scholarly journals Nadir CA-125 Is Prognostic for Recurrence, but Not for Survival in Patients With Ovarian Cancer

2021 ◽  
Author(s):  
Szymon Piatek ◽  
Grzegorz Panek ◽  
Zbigniew Lewandowski ◽  
Dominika Piatek ◽  
Przemyslaw Kosinski ◽  
...  
Keyword(s):  
Ovarian Cancer ◽  
Overall Survival ◽  
Neoadjuvant Chemotherapy ◽  
Proportional Hazards Model ◽  
Early Stage ◽  
Additive Models ◽  
Cox Proportional Hazards Model ◽  
Ca 125 ◽  
Early Stage Disease ◽  
Risk Of Recurrence

Abstract Objective of this study was to evaluate nadir CA-125 in patients with epithelial ovarian cancer. 168 patients, who achieved complete remission (no clinical and radiological signs, CA-125< 35 U/ml) after first line treatment were enrolled in the study. The relation between CA-125 and survival were examined using generalized additive models applied to the Cox proportional hazards model. The median CA-125 concentration after the treatment was 10 U/ml (2.7-35 U/ml). No correlation between CA-125 nadir and overall survival was found (p linear = 0.13; p nonlinear = 0.52). Patients with CA-125 serum concentrations of 11 - 25 U/ml and 26 - 35 U/ml had significantly higher risk of recurrence compared to patients with CA-125 concentration ≤ 10 U/ml with HR = 1.865 (P <0.0024) and HR = 2.17 (P <0.018), respectively. Nadir CA125 was not relevant for risk of recurrence in FIGO I and II (p=0.75 and p=0.99, respectively), neoadjuvant chemotherapy (p=0.49 and p=0.26 respectively) or bevacizumab (p=0.066 and p=0.26). Nadir CA-125 is not related to overall survival. Risk of ovarian cancer relapse increase with CA-125 nadir level. However in patients with early stage disease or those receiving neoadjuvant chemotherapy or bevacizumab may not be associated with recurrence risk.

scholarly journals Nadir CA-125 has prognostic value for recurrence, but not for survival in patients with ovarian cancer

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Szymon Piatek ◽  
Grzegorz Panek ◽  
Zbigniew Lewandowski ◽  
Dominika Piatek ◽  
Przemyslaw Kosinski ◽  
...  
Keyword(s):  
Ovarian Cancer ◽  
Proportional Hazards Model ◽  
Early Stage ◽  
Cox Proportional Hazards ◽  
Additive Models ◽  
Cox Proportional Hazards Model ◽  
Ca 125 ◽  
Early Stage Disease ◽  
Risk Of Recurrence ◽  
Increased Risk

AbstractThe objective of this study was to evaluate the nadir CA-125 in patients with epithelial ovarian cancer. A total of 168 patients who achieved complete remission (no clinical and radiological signs, CA-125 ≤ 35 U/ml) after first-line treatment were enrolled in the study. The relationship between CA-125 and survival was examined by applying generalized additive models to the Cox proportional hazards model. The median CA-125 concentration after the treatment was 10 U/ml (2.7–35 U/ml). The nadir CA-125 was related to progression-free survival but not to overall survival. The risk of recurrence in patients with 11–25 U/ml and 26–35 U/ml compared to patients with ≤ 10 U/ml was 1.87 (p < 0.0024) and 2.17 (p < 0.018), respectively. An increased risk of recurrence according to the nadir CA-125 (≤ 10 U/ml vs. 11–25 U/ml and ≤ 10 U/ml vs. 26–35 U/ml) was found in patients with high-grade tumours (hazard ratio, HR = 2.08 and 2.59, respectively), advanced disease (HR = 2.38 and 2.03, respectively), serous histology (HR = 2.08 and 2.43, respectively) and after complete cytoreduction (HR = 2.7 and 2.72, respectively). No correlation between the CA-125 nadir and recurrence risk was found in patients with early-stage disease or those receiving neoadjuvant chemotherapy or bevacizumab.

