolic tumor volume (MTV) and total lesion glycolysis (TLG), clinical stage, histological type, residual tumor after primary cytoreductive surgery, baseline serum carbohydrate antigen 125 (CA125) level, and the maximum standardized uptake value (SUVmax) were determined, and compared for their performance in predicting progression‐free survival (PFS). Metabolic tumor volume correlated with CA125 (r = 0.547, P < 0.001), and TLG correlated with SUVmax and CA125 (SUVmax, r = 0.437, P = 0.007; CA125, r = 0.593, P < 0.001). Kaplan–Meier analysis showed a significant difference in PFS between the groups categorized by TLG (P = 0.043; log–rank test). Univariate analysis indicated that TLG was a statistically significant risk factor for poor PFS. Multivariate analysis adjusted according to the clinicopathological features was carried out for MTV, TLG, SUVmax, tumor size, and CA125. Only TLG showed a significant difference (P = 0.038), and a 3.915‐fold increase in the hazard ratio of PFS. Both MTV and TLG (especially TLG) could serve as potential surrogate biomarkers for recurrence in patients who undergo primary cytoreductive surgery followed by platinum‐based chemotherapy, and could identify patients at high risk of recurrence who need more aggressive treatment.
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Affiliation(s)
- Makoto Yamamoto
- Department of Obstetrics and Gynecology, Faculty of Medical Sciences, University of Fukui, Fukui, Japan
| | - Tetsuya Tsujikawa
- Biomedical Imaging Research Center, Faculty of Medical Sciences, University of Fukui, Fukui, Japan
| | - Yuko Fujita
- Department of Obstetrics and Gynecology, Faculty of Medical Sciences, University of Fukui, Fukui, Japan
| | - Yoko Chino
- Department of Obstetrics and Gynecology, Faculty of Medical Sciences, University of Fukui, Fukui, Japan
| | - Tetsuji Kurokawa
- Department of Obstetrics and Gynecology, Faculty of Medical Sciences, University of Fukui, Fukui, Japan
| | - Yasushi Kiyono
- Biomedical Imaging Research Center, Faculty of Medical Sciences, University of Fukui, Fukui, Japan
| | - Hidehiko Okazawa
- Biomedical Imaging Research Center, Faculty of Medical Sciences, University of Fukui, Fukui, Japan
| | - Yoshio Yoshida
- Department of Obstetrics and Gynecology, Faculty of Medical Sciences, University of Fukui, Fukui, Japan
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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: 104] [Impact Index Per Article: 10.4] [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.
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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
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Menczer J, Ben-Shem E, Golan A, Levy T. The Significance of Normal Pretreatment Levels of CA125 (<35 U/mL) in Epithelial Ovarian Carcinoma. Rambam Maimonides Med J 2015; 6:e0005. [PMID: 25717387 PMCID: PMC4327321 DOI: 10.5041/rmmj.10180] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/14/2023] Open
Abstract
OBJECTIVE To assess the association between normal CA125 levels at diagnosis of epithelial ovarian carcinoma (EOC) with prognostic factors and with outcome. METHODS The study group consisted of histologically confirmed EOC patients with normal pretreatment CA125 levels, and the controls consisted of EOC patients with elevated (≥35 U/mL) pretreatment CA125 levels, diagnosed and treated between 1995 and 2112. Study and control group patients fulfilled the following criteria: 1) their pretreatment CA125 levels were assessed; 2) they had full standard primary treatment, i.e. cytoreductive surgery and cisplatin-based chemotherapy; and 3) they were followed every 2-4 months during the first two years and every 4-6 months thereafter. RESULTS Of 114 EOC patients who fulfilled the inclusion criteria, 22 (19.3%) had normal pretreatment CA125 levels. The control group consisted of the remaining 92 patients with ≥35 U/mL serum CA125 levels pretreatment. The proportion of patients with early-stage and low-grade disease, with optimal cytoreduction, and with platin-sensitive tumors was significantly higher in the study group than in the control group. The progression-free survival (PFS) and overall survival (OS) were significantly higher in the study group than in the control group on univariate analysis but not on multivariate analysis. CONCLUSION It seems that a normal CA125 level at diagnosis in EOC may also be of prognostic significance for the individual patient.
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Affiliation(s)
- Joseph Menczer
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, E. Wolfson Medical Center, Holon, Tel Aviv University, Sackler Faculty of Medicine, Tel Aviv, Israel
| | - Erez Ben-Shem
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, E. Wolfson Medical Center, Holon, Tel Aviv University, Sackler Faculty of Medicine, Tel Aviv, Israel
| | - Abraham Golan
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, E. Wolfson Medical Center, Holon, Tel Aviv University, Sackler Faculty of Medicine, Tel Aviv, Israel
| | - Tally Levy
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, E. Wolfson Medical Center, Holon, Tel Aviv University, Sackler Faculty of Medicine, Tel Aviv, Israel
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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.
