Associations between residual disease and survival in epithelial ovarian cancer by histologic type

Melamed, Alexander; Manning‐Geist, Beryl; Bregar, Amy; Diver, Elisabeth; Goodman, Annekathryn; Carmen, Marcela G. del; Schorge, John O.; Rauh‐Hain, J. Alejandro

doi:10.1016/j.ygyno.2017.08.003

Cited by 36 publications

(23 citation statements)

References 30 publications

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“…The 5-year survival rate is less than 30% [1]. Residual lesions after primary surgery remain one of the most important prognostic factors in patients with advanced ovarian cancer [2][3][4][5].…”

Section: Introductionmentioning

confidence: 99%

Preoperative serum levels of HE4 and CA125 predict primary optimal cytoreduction in advanced epithelial ovarian cancer: a preliminary model study

Feng

Liao

2020

J Ovarian Res

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Objective: The aim of this study is to establish a noninvasive preoperative model for predicting primary optimal cytoreduction in advanced epithelial ovarian cancer by HE4 and CA125 combined with clinicopathological parameters. Methods: Clinical data including preoperative serum HE4 and CA125 level of 83 patients with advanced epithelial ovarian cancer were collected. The sensitivity, specificity, positive predictive value, negative predictive value and overall accuracy of each clinical parameter were calculated. The Predictive Index score model and the logistic model were constructed to predict the primary optimal cytoreduction. Results: Optimal surgical cytoreduction was achieved in 62.65% (52/83) patients. Cutoff values of preoperative serum HE4 and CA125 were 777.10 pmol/L and 313.60 U/ml. (1) Patients with PIV ≥ 6 may not be able to achieve optimal surgical cytoreduction. The diagnostic accuracy, NPV, PPV and specificity for diagnosing suboptimal cytoreduction were 71, 100, 68, and 100%, respectively. (2) The logistic model was: logit p = 0.12 age − 2.38 preoperative serum CA125 level − 1.86 preoperative serum HE4 level-2.74 histological type-3.37. AUC of the logistic model in the validation group was 0.71(95%CI 0.54-0.88, P = 0.025). Sensitivity and specificity were 1.00 and 0.44, respectively. Conclusion: Age, preoperative serum CA125 level and preoperative serum HE4 level are important non-invasive predictors of primary optimal surgical cytoreduction in advanced epithelial ovarian cancer. Our PIV and logistic model can be used for assessment before expensive and complex predictive methods including laparoscopy and diagnostic imaging. Further future clinical validation is needed.

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Section: Introductionmentioning

confidence: 99%

Preoperative serum levels of HE4 and CA125 predict primary optimal cytoreduction in advanced epithelial ovarian cancer: a preliminary model study

Feng

Liao

2020

J Ovarian Res

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“…Hosono, et al 6 reported that suboptimal residual tumor size was associated with poorer prognosis in non-serous subtype tumors, but not in serous subtype tumors. Melamed, et al 7 reported that there is no prognostic significance of residual disease status by histologic subtype. Mackay, et al 8 showed that mucinous and clear cell carcinomas are poor prognostic factors in stage III/IV ovarian cancer.…”

Section: Discussionmentioning

confidence: 99%

“…Among patients with advanced ovarian cancer, those with a non-HGSC subtype were deemed to have a relatively poor prognosis, compared with HGSC, due to resistance and reduced sensitivity to standard chemotherapy. 5 6 7 8 9 10 11 Several studies have evaluated subtype-specific treatment of advanced ovarian cancer to improve the survival of patients with non-HGSC. However, these studies were performed only in patients who underwent primary debulking surgery (PDS).…”

Section: Introductionmentioning

confidence: 99%

Outcomes of Non-High Grade Serous Carcinoma after Neoadjuvant Chemotherapy for Advanced-Stage Ovarian Cancer: Single-Institution Experience

