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

Abstract

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.

Preoperative Cancer Antigen 125 Level as Predictor for Complete Cytoreduction in Ovarian Cancer: A Prospective Cohort Study and Systematic Review

“…The QUIPS quality assessment outcomes of the included studies are reported in Supporting Information Supplementary Table S3 . Generally, the risk of bias was low for most studies [ 8 , 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 ]. The risk of bias was moderate for only three studies [ 25 , 26 , 27 ].…”

“…Two studies were prospective cohort studies [ 15 , 25 ]; the other twelve studies were retrospective cohort studies [ 8 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 26 , 27 ]. Four out of 14 studies reported the results of patients who underwent primary CRS [ 15 , 16 , 17 , 25 ], and nine studies reported the results of patients who underwent interval CRS [ 8 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 26 ]. One study reported patients undergoing either primary or interval CRS [ 27 ].…”

“…Five studies reported a significant relation between lower preoperative CA-125 levels and a complete CRS rate after interval CRS [ 21 , 22 , 24 , 26 , 27 ]. Matsuhashi et al reported a significant relation between lower preoperative CA-125 levels and complete/optimal CRS ( p = 0.003) [ 19 ].…”

“…The results of our systematic review indicated a significant relation between lower preoperative level of CA-125 and complete CRS in patients who underwent an interval CRS [ 8 , 18 , 19 , 21 , 22 , 24 , 26 , 27 ]. Studies of patients who underwent a primary CRS demonstrated an inconsistent correlation between the CA-215 level and surgical outcome [ 15 , 16 , 17 , 25 , 27 ].…”

Impact of prehabilitation during neoadjuvant chemotherapy and interval cytoreductive surgery on ovarian cancer patients: a pilot study

“…Primary treatment consists of optimal primary cytoreductive surgery followed by systemic chemotherapy. In patients unsuitable for primary cytoreductive surgery due to advanced age, frailty, poor performance status, comorbidities, or disease that is unlikely to be optimally cytoreduced, neoadjuvant chemotherapy (NACT) followed by interval cytoreductive surgery should be considered [ 2 , 3 ]. Therefore, cytoreductive surgery after NACT is often undertaken in patients who are physically, nutritionally, and/or psychologically affected.…”