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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: 51] [Impact Index Per Article: 3.9] [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%).
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Affiliation(s)
- Roberto Angioli
- Department of Obstetrics and Gynaecology Campus Bio Medico University of Rome, Italy.
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18
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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: 3.8] [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.
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19
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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: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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Kang S, Park SY. To predict or not to predict? The dilemma of predicting the risk of suboptimal cytoreduction in ovarian cancer. Ann Oncol 2011; 22 Suppl 8:viii23-viii28. [DOI: 10.1093/annonc/mdr530] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
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Reid A, Ercolano E, Schwartz P, McCorkle R. The management of anxiety and knowledge of serum CA-125 after an ovarian cancer diagnosis. Clin J Oncol Nurs 2011; 15:625-32. [PMID: 22119973 DOI: 10.1188/11.cjon.625-632] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
This article describes the relationship among anxiety, distress, and serum CA-125 levels in women with ovarian cancer. Women's anxiety about monitoring their CA-125 levels during chemotherapy also is discussed. Data from a randomized trial including self-reported anxiety and emotional distress of women following surgery after a primary diagnosis of ovarian cancer, their recorded serum CA-125 levels, and knowledge about their CA-125 levels were analyzed. In the sample, 26 of 30 women had serum CA-125 levels above the normal range. At baseline, the sample had an elevated mean anxiety score and an elevated distress score. A moderate association was found between a high serum CA-125 level and a high anxiety score at baseline, but the finding was not statistically significant. A negative nonsignificant relationship was found between a high serum CA-125 level and distress at baseline. The qualitative analysis revealed two themes: anxiety and lack of knowledge of serum CA-125. Oncology nurses and nurse practitioners caring for these women should provide essential information and strategies that can help guide women with ovarian cancer through the journey of their disease.
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Affiliation(s)
- Amanda Reid
- Yale Cancer Center, Smilow Cancer Hospital, New Haven, CT, USA
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22
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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: 34] [Impact Index Per Article: 2.3] [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
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Weinberg LE, Rodriguez G, Hurteau JA. The role of neoadjuvant chemotherapy in treating advanced epithelial ovarian cancer. J Surg Oncol 2010; 101:334-43. [PMID: 20187069 DOI: 10.1002/jso.21482] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
The current management of advanced ovarian cancer consists of aggressive primary cytoreductive surgery (PCS) followed by combination platinum based chemotherapy. Recent studies have suggested that platinum-based chemotherapy may be of benefit in patients with advanced ovarian cancer prior to cytoreductive surgery (neoadjuvant chemotherapy, NACT). The concept of NACT has not been completely validated in the treatment of ovarian cancer. This review will discuss the role of NACT in patients with advanced epithelial ovarian cancer.
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Affiliation(s)
- Lori E Weinberg
- Department of Obstetrics and Gynecology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
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24
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Gerestein CG, van der Spek DW, Eijkemans MJ, Bakker J, Kooi GS, Burger CW. Prediction of residual disease after primary cytoreductive surgery for advanced-stage ovarian cancer: accuracy of clinical judgment. Int J Gynecol Cancer 2010; 19:1511-5. [PMID: 19955927 DOI: 10.1111/igc.0b013e3181bf82be] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
OBJECTIVES Treatment of patients with an advanced-stage epithelial ovarian cancer (EOC) is based on cytoreductive surgery and platinum-based chemotherapy. Amount of residual disease after primary cytoreductive surgery is an important prognostic factor. The objectives of the present study were to evaluate the accuracy and reproducibility of preoperative clinical judgment of residual disease after primary cytoreductive surgery and to compare the predictive performance of the offhand assessment to the predictive performance of prediction models. MATERIALS AND METHODS Fifteen observers (5 gynecologic oncologists, 5 gynecologists, and 5 senior residents) were offered preoperative data of 20 patients with advanced-stage EOC who underwent primary cytoreductive surgery. The observers were asked to predict residual disease after cytoreductive surgery (<or=1 or >1 cm). Their estimation was compared with the performance of 2 prediction models. RESULTS Overall, suboptimal cytoreduction was predicted with a sensitivity of 50% and a specificity of 56%. The intraclass correlation coefficient was 0.27. chi(2) Test showed no significant difference in prediction of suboptimal cytoreduction between the different subgroups and prediction models. CONCLUSIONS Clinical judgment of residual disease after primary cytoreductive surgery in patients with advanced-stage EOC shows limited accuracy. Given the poor interobserver reproducibility, prediction models could attribute to uniform treatment decisions and improve counseling.