Prognostic nomogram and index for overall survival in previously untreated patients with chronic lymphocytic leukemia

Blood ◽  
2007 ◽  
Vol 109 (11) ◽  
pp. 4679-4685 ◽  
Author(s):  
William G. Wierda ◽  
Susan O'Brien ◽  
Xuemei Wang ◽  
Stefan Faderl ◽  
Alessandra Ferrajoli ◽  
...  
Keyword(s):  
Overall Survival ◽  
Chronic Lymphocytic Leukemia ◽  
Prognostic Model ◽  
Clinical Decision Making ◽  
Early Stage ◽  
Lymphocytic Leukemia ◽  
Cox Proportional Hazards Model ◽  
Cancer Center ◽  
Early Stage Disease ◽  
Staging Systems

Abstract The clinical course for patients with chronic lymphocytic leukemia is extremely heterogeneous. The Rai and Binet staging systems have been used to risk-stratify patients; most patients present with early-stage disease. We evaluated a group of previously untreated patients with chronic lymphocytic leukemia (CLL) at initial presentation to University of Texas M. D. Anderson Cancer Center to identify independent characteristics that predict for overall survival. Clinical and routine laboratory characteristics for 1674 previously untreated patients who presented for evaluation of CLL from 1981 to 2004 were included. Univariate and multivariate analyses identified several patient characteristics at presentation that predicted for overall survival in previously untreated patients with CLL. A multivariate Cox proportional hazards model was developed, including the following independent characteristics: age, β-2 microglobulin, absolute lymphocyte count, sex, Rai stage, and number of involved lymph node groups. Inclusion of patients from a single institution and the proportion of patients younger than 65 years may limit this model. A weighted prognostic model, or nomogram, predictive for overall survival was constructed using these 6 characteristics for 5- and 10-year survival probability and estimated median survival time. This prognostic model may help patients and clinicians in clinical decision making as well as in clinical research and clinical trial design.

scholarly journals Role of PET/CT in Assessment of Recurrent Ovarian Tumors

QJM ◽  
2020 ◽  
Vol 113 (Supplement_1) ◽  
Author(s):  
S Kadry ◽  
A Haggag ◽  
A Ekbal
Keyword(s):  
Ovarian Cancer ◽  
Tumor Marker ◽  
Early Stage ◽  
Ovarian Tumors ◽  
University Hospital ◽  
Ca 125 ◽  
Early Stage Disease ◽  
Major Health Problem ◽  
Pet Ct ◽  
Suspected Recurrence

Abstract Background Ovarian cancer remains a major health problem worldwide, with over 225,000 new cases and 140,000 deaths reported annually. Despite high response after initial treatment, 20-30% of patients with early-stage disease and up to 75% of patients with advanced disease present with recurrence within two years. Early diagnosis of recurrence is crucial for determination of the best treatment. Aim of the Work is to detect the significance of PET/CT in the early detection of recurrent ovarian tumors. Patients and Method The study included 25 patients who have been diagnosed with ovarian cancer, received treatment and achieved complete response. All of the 25 patients had suspected recurrence either due to elevated tumor markers or suspicious clinical findings. The 25 patients have been referred for PET/CT scan at ElDemerdash university hospital from July 2017 to August 2018. Results Total of 25 patients were included in the study. 18 of 25 patients had high tumor marker (CA 125) level. The remaining 7 patients had suspected recurrence with normal tumor marker levels. Recurrence was confirmed by histopathology or clinical and imaging follow up in 19 patients of the 25 patients. Recurrent disease was not shown in 5 of 19 patients on CECT imaging and 1 of 19 patients on PET/CT imaging. PET/CT had a sensitivity of (94.74%), specificity of (100%) and accuracy of (96%). CECT has been reported with sensitivity of (73.68), specificity of (83.33%) and accuracy of (76%). Conclusion PET/CT is a useful tool and has a higher sensitivity, specificity and accuracy than CECT in detection of recurrent ovarian cancer.

Effect of metformin on recurrence-free survival and overall survival in diabetic patients affected by advanced ovarian cancer.

