scholarly journals Development and Validation of a Nomogram Based on CA125 Levels for Predicting Progression-Free Survival in Patients with Ovarian Cancer

2020 ◽  
Author(s):  
Minjun He ◽  
Chuanbo Xie ◽  
Jun Huang ◽  
Wei Wei ◽  
Yin Wang ◽  
...  
Keyword(s):  
Ovarian Cancer ◽  
External Validation ◽  
Progression Free Survival ◽  
Staging System ◽  
Curve Analysis ◽  
Discriminative Ability ◽  
Decision Curve Analysis ◽  
Free Survival ◽  
Figo Staging ◽  
Gynecology And Obstetrics

Abstract Background We aimed to develop and validate a nomogram incorporating CA125 levels after three cycles of chemotherapy for predicting progression-free survival (PFS) in patients with ovarian cancer.Methods The nomogram was developed in a primary cohort of 491 patients with stage II-IV ovarian cancer. Performance was assessed by concordance index (C-index), calibration curve, and decision curve analysis, and compared with the International Federation of Gynecology and Obstetrics (FIGO) staging system. The predictive value of CA125 levels after three cycles of chemotherapy was evaluated. The model was subjected to bootstrap internal validation. An independent cohort of 81 patients was used for external validation.Results CA125 levels after three cycles of chemotherapy were significantly associated with PFS. Five variables, including CA125 levels were selected to develop the nomogram. The nomogram demonstrated adequate discrimination, with a bootstrap-corrected C-index of 0.708, and good calibration. External validation of the nomogram achieved excellent discrimination (C-index, 0.724) and calibration. CA125 levels after three adjuvant chemotherapy cycles showed a marginally significant increment of discrimination to the nomogram in the primary cohort (C-index, 0.708 vs 0.668; P = 0.097). Superior discriminative ability was observed in the nomogram when compared with the FIGO staging system only in the primary cohort (C-index, 0.708 vs 0.578; P < 0.001). Decision curve analysis demonstrated that our nomogram was clinically useful.Conclusion We developed and validated a nomogram incorporating CA125 levels after three chemotherapy cycles for PFS prediction in ovarian cancer. This nomogram showed well-predictive performance and easy clinical application.

scholarly journals Development and Validation of a Nomogram Based on CA125 Levels for Predicting Progression-free Survival in Patients with Ovarian Cancer

2021 ◽  
Author(s):  
Minjun He ◽  
Hongyu Peng ◽  
Zhifeng Liu ◽  
Quanyang Gao
Keyword(s):  
Ovarian Cancer ◽  
External Validation ◽  
Progression Free Survival ◽  
Staging System ◽  
Curve Analysis ◽  
Discriminative Ability ◽  
Decision Curve Analysis ◽  
Free Survival ◽  
Figo Staging ◽  
Gynecology And Obstetrics

Abstract Background Ovarian cancer is the leading cause of death in patients with gynecological cancers, and it has very low survival. CA125 have been shown to be an important prognostic factor for PFS, Therefore, we aimed to develop and validate a nomogram incorporating CA125 levels after three cycles of chemotherapy for predicting progression-free survival (PFS) in patients with ovarian cancer.Methods The nomogram was developed in a primary cohort of 491 patients with stage II-IV ovarian cancer. Performance was assessed by concordance index (C-index), calibration curve, and decision curve analysis, and compared with the International Federation of Gynecology and Obstetrics (FIGO) staging system. The predictive value of CA125 levels after three cycles of chemotherapy was evaluated. The model was subjected to bootstrap internal validation. An independent cohort of 81 patients was used for external validation.Results CA125 levels after three cycles of chemotherapy were significantly associated with PFS. Five variables, including CA125 levels were selected to develop the nomogram. The nomogram demonstrated adequate discrimination, with a bootstrap-corrected C-index of 0.708, and good calibration. External validation of the nomogram achieved excellent discrimination (C-index, 0.724) and calibration. CA125 levels after three adjuvant chemotherapy cycles showed a marginally significant increment of discrimination to the nomogram in the primary cohort (C-index, 0.708 vs 0.668; P = 0.097). Superior discriminative ability was observed in the nomogram when compared with the FIGO staging system only in the primary cohort (C-index, 0.708 vs 0.578; P < 0.001). Decision curve analysis demonstrated that our nomogram was clinically useful.Conclusion We developed and validated a nomogram incorporating CA125 levels after three chemotherapy cycles for PFS prediction in ovarian cancer. This nomogram showed well-predictive performance and easy clinical application.