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Affiliation(s)
- Cornelis G Gerestein
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Erasmus MC, University Medical Center, Rotterdam, The Netherlands.
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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: 59] [Impact Index Per Article: 3.9] [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.
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Affiliation(s)
- Sokbom Kang
- Center for Uterine Cancer, Research Institute and Hospital, National Cancer Center, Ilsan-gu Madu-dong, Goyang, Republic of Korea.
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Ibeanu OA, Bristow RE. Predicting the outcome of cytoreductive surgery for advanced ovarian cancer: a review. Int J Gynecol Cancer 2010; 20 Suppl 1:S1-11. [PMID: 20065732 DOI: 10.1111/igc.0b013e3181cff38b] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/29/2025] Open
Abstract
INTRODUCTION Ovarian cancer is the leading cause of gynecologic cancer-related mortality in the United States. Surgical cytoreduction is the cornerstone of current treatment in patients with advanced disease, but it offers the best chances for overall survival when optimal cytoreduction is achieved. Clinicopathological and radiological models for predicting optimal resectability have not been universally applicable. OBJECTIVE To summarize the existing surgical data on current serologic, radiological, and surgical tools used to predict the resectability of advanced ovarian cancer. METHODS Systematic review of surgical studies on primary cytoreductive surgery for advanced ovarian cancer reported in the English-language literature between 1980 and 2009. RESULTS Seventeen retrospective studies using cancer antigen 125, and 8 retrospective studies using radiological imaging modalities to predict resectability of advanced ovarian cancer were reviewed. Five laparoscopic-based reports of ovarian cancer resectability were also reviewed as well as 5 studies examining the role of clinicopathological variables affecting surgical cytoreductive ability. These studies were analyzed according to the rate of optimal cytoreduction achieved and the reported sensitivity, specificity, accuracy, and predictive values of predictive parameters described. Finally, the various conclusions were compared. CONCLUSIONS The rates of optimal cytoreduction vary among surgeons. A universally applicable clinical model that can predict which patients will undergo optimal cytoreduction remains elusive. More research is needed to devise a set of uniform criteria that can be used to predict ovarian cancer resectability among different patient populations.
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Affiliation(s)
- Okechukwu A Ibeanu
- Division of Gynecologic Oncology, School of Medicine, Johns Hopkins University, Baltimore, MD 21287, USA
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Risum S, Høgdall E, Engelholm SA, Fung E, Lomas L, Yip C, Petri AL, Nedergaard L, Lundvall L, Høgdall C. A proteomics panel for predicting optimal primary cytoreduction in stage III/IV ovarian cancer. Int J Gynecol Cancer 2009; 19:1535-8. [PMID: 19955932 DOI: 10.1111/igc.0b013e3181a840f5] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
The objective of this prospective study was to evaluate CA-125 and a 7-marker panel as predictors of incomplete primary cytoreduction in patients with stage III/IV ovarian cancer (OC). From September 2004 to January 2008, serum from 201 patients referred to surgery for a pelvic tumor was analyzed for CA-125. In addition, serum was analyzed for 7 biomarkers using surface-enhanced laser desorption/ionization time-of-flight mass spectrometry. These biomarkers were combined into a single-valued ovarian-cancer-risk index (OvaRI). CA-125 and OvaRI were evaluated as predictors of cytoreduction in 75 stage III/IV patients using receiver operating characteristic curves. Complete primary cytoreduction (no macroscopic residual disease) was achieved in 31% (23/75) of the patients. The area under the receiver operating characteristic curve was 0.66 for CA-125 and 0.75 for OvaRI. The sensitivity and specificity of CA-125 for predicting incomplete cytoreduction were 71% (37/52) and 57% (13/23), respectively (P = 0.04). The sensitivity and specificity of OvaRI for predicting incomplete cytoreduction were 73% (38/52) and 70% (16/23), respectively (P = 0.001). In conclusion, CA-125 and an index of 7 biomarkers were found to be predictors of cytoreduction. However, future studies of biomarkers are anticipated to promote early diagnosis and provide prognostic information to guide treatment of OC patients. In addition, new biomarkers might also play a role in predicting outcome from primary surgery in OC patients.
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Affiliation(s)
- Signe Risum
- Department of Oncology, Finsen Center, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark.