2013 ◽  
Vol 31 (15_suppl) ◽  
pp. 5522-5522 ◽  
Author(s):  
Cecilia Simonelli ◽  
Monica Bertolotti ◽  
Paul Sabbatini ◽  
Jonathan S. Berek ◽  
Jacobus Pfisterer ◽  
...  
Keyword(s):  
Ovarian Cancer ◽  
Overall Survival ◽  
Prognostic Factors ◽  
Proportional Hazards Model ◽  
Advanced Ovarian Cancer ◽  
Cox Proportional Hazards Model ◽  
Diabetic Patients ◽  
Recurrence Free Survival ◽  
Double Blind ◽  
Free Survival

5522^ Background: Metformin, has recently shown some anti-cancer activities in ovarian cancer, both in vitro and in vivo. Methods: Analysis of Recurrence Free Survival (RFS) and Overall Survival (OS) was performed in patients (pts) with diabetes (D) treated with metformin (DMet+) or not (DMet-) enrolled in the MIMOSA trial, a randomized double-blind placebo-controlled international trial of Abagovomab maintenance therapy in 888 pts with advanced ovarian cancer. In the MIMOSA trial, no differences in the RFS and OS were observed between Abagovomab (n = 593) and Placebo arm (n = 295); hence, the present RFS and OS analysis (DMet+ vs DMet-) was run regardless of treatment allocation. A Cox proportional hazards model was used for adjusting the analysis for the predefined prognostic factors: Figo stage (III, IV), tumor size after debulking (residual tumor <1 cm, >1cm); CA125 serum level after 3th cycle (<35U/ml, >35U/ml). In addition, comparison of RFS and OS was done between DMet+and the overall MIMOSA population not exposed to metformin (ALLMet-), and between the overall diabetic pts (ALLD+) and non-diabetic pts (ALLD-). Results: In the ALL population (n = 888), 42 pts were affected by diabetes (ALLD+) divided to DMet+ (n = 27) and DMet- (n = 15), without difference in the prognostic factors distribution. When analysis was done in ALLD+, RFS median time was not reached in the DMet+ group whereas it was 328 days [CI: 30-660] in DMet- group with HR favoring DMet+=0.419 [CI:0.175-1.002]; p = 0.05. Median OS time was also not reached in the DMet+ group whereas it was 786 days [CI:262-NE] in DMet- group with HR=0.295 [CI:0.109-0.803]; p = 0.02. Interestingly HR for RFS time was still in favour of DMet+ group when compared to the ALLMet- (n=861) with HR=0.575 (CI=0.324-1.022); p = 0.06. When ALLD+ were compared with ALLD-(n = 846), no significant differences was detected in RFS and OS time. Conclusions: The present results are the first prospectively analyzed data demonstrating a favourable impact of metformin treatment on RFS and OS in pts affected by advanced ovarian cancer. Clinical trial information: NCT00418574.

scholarly journals Causes of death and effect of non-cancer-specific death on rates of overall survival in adult classic Hodgkin lymphoma: a populated-based competing risk analysis

BMC Cancer ◽  
2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Jie Gao ◽  
Yingying Chen ◽  
Pengqiang Wu ◽  
Fujue Wang ◽  
Huan Tao ◽  
...  
Keyword(s):  
Overall Survival ◽  
Proportional Hazards ◽  
Proportional Hazards Model ◽  
Risk Model ◽  
Early Stage ◽  
Cox Proportional Hazards ◽  
Cox Proportional Hazards Model ◽  
Competing Risk ◽  
Hazards Model ◽  
Classic Hodgkin Lymphoma