scholarly journals Development and Validation of a Nomogram Based on CA125 Levels for Predicting Progression-free Survival in Patients with Ovarian Cancer

2021 ◽  
Author(s):  
Minjun He ◽  
Hongyu Peng ◽  
Zhifeng Liu ◽  
Quanyang Gao
Keyword(s):  
Ovarian Cancer ◽  
External Validation ◽  
Progression Free Survival ◽  
Staging System ◽  
Curve Analysis ◽  
Discriminative Ability ◽  
Decision Curve Analysis ◽  
Free Survival ◽  
Figo Staging ◽  
Gynecology And Obstetrics

Abstract Background Ovarian cancer is the leading cause of death in patients with gynecological cancers, and it has very low survival. CA125 have been shown to be an important prognostic factor for PFS, Therefore, we aimed to develop and validate a nomogram incorporating CA125 levels after three cycles of chemotherapy for predicting progression-free survival (PFS) in patients with ovarian cancer.Methods The nomogram was developed in a primary cohort of 491 patients with stage II-IV ovarian cancer. Performance was assessed by concordance index (C-index), calibration curve, and decision curve analysis, and compared with the International Federation of Gynecology and Obstetrics (FIGO) staging system. The predictive value of CA125 levels after three cycles of chemotherapy was evaluated. The model was subjected to bootstrap internal validation. An independent cohort of 81 patients was used for external validation.Results CA125 levels after three cycles of chemotherapy were significantly associated with PFS. Five variables, including CA125 levels were selected to develop the nomogram. The nomogram demonstrated adequate discrimination, with a bootstrap-corrected C-index of 0.708, and good calibration. External validation of the nomogram achieved excellent discrimination (C-index, 0.724) and calibration. CA125 levels after three adjuvant chemotherapy cycles showed a marginally significant increment of discrimination to the nomogram in the primary cohort (C-index, 0.708 vs 0.668; P = 0.097). Superior discriminative ability was observed in the nomogram when compared with the FIGO staging system only in the primary cohort (C-index, 0.708 vs 0.578; P < 0.001). Decision curve analysis demonstrated that our nomogram was clinically useful.Conclusion We developed and validated a nomogram incorporating CA125 levels after three chemotherapy cycles for PFS prediction in ovarian cancer. This nomogram showed well-predictive performance and easy clinical application.

scholarly journals Clinical Utility of a Nomogram for Predicting 30-Days Poor Outcome in Hospitalized Patients With COVID-19: Multicenter External Validation and Decision Curve Analysis

2020 ◽  
Vol 7 ◽  
Author(s):  
Bin Zhang ◽  
Qin Liu ◽  
Xiao Zhang ◽  
Shuyi Liu ◽  
Weiqi Chen ◽  
...  
Keyword(s):  
Prognostic Factors ◽  
Clinical Utility ◽  
Predictive Accuracy ◽  
Fasting Blood Glucose ◽  
External Validation ◽  
Predictive Performance ◽  
Curve Analysis ◽  
Discriminative Ability ◽  
Decision Curve Analysis ◽  
Poor Outcome