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Contemporary considerations for neoadjuvant chemotherapy in primary ovarian cancer. Curr Oncol Rep 2009; 11:457-65. [DOI: 10.1007/s11912-009-0062-y] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Yoo SC, Chang SJ. In reply. J Gynecol Oncol 2009; 19:279-80. [PMID: 19471657 DOI: 10.3802/jgo.2008.19.4.280] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Affiliation(s)
- Seung-Chul Yoo
- Department of Obstetrics and Gynecology, Ajou University School of Medicine, Suwon, Korea
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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: 62] [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.
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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: 45] [Impact Index Per Article: 2.8] [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.
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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: 33] [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.
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Affiliation(s)
- A H M M Arits
- Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands
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Bristow RE, Eisenhauer EL, Santillan A, Chi DS. Delaying the primary surgical effort for advanced ovarian cancer: a systematic review of neoadjuvant chemotherapy and interval cytoreduction. Gynecol Oncol 2006; 104:480-90. [PMID: 17166564 DOI: 10.1016/j.ygyno.2006.11.002] [Citation(s) in RCA: 147] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2006] [Revised: 10/29/2006] [Accepted: 11/06/2006] [Indexed: 01/08/2023]
Abstract
OBJECTIVE To summarize the existing data on interval cytoreductive surgery and neoadjuvant chemotherapy as alternative treatment strategies for patients with advanced-stage ovarian cancer. METHODS All investigational studies with evaluable survival data on interval cytoreductive surgery and neoadjuvant chemotherapy for ovarian cancer reported in the English language literature between 1989 and 2006 were systematically reviewed. RESULTS Three randomized trials and six non-randomized studies of interval cytoreduction following suboptimal initial surgery were identified. Twenty-six studies, including a total of 1336 patients, reporting on neoadjuvant chemotherapy administered in lieu of primary cytoreductive surgery were analyzed according to the survival outcome achieved, the degree of surgical effort or success, and the particular selection criteria employed to justify deferring an attempt at primary cytoreductive surgery. CONCLUSIONS Interval surgery following a concerted but suboptimal attempt at up-front cytoreduction does not appear to have an appreciable impact on survival outcome. Maximal primary cytoreductive surgery remains the standard of care for the majority of women with suspected advanced ovarian cancer. Neoadjuvant chemotherapy represents a viable alternative management strategy for the limited number of patients felt to be optimally unresectable by an experienced ovarian cancer surgical team; however, currently available data suggest that the survival outcome achievable with initial chemotherapy is inferior to successful up-front cytoreductive surgery. Additional research is needed to devise universal selection criteria for neoadjuvant chemotherapy, determine the most efficacious treatment program, and characterize the appropriate proportion of patients in which an attempt at primary surgery should be abandoned in favor of initial chemotherapy.
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Affiliation(s)
- Robert E Bristow
- The Kelly Gynecologic Oncology Service, Department of Gynecology and Obstetrics, The Sidney Kimmel Comprehensive Cancer Center, The Johns Hopkins Medical Institutions, 600 North Wolfe Street, Phipps #281, Baltimore, MD 21287, USA.
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Lambaudie E, Collinet P, Vinatier D. Tumeurs de l'ovaire et CA 125 en 2006. ACTA ACUST UNITED AC 2006; 34:254-7. [PMID: 16529967 DOI: 10.1016/j.gyobfe.2006.01.026] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2005] [Accepted: 01/12/2006] [Indexed: 11/20/2022]
Abstract
The authors propose to report progress on the use of the CA 125 serum assay. It affects three situations: screening, diagnosis and the follow-up of the patients dealt with ovarian tumour either of benign or malignant nature. For each situation the interest and the relevance of CA 125 assay will be approached.
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Affiliation(s)
- E Lambaudie
- Service de gynécologie chirurgicale, hôpital Jeanne-de-Flandre, CHRU de Lille, 2, avenue Oscar-Lambret, 59037 Lille cedex, France.
