A predictive score for optimal cytoreduction at interval debulking surgery in epithelial ovarian cancer: a two- centers experience

Ghisoni, Eleonora; Katsaros, Dionyssios; Aglietta, Massimo; Vaira, Marco; Simone, Michele De; Mittica, Gloria; Giannone, Gaia; Robella, Manuela; Genta, Sofia; Lucchino, Fabiola; Marocco, F; Borella, Fulvio; Valabrega, Giorgio; Ponzone, Riccardo

doi:10.1186/s13048-018-0415-y

Cited by 25 publications

(31 citation statements)

References 43 publications

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“…They concluded with a preoperative CA-125 >500 U/ml, extensive upper abdominal procedures were necessary in 50% of cases to achieve residual disease ≤1 cm compared to those with CA-125 <500 U/ml (P=0.001) ( 24 ). A previous study evaluated a predictive score to anticipate optimal cytoreduction at interval debulking surgery ( 11 ). In that study three criteria predicted independently R>0 mm significantly at interval debulking surgery: CA125 before neoadjuvant chemotherapy >550 U/ml ( 11 ); the other criteria were age ≥ 60 years and Peritoneal Cancer Index (PCI) >16( 11 ).…”

Section: Discussionmentioning

confidence: 99%

“…A previous study evaluated a predictive score to anticipate optimal cytoreduction at interval debulking surgery ( 11 ). In that study three criteria predicted independently R>0 mm significantly at interval debulking surgery: CA125 before neoadjuvant chemotherapy >550 U/ml ( 11 ); the other criteria were age ≥ 60 years and Peritoneal Cancer Index (PCI) >16( 11 ).…”

Section: Discussionmentioning

confidence: 99%

“…Known is the greater CA125 levels the more advanced stages (10). A previous study demonstrated that a CA125 level >550 U/ml before neoadjuvant chemotherapy is an independent risk factor of suboptimal debulking at interval debulking surgery (11). Selection criteria identifying patients who will benefit from interval debulking surgery are required.…”

Section: Prognostic Relevance Of High Pretreatment Ca125mentioning

confidence: 99%

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Prognostic relevance of high pretreatment CA125 levels in primary serous ovarian cancer

Bachmann

Brucker

Stäbler³

et al. 2020

Mol Clin Oncol

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The objective of the present study was to analyze the prognostic relevance of pretreatment serum CA125 ≥500 U/ml and its role as a non-invasive factor for estimating optimal cytoreduction (≤1 cm) in primary serous ovarian cancer. Clinicopathological parameters and CA125 levels prior to primary cytoreductive surgery were retrospectively evaluated in all 261 consecutive patients with primary epithelial ovarian cancer from a single centre. Inclusion criteria were existing preoperative CA125 level, serous ovarian cancer and performed full primary treatment (surgery/platinum-based chemotherapy). A total of 136 patients met the criteria. Among them, 74 patients had CA125 ≥500 U/ml. The other 62 patients that met the aforementioned criteria and had CA125 <500 U/ml were defined as controls. The present study tested cut-off CA125 values to detect subgroups affecting prognosis. The goal was to evaluate patients with optimal cytoreduction (R≤1 cm). Univariate analyses were performed with PASW to identify clinicopathological parameters associated with the pretreatment CA125 level. For survival analyses, a cut-off-value of CA125 ≥500 U/ml was used to identify the association between preoperative CA125 levels, resection status and prognosis. To test significant differences between examined groups, Student's t-test and the Mann-Whitney test were used. P<0.05 was considered to indicate a statistically significant difference. Significantly worse prognosis in terms of overall survival (P=0.023) and progression-free survival (P=0.011) was detected in the CA125 ≥500 U/ml group of optimally cytoreduced patients compared with in the CA125 <500 U/ml group. The complete cytoreduction rate was higher in CA125 <500 U/ml (33.9%) vs. CA125 ≥500 U/ml (21.6%). A CA125 level >1,404 U/ml had a higher rate of suboptimal cytoreduction (32.4%) compared with lower CA125 levels. A pretreatment CA125 level ≥500 U/ml had significantly worse prognostic impact after optimal cytoreduction compared with CA125 <500 U/ml. The higher the CA125 level the higher the suboptimal cytoreduction rate. Patients with CA125 ≥500 U/ml may be candidates for an initial laparoscopic approach to specify resectability and to determine how to proceed. Overall, CA125 levels appear to be helpful in predicting suboptimal cytoreductive surgery for patients with primary ovarian cancer, but should be interpreted together with clinical and radiologic findings. This may improve defining the optimal treatment strategy in these patients.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Prognostic Relevance Of High Pretreatment Ca125mentioning

confidence: 99%

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Prognostic relevance of high pretreatment CA125 levels in primary serous ovarian cancer