Aim: Early detection of coronavirus disease 2019 (COVID-19) patients who are likely to develop worse outcomes is of great importance, which may help select patients at risk of rapid deterioration who should require high-level monitoring and more aggressive treatment. We aimed to develop and validate a nomogram for predicting 30-days poor outcome of patients with COVID-19.Methods: The prediction model was developed in a primary cohort consisting of 233 patients with laboratory-confirmed COVID-19, and data were collected from January 3 to March 20, 2020. We identified and integrated significant prognostic factors for 30-days poor outcome to construct a nomogram. The model was subjected to internal validation and to external validation with two separate cohorts of 110 and 118 cases, respectively. The performance of the nomogram was assessed with respect to its predictive accuracy, discriminative ability, and clinical usefulness.Results: In the primary cohort, the mean age of patients was 55.4 years and 129 (55.4%) were male. Prognostic factors contained in the clinical nomogram were age, lactic dehydrogenase, aspartate aminotransferase, prothrombin time, serum creatinine, serum sodium, fasting blood glucose, and D-dimer. The model was externally validated in two cohorts achieving an AUC of 0.946 and 0.878, sensitivity of 100 and 79%, and specificity of 76.5 and 83.8%, respectively. Although adding CT score to the clinical nomogram (clinical-CT nomogram) did not yield better predictive performance, decision curve analysis showed that the clinical-CT nomogram provided better clinical utility than the clinical nomogram.Conclusions: We established and validated a nomogram that can provide an individual prediction of 30-days poor outcome for COVID-19 patients. This practical prognostic model may help clinicians in decision making and reduce mortality.

scholarly journals FIGO 2018 Staging for Cervical Cancer: Influence on Stage Distribution and Outcomes in the 3D-Image-Guided Brachytherapy Era

Cancers ◽  
2020 ◽  
Vol 12 (7) ◽  
pp. 1770
Author(s):  
Kento Tomizawa ◽  
Takuya Kaminuma ◽  
Kazutoshi Murata ◽  
Shin-ei Noda ◽  
Daisuke Irie ◽  
...  
Keyword(s):  
Cervical Cancer ◽  
Progression Free Survival ◽  
Staging System ◽  
Cervical Squamous Cell Carcinoma ◽  
Stage Migration ◽  
Cervical Cancers ◽  
Stage Distribution ◽  
Image Guided ◽  
Figo Staging ◽  
Gynecology And Obstetrics

Recent widespread use of three-dimensional image-guided brachytherapy (3D-IGBT) has improved radiotherapy outcomes of cervical cancer dramatically. In 2018, the International Federation of Gynecology and Obstetrics (FIGO) staging system for cervical cancer was revised. However, the influence of the revisions on the stage distribution and outcomes of cervical cancers treated with 3D-IGBT remains unclear. Here, we retrospectively analyzed 221 patients with cervical squamous cell carcinoma treated with definitive radiotherapy using 3D-IGBT (median follow-up, 60 months). The stage distribution and outcomes were compared between the 2009 and 2018 schemas. Stage migration occurred in 52.9% of the patients. Patients classified with the 2018 criteria as stage IIICr had the highest proportion (43.8%) of migration, and were mainly from the 2009 stages IIB and IIIB. The 2009 and 2018 schemas showed comparable performance at stratifying 5-year overall survival (OS) and 5-year progression-free survival (PFS) for patients in stages IB–IVA. The 2018 criteria effectively stratified 5-year OS and PFS in the stage III substages. The 5-year OS and PFS for stage IIIC1r patients varied according to tumor T stage. These data provide evidence for the utility of the revised 2018 FIGO staging system in the clinical management of cervical cancers in the 3D-IGBT era.

scholarly journals Development and Validation of Nomograms to Predict Long-term Oncological Outcomes in Serous Ovarian Cancer

2021 ◽  
Author(s):  
Liu Yuan-yuan ◽  
Zhao Ren-feng ◽  
Liu Chao ◽  
Zhou Jie ◽  
Yang Liu ◽  
...  
Keyword(s):  
Ovarian Cancer ◽  
Confidence Interval ◽  
Cox Regression ◽  
External Validation ◽  
Curve Analysis ◽  
Serous Ovarian Cancer ◽  
Operating Characteristics ◽  
Decision Curve Analysis ◽  
Training Cohort