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Le scanner multibarrettes : un outil indispensable au bilan d’extension des cancers de l’ovaire. IMAGERIE DE LA FEMME 2005. [DOI: 10.1016/s1776-9817(05)80674-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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Gemer O, Lurian M, Gdalevich M, Kapustian V, Piura E, Schneider D, Lavie O, Levy T, Fishman A, Dgani R, Levavi H, Beller U. A multicenter study of CA 125 level as a predictor of non-optimal primary cytoreduction of advanced epithelial ovarian cancer. Eur J Surg Oncol 2005; 31:1006-10. [PMID: 16005601 DOI: 10.1016/j.ejso.2005.05.009] [Citation(s) in RCA: 38] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2004] [Revised: 05/12/2005] [Accepted: 05/18/2005] [Indexed: 11/24/2022] Open
Abstract
AIMS To provide a large database of pre-operative CA 125 levels which may predict inappropriate cytoreductive surgery in patients with advanced epithelial ovarian cancer. METHODS A multicenter review of the records of 424 patients with FIGO stage III and IV epithelial ovarian cancer of patients who underwent primary cytoreductive surgery was performed. The validity of pre-operative CA 125 level measurement as a single predictor of the possibility to achieve only suboptimal cytoreduction was evaluated by calculating the sensitivity and the specificity of various cut-off values. The relative importance of different cut-off values in achieving the best predictive validity was assessed by a receiver operating characteristics (ROC) curve. RESULTS Optimal cytoreduction (largest diameter of residual tumour < or =1 cm) was achieved in 242 patients. The median CA 125 level in optimally cytoreduced patients was lower than in those patients suboptimally debulked (304 vs 863 U/mL; p<0.001). The area under the ROC curve was 0.65 (95% confidence interval, 0.60-0.71) and the CA 125 threshold derived from the ROC was 400 U/mL. The accuracy of the test at this level was 62%. CONCLUSIONS The clinical applicability of the ROC derived CA 125 threshold is limited. The data accrued in the study provides a basis for decision-making regarding the place of primary surgery various CA 125 levels.
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Affiliation(s)
- O Gemer
- Department of Obstetrics and Gynecology Barzilai Medical Center, 78306 Ashkelon, Ben Gurion University of the Negev, Israel.
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Rouzier R, Pomel C. Update on the role of laparoscopy in the treatment of gynaecological malignancy. Curr Opin Obstet Gynecol 2005; 17:77-82. [PMID: 15711416 DOI: 10.1097/00001703-200502000-00014] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
PURPOSE OF REVIEW To update the available information and to report on how the recent literature has better defined the role of laparoscopy for the management of gynaecological malignancies. RECENT FINDINGS When compared with laparotomy, laparoscopy provides a similar outcome with a shorter hospitalization, an earlier recovery, and an improved quality of life for the treatment of endometrial cancer. Recent reports in the literature on cervical cancer management now include follow-up data; however, only one study included a control group. These studies confirm the feasibility of radical hysterectomy by laparoscopy. The 2-year disease-free and overall survivals were similar in patients treated by laparoscopy and laparotomy in the study that included a control group. The role of laparoscopy for early ovarian cancer is limited by the absence of available data on upstaging. For advanced ovarian carcinoma, new applications of laparoscopy, such as laparoscopic fluorescence detection after intraperitoneal application of 5-aminolevulinic acid, have been reported but the real utility needs further investigation. One of the challenges for the development of laparoscopic surgery is the difficulty for physicians of acquiring advanced laparoscopic surgical skills. SUMMARY The feasibility and safety of laparoscopy for most of the surgical procedures that are used for gynaecological malignancies are now established from cohort or case-control analytical studies. The absence of large phase III studies needs to be balanced by the relatively low incidence of cervical and ovarian cancer.
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Affiliation(s)
- Roman Rouzier
- Department of Gynaecologic Oncology Surgery, Gustave Roussy Institute, Villejuif, France
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Morice P, Leblanc E, Narducci F, Pomel C, Pautier P, Chevalier A, Lhommé C, Castaigne D. Chirurgie initiale ou d'intervalle dans les cancers de l'ovaire de stade avancé ? État de la question en 2004 et critères de sélection des patientes. ACTA ACUST UNITED AC 2005; 33:55-63. [PMID: 15752668 DOI: 10.1016/j.gyobfe.2004.11.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2004] [Accepted: 11/15/2004] [Indexed: 10/25/2022]
Abstract
The management of advanced stage ovarian cancer has been deeply modified over the last few years. In patients with massive peritoneal spread, the use of neoadjuvant chemotherapy, followed by interval surgery, reduces the morbidity of radical surgery with an improvement of the quality of life. Nevertheless, results of ongoing randomized studies should be waited before stating about the results on survival of such management compared to initial debulking surgery. Waiting such results, the standard treatment of advanced stage ovarian cancer in 2005 remains initial surgery, performed in order to obtain ideally a total resection of all macroscopic diseases, and followed by adjuvant chemotherapy. However, in patients with massive spread, interval debulking surgery is becoming an interesting option, and will perhaps become a standard management. But criteria to select patients between initial and interval debulking surgery should be clearly defined. Those different points will be studied in this paper.
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Affiliation(s)
- P Morice
- Service de chirurgie, institut Gustave-Roussy, 39, rue Camille-Desmoulins, 94805 Villejuif cedex, France.
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