Bachmann

Brucker

Stäbler³

et al. 2020

Mol Clin Oncol

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“…Ghisoni et al proposed a predictive model for optimal cytoreduction at IDS by utilizing parameters such as age and CA-125 levels at diagnosis. The peritoneal cancer index was assessed during laparoscopy at IDS [29]. Among those parameters, the peritoneal cancer index was the most weighed since it had the most positive predictive value of incomplete cytoreduction at IDS.…”

Section: Discussionmentioning

confidence: 99%

Nadir CA-125 serum levels during neoadjuvant chemotherapy and no residual tumor at interval debulking surgery predict prognosis in advanced stage ovarian cancer

et al. 2020

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Background: Recent phase III randomized trials have suggested that neoadjuvant chemotherapy followed by interval debulking surgery (NACT-IDS) is a treatment option for patients with advanced epithelial ovarian cancer. This study aimed to use CA-125 and computed tomography (CT) scanning to generate a simple and clinically applicable model of predicting complete cytoreduction by interval debulking surgery (IDS) and the overall survival in patients who receive taxane/platinum-based chemotherapy as neoadjuvant chemotherapy (NACT). Methods: Patients with stage IIIc or IV epithelial ovarian cancer who underwent taxane/platinum-based NACT followed by IDS in Gunma Prefectural Cancer Center, Takasaki General Medical Center, and Gunma University from April 2009 to March 2015 were included. Patients underwent a CT scan to confirm confirm tumors unresectable by standard surgery before NACT. CA-125 levels were measured pre-NACT, after each cycle of NACT, and before IDS. CT was also performed before IDS to evaluate tumor metastasis. Data were collected retrospectively and analyzed to determine the predictive factors of complete resection and overall survival. Results: Among 63 patients who received NACT-IDS, 43 and 20 patients had stages IIIc and IV epithelial ovarian cancer at diagnosis, respectively. CT predictors of residual tumors after IDS such as extra-ovarian implants (P = 0.009) and omental cakes (P = 0.038) were not present. Univariate analysis revealed that the independent factors for overall survival were no residual tumor by IDS (P = 0.0016) and CA125 ≤ 20 U/ml before IDS (P = 0.0011). Conclusions: Although this study had a small sample size, NACT-IDS used to completely remove macroscopic disease which significantly improved the prognosis of patients with preoperative CA-125 ≤ 20 U/ml. Results from this study provide useful information for future studies on the management of patients with advanced epithelial ovarian cancer.

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“…[15][16][17][18][19][20][21][22] In a recent two center study, age over 60 years, cancer antigen (CA) 125 levels >550 IU/L and peritoneal cancer index of >16 were identified as significant factors associated with suboptimal cytoreduction at interval debulking. 23 It is vital for radiologists to develop an understanding of the practices surrounding the management of patients with ovarian cancer in their own centers and deliver reports that caters to such decision-making.…”

Section: Staging Prognosis and Management Strategiesmentioning

confidence: 99%

Management Driven Structured Reporting in Ovarian Cancer

Chandramohan

Panda

Thomas

et al. 2019

Journal of Gastrointestinal and Abdominal Radiology

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Since majority (80%) of ovarian cancer patients present at an advanced stage, imaging performed on these patients have numerous findings. The combination of multiple findings on imaging, complexity of anatomical structures which are involved in ovarian cancer, and the need to perceive certain subtle imaging features which would impact management often makes it challenging to systematically review images of these patients. Similarly, it is difficult to effectively communicate these findings in radiology reports. Structured reporting that is geared toward clinical decision-making has been an area of recognized need. An understanding of the review areas, which aid clinical decision-making in a multidisciplinary team setting at our institution led us to the proposed structured reporting template for ovarian cancer. Through this review, the authors would like to share this reporting template with examples.

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A predictive score for optimal cytoreduction at interval debulking surgery in epithelial ovarian cancer: a two- centers experience

Cited by 25 publications

References 43 publications

Prognostic relevance of high pretreatment CA125 levels in primary serous ovarian cancer

Prognostic relevance of high pretreatment CA125 levels in primary serous ovarian cancer

Nadir CA-125 serum levels during neoadjuvant chemotherapy and no residual tumor at interval debulking surgery predict prognosis in advanced stage ovarian cancer

Management Driven Structured Reporting in Ovarian Cancer

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