Abstract Background: Nomograms are statistics-based predictive tools that integrate predictive factors. We developed and validated a nomogram to predict overall survival (OS) in serous ovarian cancer (SOC).Methods: In total, 6957 patients from the SEER database were included in the training group; the external validation group included 1244 SOC patients from two Chinese hospitals. The nomogram was structured on Cox regression analyses and was evaluated in both the training and validation groups using consistency index, area under the receiver operating characteristics curve (AUC), calibration plots, and risk subgroup classification. Kaplan–Meier curves were plotted to compare survival outcomes between subgroups. A decision-curve analysis was used to test the clinical value of the nomogram.Results: The independent factors identified by multivariate analysis in the training cohort and selected for the nomogram included age, tumor grade, and FIGO stage. The consistency indexes for OS were 0.689 (95% confidence interval: 0.677–0.701) in the training cohort and 0.639 (95% confidence interval: 0.601–0.670) in the validation cohort; the AUCs were 0.675 and 0.661 in the validation cohorts, respectively. Calibration curves showed good consistency between predicted and actual 3- and 5-year OS. Significant differences were observed in the survival curves of different risk subgroups. The decision-curve analysis indicated our nomogram was superior to the AJCC staging system.Conclusion: We constructed a nomogram to predict long-term OS in SOC and externally verified it in an Asian population. This nomogram showed more accurate survival predictions, which will help provide personalized treatments and follow-up strategies.

Combined Plasma Fibrinogen and Neutrophil Lymphocyte Ratio in Ovarian Cancer Prognosis May Play a Role?

2018 ◽  
Vol 28 (5) ◽  
pp. 939-944 ◽  
Author(s):  
Claudia Marchetti ◽  
Alessia Romito ◽  
Angela Musella ◽  
Giulia Santo ◽  
Innocenza Palaia ◽  
...  
Keyword(s):  
Ovarian Cancer ◽  
Progression Free Survival ◽  
Neutrophil To Lymphocyte Ratio ◽  
Cancer Prognosis ◽  
Response To Treatment ◽  
Debulking Surgery ◽  
Free Survival ◽  
Lymphocyte Ratio ◽  
Gynecology And Obstetrics ◽  
The Absolute

ObjectivesIn ovarian cancer (OC), approximately 70% will relapse within 12 months from diagnosis; inflammation plays an important role in cancer initiating and progression; thus, a combination of neutrophil-to-lymphocyte ratio (NLR) and fibrinogen (F-NLR) has been proposed as prognostic marker in several tumors. The aim of our study was to investigate the correlation between NLR, fibrinogen, and F-NLR and survival in OC population.MethodsPatients with diagnosis of OC admitted to our institute between 2011 and 2016 were included. Data about pretreatment complete blood count were collected. Neutrophil-to-lymphocyte ratio was defined as the absolute neutrophil count divided by the absolute lymphocyte count; the F-NLR score was 0 for low NLR and fibrinogen, 1 for low NLR and high fibrinogen, or, conversely, 2 for both high markers. We correlated this index with progression-free survival.ResultsA total of 94 patients were enrolled. Median age at diagnosis was 55 (34–83) years; more than 80% of patients presented International Federation of Gynecology and Obstetrics stage III–IV at diagnosis, and 72 (77%) presented high-grade serous histology. Primary debulking surgery was performed in 57 women (60%), whereas 37 (40%) underwent interval debulking surgery.Mean serum NLR was 5.25 ± 5.37, and mean serum fibrinogen value was 4.19 ± 0.97 g/L. The median follow-up time was 27 months (range, 8–60 months). All patients with F-NLR value of 2 presented advanced disease compared with 64% of those with F-NLR of 0 (P< 0.031); these patients more frequently required neoadjuvant chemotherapy (P< 0.003) and more often had platinum-resistant disease (P< 0.022). Patients with high F-NLR presented worse progression-free survival than did patients with low F-NLR (12 vs 42 months, respectively,P= 0.023).ConclusionsCombining NLR and fibrinogen levels could be used as a factor for prediction of prognosis and response to treatment in patients affected with OC.

