CA125 normalization within 60 days as an independent prognostic factor for patients with advanced epithelial ovarian cancer

2021 ◽  
pp. 1-9
Author(s):  
Yi-Chiao Liao ◽  
Yu-Che Ou ◽  
Chen-Hsuan Wu ◽  
Hung-Chun Fu ◽  
Ching-Chou Tsai ◽  
...  
Keyword(s):  
Ovarian Cancer ◽  
Adjuvant Chemotherapy ◽  
Epithelial Ovarian Cancer ◽  
Cytoreductive Surgery ◽  
Cox Regression ◽  
Survival Outcomes ◽  
Cox Regression Analysis ◽  
Ca125 Level ◽  
Advanced Epithelial Ovarian Cancer ◽  
The Impact

BACKGROUND: CA125 level normalization at different chemotherapy cycles has been reported to be a prognosticator in advanced epithelial ovarian cancer. OBJECTIVE: In the present study, we investigated whether the time (in days) to CA125 normalization or nadir during treatment could be used as markers to predict survival. METHODS: Patients with FIGO stage III–IV epithelial ovarian cancer treated with cytoreductive surgery followed by adjuvant chemotherapy between 2008 and 2016 were enrolled in this retrospective study. Clinicopathological characteristics, changes in CA125 level during treatment, and survival outcomes were analyzed. Time-dependent receiver operating characteristic curve analysis was used to determine the optimal cut-off values of the time to normalization and time to nadir of CA125 levels to predict survival. Univariate and multivariate Cox regression analysis were used to examine the impact of each variable on survival. RESULTS: A total of 106 patients were included in the analysis. The optimal cut-off values for the time to normalization and nadir for predicting survival were 60 and 194 days, respectively. In Kaplan-Meier survival analysis, CA125 level normalization ⩽ 60 days and CA125 ⩽ 35 u/mL after the third cycle, and CA125 level ⩽ 10 u/mL after the sixth cycle of chemotherapy were associated with significantly better 5-year progression-free survival (PFS) and overall survival (OS). In multivariate analysis, only CA125 level normalization > 60 days was significantly associated with poor survival outcomes (PFS, HR 2.62 [95% CI: 1.54, 4.45], p= 0.004; OS, HR 2.40 [95% CI: 1.19, 4.81], p= 0.014). CONCLUSIONS: Normalization of CA125 level within 60 days after cytoreductive surgery followed by adjuvant chemotherapy in patients with advanced ovarian epithelial cancer could be used as a marker to predict survival.

CA125 levels are a weak predictor of optimal cytoreductive surgery in patients with advanced epithelial ovarian cancer

2003 ◽  
Vol 13 (2) ◽  
pp. 120-124 ◽  
Author(s):  
S. Memarzadeh ◽  
S. B. Lee ◽  
J. S. Berek ◽  
R. Farias-Eisner
Keyword(s):  
Ovarian Cancer ◽  
Epithelial Ovarian Cancer ◽  
Cytoreductive Surgery ◽  
Predictive Value ◽  
Maximal Dimension ◽  
Optimal Cytoreduction ◽  
Cut Point ◽  
Ca125 Level ◽  
The Mean ◽  
Advanced Epithelial Ovarian Cancer

The utility of preoperative CA125 to predict optimal primary tumor cytoreduction in patients with advanced (stages IIIC and IV) epithelial ovarian cancer is controversial. In this paper, we retrospectively review patients with stage IIIC and IV epithelial ovarian cancer who underwent primary cytoreductive surgery from 1989 to 2001. Ninety-nine patients were identified and included in the analysis. All patients had preoperative CA125 levels measured. Operative and pathology reports were reviewed. Optimal cytoreduction was defined as largest volume of residual disease < 1 cm in maximal dimension. Mean values were compared with t-test on a log scale when needed. The optimal cut-point for discriminating between those with vs. without optimal cytoreduction was determined using the receiver operator curve (ROC) method. Optimal cytoreduction was achieved in 73% of patients. Among patients with optimal cytoreductive status the mean CA125 level was 569, while among patients with suboptimal cytoreduction the mean CA125 level was 1520 (P < 0.007). A CA125 level of 912 was identified as the optimal cut-point to distinguish the two groups. Using this CA125 level, the sensitivity of this test in predicting optimal cytoreduction was 58% and the specificity was 54%. The positive predictive value of CA125 for optimal cytoreduction was 78% and the negative predictive value was 31%. We conclude that CA125 level is a weak positive and negative predictor of optimal cytoreductive surgery in patients with advanced epithelial ovarian cancer. The CA125 level should not be used as a primary predictor of the outcome of cytoreductive surgery and should be viewed in the context of all other preoperative features.

scholarly journals Role of Reactive Thrombocytosis After Primary Cytoreductive Surgery in Advanced Ovarian Cancer

2021 ◽  
Author(s):  
Myeong-Seon Kim ◽  
Seung Hun Baek ◽  
Joseph J. Noh ◽  
Jung In Shim ◽  
Jun Hyeok Kang ◽  
...  
Keyword(s):  
Ovarian Cancer ◽  
Adjuvant Chemotherapy ◽  
Epithelial Ovarian Cancer ◽  
Cytoreductive Surgery ◽  
Advanced Ovarian Cancer ◽  
Figo Stage ◽  
Reactive Thrombocytosis ◽  
Entire Cohort ◽  
Platelet Counts ◽  
Advanced Epithelial Ovarian Cancer