Abstract Background The improved prognosis of classic Hodgkin lymphoma (cHL) has been accompanied by elevated risks of non–cancer-specific death (non-CSD). The aim of this study was to verify the occurrence of non-CSD and its effect on rates of overall survival among adult patients with cHL. Methods To ensure sufficient follow-up time, we analyzed retrospective data from patients aged ≥20 years with cHL that was diagnosed between 1983 and 2005 in the Surveillance, Epidemiology, and End Results (SEER) database. Logistic regression was applied to analyze the non-CSD occurrence in relation to all factors. Using Fine-Gray’s method, we calculated the cumulative incidences of CSD and non-CSD. Stacked cumulative incidence plots and ratio of non-CSD to all causes of death were applied to evaluate the effect of non-CSD on rates of overall survival. Finally, we analyzed long-term mortality through Cox proportional hazard regression analysis and competing risk regression analysis to emphasize a more appropriate model of survival for patients with cHL. Results Among the 18,518 patients included, there were 3768 cases of CSD (20.3%) and 3217 of non-CSD (17.4%). Older age, earlier period, male sex, unmarried status, mixed cellularity (MC) and lymphocyte-depletion (LD) histological subtype, and patients received radiotherapy (RT) only were associated with more non-CSD according to binary logistic analysis. The cumulative incidence of non-CSD exceeded CSD after approximately 280 months follow-up. The most common causes of non-CSDs were cardiovascular disease, subsequent primary neoplasms, infectious diseases, accidents, and suicide. In a Cox proportional hazards model, patients who were black, unmarried, at an advanced stage or underwent chemotherapy (CT) alone were at greater risk of mortality than were white patients, who were married, at an early stage, and underwent combined modality; these populations were also found to be at greater risk for CSD in a competing risk model, but the risk of non-CSD did not differ significantly according to race and marital status, patients with early-stage disease and who underwent RT only were found to be at higher risk of non-CSD instead. Conclusions Lymphoma was the cause of death in most patients who died, but non-CSD was not unusual. Patients with cHL should be monitored closely for signs of cardiovascular disease and malignant tumors. Rates of overall survival of patients were diminished by non-CSD, and a competing risk model was more suitable for establishing the prognosis than was the Cox proportional hazards model.

Stem-like markers in the circulating tumor cells assessment in ovarian cancer.

2021 ◽  
Vol 39 (15_suppl) ◽  
pp. e17542-e17542
Author(s):  
Snezhanna Gening ◽  
Tatyana Abakumova ◽  
Inna Antoneeva ◽  
Tatyana Gening
Keyword(s):  
Ovarian Cancer ◽  
Tumor Cells ◽  
Circulating Tumor Cells ◽  
Proportional Hazards ◽  
Proportional Hazards Model ◽  
Cox Regression ◽  
Cox Proportional Hazards ◽  
Cox Proportional Hazards Model ◽  
Ca 125 ◽  
Blood Samples

e17542 Background: Circulating tumor cells (CTCs) are a potential source of dissemination and relapse in ovarian cancer (OC). Stem cell properties can provide a survival advantage for CTCs. The clinical significance of stem-like CTCs in OC remains to be studied. We aimed to assess the quantities of the stem, epithelial, mesenchymal CTCs and their relationships with the clinical parameters in the OC. Methods: Peripheral blood samples (7.5 ml) were obtained from patients with primary epithelial OC before treatment. CTCs were isolated by flow cytometry (Cytoflex S (Beckman Coulter, USA)) using antibodies to CD45 (BioLegend, USA); CD44 (BioLegend, USA), CD133 (Miltenyi biotec, Germany), ALDH (Stemcell, Canada) to detect the stem markers; EpCAM (BioLegend, USA), cytokeratins 8, 18 (Abcam plc., UK), vimentin (BioLegend, USA) for epithelial and mesenchymal markers. Blood samples from patients with benign ovarian tumors served as a control. Informed voluntary consent was obtained from all the women. Statistical processing included Mann-Whitney U-test, linear regression, Cox proportional hazards model for progression-free survival (PFS) (Statistica 13.0 (TIBCO, USA)). Results: The study included 30 patients, median age 64 (34-76) years. 15 patients had a FIGO stage IV, 12 - stage III, 1 – stage II and 1 – stage I. The content of CTCs populations is presented in the table. The CTCs counts did not differ depending on age, platelet count, and stage 3 or 4. The amount of CD45-CK+Vim- was higher in the presence of ascites (p = 0.035). We found a regression relationship between the serum CA-125 and the number of CD45-CD44+CD133+ (R2= 0.220, p = 0.016); the leukocyte count in blood and CD45-CD44+ALDHhigh (R2= 0.234, p = 0.017); the number of CD45-Vim+ and CD45-CD44+CD133+ALDH+ (R2= 0.305, p = 0.014); CD45-CK-Vim+ and CD45-EpCAM+CK+ (R2= 0.717, p < 0.001). The Cox regression model for PFS included the number of CD45-CD44+CD133+ALDH+ (HR 1.51 95% CI 1.01-2.24 p = 0.043) and the cytoreductive surgery performance (HR 0.09 95% CI 0.01-0.89 p = 0.039) during the first line of treatment. Conclusions: Various populations of circulating tumor cells coexist in ovarian cancer patients. The use of a combination of stem markers in the CTCs detection can increase their prognostic value in OC. This work was supported by the RFBR grant No. 19-315-90011.[Table: see text]

Predictive factors of cytoreductive surgery in epithelial ovarian cancer in a Mexican women cohort.