et al. 2018

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PurposeOutcomes in patients with ovarian high-grade serous carcinoma (HGSC) treated with neoadjuvant chemotherapy (NAC) have been widely studied; however, there is limited information on responses to chemotherapy among patients with non-HGSC. The aim of this study was to compare the survival outcomes of patients with advanced-stage non-HGSC and HGSC treated with NAC.Materials and MethodsThis study was a retrospective analysis of patients with advanced-stage ovarian cancer treated at Yonsei Cancer Hospital between 2006 and 2017. The demographics, chemotherapy response, and survival rates were compared between patients with non-HGSC and those with HGSC.ResultsAmong 220 patients who underwent NAC, 25 (11.4%) patients had non-HGSC histologic subtypes, and all received a taxane-platinum combination regimen for NAC. Patients with non-HGSC had lower baseline cancer antigen-125 levels (p<0.001), poorer response rates (p<0.001), lower rates of optimal cytoreduction (p=0.003), and poorer progression-free survival (PFS) (median PFS 10.3 months vs. 18.3 months; p=0.009) and overall survival (OS) (median OS 25.5 months vs. 60.6 months; p<0.001), compared to those with HGSC. In multivariate analysis, non-HGSC was a negative prognostic factor for both PFS [hazard ratio (HR), 3.19; 95% confidence interval (CI), 1.73–5.88] and OS (HR, 4.22; 95% CI, 2.07–8.58).ConclusionIn this study, poorer survival outcomes were observed in patients who underwent NAC for treatment of non-HGSC versus those treated for HGSC. Different treatment strategies are urgently required to improve survival outcomes for patients with non-HGSC undergoing NAC.

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“…Since cancer registars started capturing residual disease from 2010 onwards, similarly to a previous report we included patients diagnosed between 2011 and 2014 6. Patients with advanced stage disease (II–IV), were selected for further analysis.…”

Section: Methodsmentioning

confidence: 99%

“…While all patients with advanced stage malignant ovarian germ cell tumor routinely receive adjuvant chemotherapy, the extent of cytoreductive surgery necessary to achieve good oncologic outcomes is currently a matter of debate 5. For epithelial ovarian tumors, complete gross resection has been associated with superior survival regardless of histologic subtype 6. Similarly, some retrospective studies have identified the presence of residual disease as a negative prognostic factor for patients with malignant ovarian germ cell tumors 7–11.…”

Section: Introductionmentioning

confidence: 99%

Prognostic significance of residual disease in advanced stage malignant ovarian germ cell tumors

Nasioudis

Chapman‐Davis

Frey

et al. 2019

Int J Gynecol Cancer

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ObjectiveTo investigate the prognostic significance of complete gross resection following cytoreductive surgery for patients with advanced stage malignant ovarian germ cell tumors.MethodsThe National Cancer Data Base was accessed and patients diagnosed with an advanced stage (II-IV) malignant ovarian germ cell tumor who underwent primary cytoreductive surgery between 2011 and 2014 were selected for further analysis. For analysis purposes two groups were formed: patients with complete gross resection and those with macroscopic residual disease. Demographic and clinico-pathological characteristics were compared with the chi-square and Mann–Whitney U test. Univariate survival analysis was performed with the log-rank test after generation of Kaplan–Meier curves, while a Cox proportional hazard model was constructed to evaluate mortality after controlling for confounders.ResultsA total of 343 patients who met the inclusion criteria were identified. Residual disease status was available for 276 patients: the rate of complete gross resection was 69.2 %. By univariate analysis there was no difference in overall survival between patients in the complete gross resection and macroscopic residual disease groups, P= 0.26; 3-year overall survival rates: 86.4 % and 82.8 %, respectively. No difference in overall survival was noted following stratification by histology; P = 0.64 and P = 0.24 for dysgerminoma and non-dysgerminoma tumor groups. After controlling for stage IV disease, histology and the administration of chemotherapy, macroscopic residual disease was not associated with a worse mortality (HR: 1.22, 95% CI: 0.61 to 2.46).ConclusionsMacroscopic residual disease following primary cancer-directed surgery was not associated with a worse prognosis in a cohort of patients with advanced stage malignant ovarian germ cell tumors.

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Associations between residual disease and survival in epithelial ovarian cancer by histologic type

Cited by 36 publications

References 30 publications

Preoperative serum levels of HE4 and CA125 predict primary optimal cytoreduction in advanced epithelial ovarian cancer: a preliminary model study

Preoperative serum levels of HE4 and CA125 predict primary optimal cytoreduction in advanced epithelial ovarian cancer: a preliminary model study

Outcomes of Non-High Grade Serous Carcinoma after Neoadjuvant Chemotherapy for Advanced-Stage Ovarian Cancer: Single-Institution Experience

Prognostic significance of residual disease in advanced stage malignant ovarian germ cell tumors

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