Abstract We investigated the incidence of reactive thrombocytosis after maximal cytoreductive surgery in advanced epithelial ovarian cancer and its role on survival. We retrospectively reviewed electronic medical records of patients who underwent primary cytoreductive surgery for advanced epithelial ovarian cancer from January 1, 2012, and December 31, 2017. We analyzed the correlation serum platelet counts and prognosis at various time points including before surgery, during peri-operative period, and on each cycle of adjuvant chemotherapy.474 patients were eligible for the analysis. 401 patients (84.6%) were FIGO stage III and 405 patients (85.4%) were serous adenocarcinoma. 79 patients (22.6%) had splenectomy and optimal cytoreduction was achieved at 326 patients (68.8%). A week after surgery, thrombocytosis was observed in 229 patients (48.3%) patients in the entire cohort. Especially, higher platelet counts were observed in patients with splenectomy compared with patients without splenectomy. In particular, thrombocytosis on 5th cycle of adjuvant chemotherapy showed most significant impact on overall survival in multivariate analysis. In a logistic regression model, splenectomy significantly attributed to thrombocytosis on 5th cycle.Reactive thrombocytosis after primary cytoreductive surgery is associated with poor survival in advanced epithelial ovarian cancer, particularly when thrombocytosis was observed during adjuvant chemotherapy.

scholarly journals Role of Reactive Thrombocytosis After Primary Cytoreductive Surgery in Advanced Ovarian Cancer

2021 ◽  
Author(s):  
Seung Hun Baek ◽  
Myeong-Seon Kim ◽  
Joseph J. Noh ◽  
Jung In Shim ◽  
Jun Hyeok Kang ◽  
...  
Keyword(s):  
Ovarian Cancer ◽  
Adjuvant Chemotherapy ◽  
Epithelial Ovarian Cancer ◽  
Cytoreductive Surgery ◽  
Advanced Ovarian Cancer ◽  
Reactive Thrombocytosis ◽  
Peritoneal Cancer ◽  
Time Points ◽  
Platelet Counts ◽  
Advanced Epithelial Ovarian Cancer

Abstract Background: We investigated the incidence of reactive thrombocytosis after maximal cytoreductive surgery in advanced epithelial ovarian cancer and its role on survival. Methods: We retrospectively reviewed electronic medical records of patients who underwent primary cytoreductive surgery for advanced epithelial ovarian/fallopian cancer or peritoneal cancer from January 1, 2012, and December 31, 2017. In addition to known clinical prognostic factors, we analyzed the correlation serum platelet counts and prognosis at various time points including before surgery, during peri-operative period, and on each cycle of adjuvant chemotherapy.Results: 474 patients were eligible for the analysis. Median age was 54 years (18-88). 401 patients (84.6%) were FIGO stage III and 405 patients (85.4%) were serous adenocarcinoma. 79 patients (22.6%) had splenectomy and optimal cytoreduction (residual < 1 cm) was achieved at 326 patients (68.8%). A week after surgery, thrombocytosis was observed in 229 patients (48.3%) patients in the entire cohort. Especially, higher platelet counts were observed in patients with splenectomy compared with patients without splenectomy at various time points after surgery. Subgroup of patients who had persistent thrombocytosis during adjuvant chemotherapy showed poor survivals. In particular, thrombocytosis on 5th cycle of adjuvant chemotherapy showed most significant impact on overall survival (HR; 1.871, 95%CI; 1.034-3.386, p = 0.038) among various time points in multivariate analysis. In a logistic regression model, splenectomy (p < 0.001) significantly attributed to thrombocytosis on 5th cycle. Conclusion: Reactive thrombocytosis after primary cytoreductive surgery is associated with poor survival in advanced epithelial ovarian cancer, particularly when thrombocytosis was observed during adjuvant chemotherapy.

scholarly journals Clinical Impact of Lymphadenectomy after Neoadjuvant Chemotherapy in Advanced Epithelial Ovarian Cancer: A Review of Available Data

2021 ◽  
Vol 10 (2) ◽  
pp. 334
Author(s):  
Stephanie Seidler ◽  
Meriem Koual ◽  
Guillaume Achen ◽  
Enrica Bentivegna ◽  
Laure Fournier ◽  
...  
Keyword(s):  
Ovarian Cancer ◽  
Lymph Node ◽  
Neoadjuvant Chemotherapy ◽  
Epithelial Ovarian Cancer ◽  
Lymph Node Dissection ◽  
Prospective Trial ◽  
Node Dissection ◽  
Advanced Epithelial Ovarian Cancer ◽  
The Impact ◽  
Systematic Lymph Node Dissection

Recent robust data allow for omitting lymph node dissection for patients with advanced epithelial ovarian cancer (EOC) and without any suspicion of lymph node metastases, without compromising recurrence-free survival (RFS), nor overall survival (OS), in the setting of primary surgical treatment. Evidence supporting the same postulate for patients undergoing complete cytoreductive surgery after neoadjuvant chemotherapy (NACT) is lacking. Throughout a systematic literature review, the aim of our study was to evaluate the impact of lymph node dissection in patients undergoing surgery for advanced-stage EOC after NACT. A total of 1094 patients, included in six retrospective series, underwent either systematic, selective or no lymph node dissection. Only one study reveals a positive effect of lymphadenectomy on OS, and two on RFS. The four remaining series fail to demonstrate any beneficial effect on survival, neither for RFS nor OS. All of them highlight the higher peri- and post-operative complication rate associated with systematic lymph node dissection. Despite heterogeneity in the design of the studies included, there seems to be a trend showing no improvement on OS for systematic lymph node dissection in node negative patients. A well-conducted prospective trial is mandatory to evaluate this matter.

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