Role of surgical outcome as prognostic factor in advanced epithelial ovarian cancer: A combined exploratory analysis of 3 prospectively randomized phase 3 multicenter trials

Bois, Andreas du; Reuß, Alexander; Pujade-Lauraine, Éric; Harter, Philipp; Ray‐Coquard, Isabelle; Pfisterer, Jacobus

doi:10.1002/cncr.24149

Cited by 1,318 publications

(491 citation statements)

References 93 publications

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“…Therapeutic options for this advanced disease (International Federation of Gynecology and Obstetrics, FIGO stage IIB–IV) are either primary debulking surgery followed by adjuvant chemotherapy or induction chemotherapy followed by interval debulking surgery. The outcome of debulking surgery is by far the most important prognostic factor for patients with advanced ovarian cancer, and surgery should always be aimed at achieving complete removal of macroscopic tumour 2, 3. At the same time, recent investigations have led to the discovery that skeletal muscle area (SMA) changes detected on computed tomography (CT) may be closely related to ovarian cancer survival as well 4, 5.…”

Section: Introductionmentioning

confidence: 99%

Psoas muscle area is not representative of total skeletal muscle area in the assessment of sarcopenia in ovarian cancer

Rutten

Ubachs

Kruitwagen

et al. 2017

J cachexia sarcopenia muscle

163

133

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BackgroundComputed tomography measurements of total skeletal muscle area can detect changes and predict overall survival (OS) in patients with advanced ovarian cancer. This study investigates whether assessment of psoas muscle area reflects total muscle area and can be used to assess sarcopenia in ovarian cancer patients.MethodsOvarian cancer patients (n = 150) treated with induction chemotherapy and interval debulking were enrolled retrospectively in this longitudinal study. Muscle was measured cross sectionally with computed tomography in three ways: (i) software quantification of total skeletal muscle area (SMA); (ii) software quantification of psoas muscle area (PA); and (iii) manual measurement of length and width of the psoas muscle to derive the psoas surface area (PLW). Pearson correlation between the different methods was studied. Patients were divided into two groups based on the extent of change in muscle area, and agreement was measured with kappa coefficients. Cox‐regression was used to test predictors for OS.ResultsCorrelation between SMA and both psoas muscle area measurements was poor (r = 0.52 and 0.39 for PA and PLW, respectively). After categorizing patients into muscle loss or gain, kappa agreement was also poor for all comparisons (all κ < 0.40). In regression analysis, SMA loss was predictive of poor OS (hazard ratio 1.698 (95%CI 1.038–2.778), P = 0.035). No relationship with OS was seen for PA or PLW loss.ConclusionsChange in psoas muscle area is not representative of total muscle area change and should not be used to substitute total skeletal muscle to predict survival in patients with ovarian cancer.

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Section: Introductionmentioning

confidence: 99%

Psoas muscle area is not representative of total skeletal muscle area in the assessment of sarcopenia in ovarian cancer

Rutten

Ubachs

Kruitwagen

et al. 2017

J cachexia sarcopenia muscle

163

133

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“…3 Age, FIGO stage, residual tumor in debulking surgery and platinum sensitivity are the most important prognostic factors in EOC. 1,4 The serum tumor marker CA125 and computed tomography (CT) imaging are currently used for primary therapy response evaluation in EOC. 5,6 CA125 is a MUC16 gene coded glycoprotein, which is physiologically expressed in pleural surface, airway epithelium, lacrimal glands, endometrium, and endocervix.…”

Section: Introductionmentioning

confidence: 99%

Postoperative human epididymis protein 4 predicts primary therapy outcome in advanced epithelial ovarian cancer

et al. 2017

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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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“…This is consistent with results from recent studies identifying this histological subtype as an adverse prognostic feature irrespective of other important factors, such as surgical outcome. 16 Again, differences in molecular profile could, at least partially, explain this striking difference. P53 mutations are rare in mucinous histotypes, suggesting that the combination of a taxane with carboplatin or cisplatin may be inadequate, as outlined above.…”

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confidence: 99%

Mucinous but not clear cell histology is associated with inferior survival in patients with advanced stage ovarian carcinoma treated with platinum‐paclitaxel chemotherapy

Bamias

Ψαλτοπούλου

Sotiropoulou

et al. 2010

Cancer

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BACKGROUND: Mucinous and clear cell histology have been associated with adverse prognosis in ovarian carcinomas. The authors compared the outcome of these subtypes with that of serous tumors in patients who were treated with combination paclitaxel/platinum at their center. METHODS: Four hundred twenty patients with histologically confirmed, serous (n ¼ 367), mucinous (n ¼ 24), or clear cell (n ¼ 29) ovarian carcinomas, International Federation of Gynecology and Obstetrics stage III or IV disease, and who were treated with paclitaxel/platinum after cytoreductive surgery were included in this analysis. RESULTS: The median overall survival for each histological subtype was 47.7 months (95% confidence interval [CI], 37.7-57.7 months) for serous, 15.4 months (95% CI, 4.2-26.6 months) for mucinous, and 36.6 months (95% CI, 22.7-50.5 months) for clear cell carcinomas. Cox regression analysis showed that mucinous histology was an independent predictor of poor prognosis compared with serous tumors (hazard ratio, 0.360; 95% CI, 0.215-0.603; P ¼ .001). In contrast, such a difference between clear cell and serous carcinomas was not found (P ¼ .337). Median survival of patients with mucinous tumors and residual disease >2 cm was poor, averaging 7.1 months (95% CI, 4.6-9.6 months). CONCLUSIONS: Mucinous but not clear cell histology is associated with significantly worse prognosis in advanced ovarian cancer treated with combination platinum/paclitaxel. Different therapeutic strategies should be studied in this entity.

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Role of surgical outcome as prognostic factor in advanced epithelial ovarian cancer: A combined exploratory analysis of 3 prospectively randomized phase 3 multicenter trials

Abstract: BACKGROUND: Primary surgery followed by platinum-taxane based chemotherapy has been the standard therapy in advanced ovarian cancer. However, the prognostic role of complete and so-called optimal and

Cited by 1,318 publications

References 93 publications

Psoas muscle area is not representative of total skeletal muscle area in the assessment of sarcopenia in ovarian cancer

Psoas muscle area is not representative of total skeletal muscle area in the assessment of sarcopenia in ovarian cancer

Postoperative human epididymis protein 4 predicts primary therapy outcome in advanced epithelial ovarian cancer

Mucinous but not clear cell histology is associated with inferior survival in patients with advanced stage ovarian carcinoma treated with platinum‐paclitaxel chemotherapy

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