2019 ◽  
Vol 37 (15_suppl) ◽  
pp. e17099-e17099
Author(s):  
Flavia Morales Vasquez ◽  
Ricardo Raziel Peña Gonzalez ◽  
Horacio Noé López Basave
Keyword(s):  
Ovarian Cancer ◽  
Cytoreductive Surgery ◽  
Proportional Hazards ◽  
Proportional Hazards Model ◽  
Cox Proportional Hazards ◽  
Cox Proportional Hazards Model ◽  
Ca 125 ◽  
Mexican Women ◽  
Hazards Model ◽  
Optimal Debulking

e17099 Background: Cytoreductive surgery is the most important prognostic factor in ovarian cancer. To identify in a timely manner the patients who are not candidates for optimal debulking, does not delay and optimize the treatment. Objetive: Identify the presurgical factors that characterize patients in whom optimal cytoreduction is not possible. Methods: Observational study in a retrospective cohort (n = 255) that compared pre-surgical factors between patients with optimal debulking (n = 65) and suboptimal (n = 190). Non-parametric tests were used, a Cox proportional hazards model was constructed and survival curves were drawn by method of Kaplan y Meier. Results: 255 patients were included. 75% achieved optimal debulking. 9 out of 10 evaluated tomography criteria showed association (p < 0.001) with suboptimal cytoreduction. The best cut-off value of Ca-125 to predict suboptimal surgery was 774 IU / mL. Only clinical ascites showed association with the result of the surgery (p < 0.001). There was no difference in complications between both groups (p = 0.267). The rate of optimal debulking has improved over time (p = 0.049). The turn of the surgeries has no impact on the overall survival of the patients (p = 0.792). Conclusions: Objective parameters (tomography and laboratory) should be used to select patients who are not candidates for surgery. The Clinical evaluation without objective parameters is not enough

Preoperative Sensitivity and Specificity for Early-Stage Ovarian Cancer When Combining Cancer Antigen CA-125II, CA 15-3, CA 72-4, and Macrophage Colony-Stimulating Factor Using Mixtures of Multivariate Normal Distributions

2004 ◽  
Vol 22 (20) ◽  
pp. 4059-4066 ◽  
Author(s):  
Steven J. Skates ◽  
Nora Horick ◽  
Yinhua Yu ◽  
Feng-Ji Xu ◽  
Andrew Berchuck ◽  
...  
Keyword(s):  
Ovarian Cancer ◽  
Early Stage ◽  
Ca 125 ◽  
Early Stage Disease ◽  
Stage Disease ◽  
Macrophage Colony Stimulating Factor ◽  
Macrophage Colony ◽  
Screening Sensitivity ◽  
Stimulating Factor ◽  
Combining Information

Purpose In CA-125–based ovarian cancer screening trials, overall specificity and screening sensitivity of ultrasound after an elevated CA-125 exceeded 99.6% and 70%, respectively, thereby yielding a positive predictive value (PPV) exceeding 10%. However, sensitivity for early-stage disease was only 40%. This study aims to increase preoperative sensitivity for early-stage ovarian cancer while maintaining the annual referral rate to ultrasound at 2% by combining information across CA-125II, CA 15-3, CA 72-4, and macrophage colony-stimulating factor (M-CSF). For direct comparisons between marker panels, all sensitivity results correspond to a 98% fixed first-line specificity (referral rate 2%). Patients and Methods Logistic regression, classification tree, and mixture discriminant analysis (MDA) models were fit to a training data set of preoperative serum measurements (63 patients, 126 healthy controls) from one center. Estimates from the training set applied to an independent validation set (60 stage I to II patients, 98 healthy controls) from two other centers provided unbiased estimates of sensitivity. Results Preoperative sensitivities for early-stage disease of the optimal panels were 45% for CA-125II; 67% for CA-125II and CA 72-4; 70% for CA-125II, CA 72-4, and M-CSF; and 68% for all four markers (latter two results using MDA). Conclusion Efficiently combining information on CA-125II, CA 72-4, and M-CSF significantly increased preoperative early-stage sensitivity from 45% with CA-125II alone to 70%, while maintaining 98% first-line specificity. Screening trials with these markers using MDA followed by referral to ultrasound may maintain previously high levels of specificity and PPV, while significantly increasing early-stage screening sensitivity. MDA is a useful, biologically justified method for combining biomarkers.