Treatment and prognosis of epithelial ovarian cancer in Iran

2007 ◽  
Vol 25 (18_suppl) ◽  
pp. 5586-5586
Author(s):  
R. Khodabakhshi ◽  
S. Yahyazadeh Jabbari ◽  
M. Gohari ◽  
B. Sadrolhefazi ◽  
A. Mosavizadeh ◽  
...  
Keyword(s):  
Ovarian Cancer ◽  
Surgical Procedure ◽  
Response Rate ◽  
Chemotherapy Regimen ◽  
Progression Free Survival ◽  
Staging System ◽  
Chemotherapy Response ◽  
Free Survival ◽  
Epithelial Tumors ◽  
Progression Of Disease

5586 Background: Ovarian cancer is the most lethal gynecologic malignancy in the US, with 14,500 women dying of this disease annually. The aims of this study are to describe brief epidemiologic variations, response rate for usual chemotherapy regimen and progression free survival analysis in Iranian patients. Patients and Methods: 98 women with confirmed ovarian cancer who have been undergone surgery followed by chemotherapy at three hospitals in Tehran (Iran) between 1997 and 2003 were enrolled in this retrospective study. FIGO staging system has been applied. We have collected data regarding age, pathologic variations, surgical procedure (complete, partial, biopsy), chemotherapy, response rate, and time to progression of disease. Results: From a total of 98 patients, there were 80 (81.6%) epithelial, 12 (12.2%) germ cell, 5 (5.1%) granulosa cell tumors and one case of lymphoma. Response rate have been evaluated for 60 patients with epithelial cancer. Overall mean age was 46.7 and average age for epithelial tumors and non-epithelial tumors were 49.6 and 34.3 respectively. Complete surgical procedure with staging and optimal residue had been performed for 18 patients. Stage III was the most common stage (46.1%). In 78.3% of patients complete or partial response were seen, while 21.7% of patients showed stable or progressive disease. The most important prognostic factors were stage, and extent of surgical procedure. Median progression-free survival was 24.2 months. Conclusion: Overall average-age of our patients is lower than expected. Besides, a large proportion of the patients are referred in advanced stages. Although, higher response rate has been produced by taxane-based regimen in comparison of traditional chemotherapy; but it was not statistically significant. Retrospective evaluation, low number of the patients, non-uniform usage of chemotherapy regimen could influence our results. No significant financial relationships to disclose.

International Federation of Gynecology and Obstetrics Staging Classification for Cancer of the Ovary, Fallopian Tube, and Peritoneum: Estimation of Survival in Patients With Node-Positive Epithelial Ovarian Cancer

2015 ◽  
Vol 25 (1) ◽  
pp. 49-54 ◽  
Author(s):  
Augusto Pereira ◽  
Tirso Pérez-Medina ◽  
Javier F. Magrina ◽  
Paul M. Magtibay ◽  
Ana Rodríguez-Tapia ◽  
...  
Keyword(s):  
Ovarian Cancer ◽  
Epithelial Ovarian Cancer ◽  
Staging System ◽  
Peritoneal Metastases ◽  
International Federation ◽  
Anatomical Location ◽  
Abdominal Lymph Node ◽  
Node Positive ◽  
Figo Staging ◽  
Gynecology And Obstetrics