The Role of CA 125 in Screening for Ovarian Cancer

1998 ◽  
Vol 13 (4) ◽  
pp. 216-220 ◽  
Author(s):  
A.N. Rosenthal ◽  
I.J. Jacobs
Keyword(s):  
Ovarian Cancer ◽  
Early Stage ◽  
Survival Rates ◽  
Ca 125 ◽  
Early Stage Disease ◽  
Mathematical Algorithm ◽  
Gynaecological Malignancy ◽  
Stage Disease ◽  
Screening Strategies ◽  
Randomised Controlled

Ovarian cancer has the worst prognosis of any gynaecological malignancy, primarily because it tends to present at an advanced stage. The excellent survival rates of early stage disease have provided the rationale for efforts to detect ovarian cancer early by screening, in the hope that survival rates will be improved. Available data suggests that CA 125 is elevated in the majority of epithelial ovarian malignancies prior to clinical presentation. Large trials of screening for ovarian cancer indicate that using a CA 125 cutoff value of 30 U/mL has good sensitivity, but inadequate specificity for detecting preclinical disease. Use of transvaginal ultrasonography as a second-line test in women with elevated CA 125 levels improves specificity to acceptable levels, as does use of a mathematical algorithm which analyses rates of change of CA 125. Two major randomised controlled trials, investigating the effect of screening strategies incorporating CA 125 on mortality, are currently underway.

scholarly journals Overexpression of long noncoding RNA PTPRG-AS1 is associated with poor prognosis in epithelial ovarian cancer

2020 ◽  
Vol 66 (7) ◽  
pp. 948-953
Author(s):  
Xue-Ying Ren ◽  
Wei-Bin Yang ◽  
Yun Tian
Keyword(s):  
Ovarian Cancer ◽  
Overall Survival ◽  
Epithelial Ovarian Cancer ◽  
Noncoding Rna ◽  
Proportional Hazards Model ◽  
Critical Role ◽  
Disease Free Survival ◽  
Cox Proportional Hazards Model ◽  
Free Survival ◽  
Disease Free

SUMMARY OBJECTIVE Long noncoding RNAs (lncRNAs) have been shown to play a critical role in tumor progression. Abnormal expression of LncRNA PTPRG antisense RNA 1 (PTPRG-AS1) has been reported in several tumors. Hence, we aimed to determine the expression and clinical significance of PTPRG-AS1 in epithelial ovarian cancer (EOC) patients. METHODS The expressions of PTPRG-AS1 were assessed in 184 pairs of EOC tumor specimens and adjacent normal tissues. The levels of target lncRNAs and GAPDH were examined using standard SYBR-Green methods. The relationships between the expressions of PTPRG-AS1 and the clinicopathological features were analyzed using the chi-square test. Multivariate analysis using the Cox proportional hazards model was performed to assess the prognostic value of PTPRG-AS1 in EOC patients. RESULTS We confirmed that the expressions of PTPRG-AS1 were distinctly higher in the EOC tissue compared with the adjacent non-tumor specimens (p < 0.01). Higher levels of PTPRG-AS1 in EOC patients were associated with advanced FIGO stage (p = 0.005), grade (p = 0.006), and distant metastasis (p = 0.005). Survival analyses revealed that patients with high expressions of PTPRG-AS1 had a distinctly decreased overall survival (p = 0.0029) and disease-free survival (p = 0.0009) compared with those with low expressions of PTPRG-AS1. Multivariate assays indicated that PTPRG-AS1 expression was an independent prognostic factor for both overall survival and disease-free survival in EOC (Both p < 0.05). CONCLUSIONS Our study suggests that PTPRG-AS1 may serve as a novel prognostic biomarker for EOC patients.

Sign in / Sign up

Export Citation Format

Share Document