ObjectiveThe objective of this study was to determine the survival of patients with node-positive epithelial ovarian cancer according to the 2014 International Federation of Gynecology and Obstetrics (FIGO) staging system.Materials and MethodsWe performed a retrospective chart review. Data from all consecutive patients with node-positive epithelial ovarian cancer (stages IIIC and IV) who underwent cytoreductive surgery at the Mayo Clinic from 1996 to 2000 were reassessed to evaluate the prognostic significance of the new FIGO stages. Multivariate Cox regression was performed, and Kaplan-Meier survival curves constructed.ResultsThe distribution of the restaged patients was as follows: IIIA1, 23 patients (IIIA1i, 9 patients; and IIIA1ii, 14 patients); IIIA2, 3 patients; IIIB, 4; IIIC, 67 patients; IVA, 4 patients; and IVB, 15 patients. In the univariate analysis, the relative risk for positive nodes greater than 10 mm on the longer axis was 2.57 and 3.00 for patients with microscopic peritoneal disease, compared with patients with microscopic positive nodes. However, the difference was not statistically significant. Moreover, the univariate analyses revealed statistically significant differences for 2014 FIGO stages (IIIA, IIIB, IIIC, and IVA-B), anatomical sites of peritoneal metastases, and disease staged at IIIC because of the presence of omental metastases. Multivariate analysis showed that survival was higher in patients restaged to IIIA-B than in those restaged to IIIC and IV (hazard ratios, 2.75 and 3.16, respectively; P = 0.002). The hazard ratio for patients with abdominal peritoneal metastases was 2.76 compared with patients with pelvic peritoneal metastases (P = 0.001).ConclusionsThe current 2014 FIGO staging system for ovarian cancer successfully correlates survival, anatomical location of peritoneal metastases, and extra-abdominal lymph node metastases.

scholarly journals Safety and Efficacy of Weekly Paclitaxel and Cisplatin Chemotherapy for Ovarian Cancer Patients with Hypersensitivity to Carboplatin

Cancers ◽  
2021 ◽  
Vol 13 (4) ◽  
pp. 640
Author(s):  
Shinichi Tate ◽  
Kyoko Nishikimi ◽  
Ayumu Matsuoka ◽  
Satoyo Otsuka ◽  
Makio Shozu
Keyword(s):  
Ovarian Cancer ◽  
Progressive Disease ◽  
Renal Toxicity ◽  
Progression Free Survival ◽  
Median Number ◽  
Weekly Paclitaxel ◽  
Peritoneal Carcinoma ◽  
Free Survival ◽  
Safety And Efficacy ◽  
Carboplatin Hypersensitivity

Background: This study aimed to evaluate the safety and efficacy of weekly paclitaxel and cisplatin chemotherapy (wTP) in patients with ovarian cancer who developed carboplatin hypersensitivity reaction (HSR). Methods: We retrospectively investigated 86 patients with ovarian, fallopian tube, and peritoneal carcinoma who developed carboplatin HSR during previous chemotherapy (carboplatin and paclitaxel) at our institution between 2011 and 2019. After premedication was administered, paclitaxel was administered over 1 h, followed by cisplatin over 1 h (paclitaxel 80 mg/m2; cisplatin 25 mg/m2; 1, 8, 15 day/4 weeks). We investigated the incidence of patients who successfully received wTP for at least one cycle, treatments compliance, progression-free survival (PFS), and overall survival (OS). Results: The median number of wTP administration cycles was 4 (Interquartile Range IQR, 3–7), 71 patients (83%) successfully received wTP, and 15 patients (17%) developed cisplatin HSR. The efficacy of treatment was as follows: 55 (64%) patients completed the scheduled wTP, 9 (10%) patients discontinued due to HSR to cisplatin within 6 cycles, 1 (1%) patient discontinued due to renal toxicity (grade 2) at the 6th cycle, and 21 (24%) patients discontinued due to progressive disease within 6 cycles. The median PFS and OS after administration of wTP were 10.9 months (95% CI: 7.7–17.7) and 25.9 months (95% CI: 19.0–50.2), respectively. Conclusions: wTP was safe and well-tolerated in patients who developed carboplatin HSR.

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