scholarly journals Does preoperative CA-125 cutoff value and percent reduction in CA-125 levels correlate with surgical and survival outcome after neoadjuvant chemotherapy in patients with advanced-stage ovarian cancer? – Our experience from a tertiary cancer institute

2020 ◽  
Vol 09 (01) ◽  
pp. 30-33 ◽  
Author(s):  
Monisha Gupta ◽  
Shilpa Mukesh Patel ◽  
Ruchi Arora ◽  
Rajneesh Tiwari ◽  
Pariseema Dave ◽  
...  
Keyword(s):  
Ovarian Cancer ◽  
Neoadjuvant Chemotherapy ◽  
Progression Free Survival ◽  
Survival Outcome ◽  
Complete Cytoreduction ◽  
Ca 125 ◽  
Survival Outcomes ◽  
Advanced Stage ◽  
Patient Counseling ◽  
Before And After

Abstract Aim: The aim of the study is to evaluate percent fall in CA-125 levels after neoadjuvant chemotherapy (NAC) and preoperative CA-125 value to predict surgical and survival outcomes in women with advanced-stage epithelial ovarian cancer (EOC). Methods: A retrospective review of 406 women receiving NAC for advanced-stage EOC from January 2012 to July 2015 was conducted. Data were collected for demography, radiographic profile, CA-125 levels before and after NAC, chemotherapy, and surgicopathological information. Percent fall in CA-125 was categorized into two groups: <95% (R < 95) and >95% (R > 95) fall from prechemotherapy to preoperative levels. Similarly, women were also categorized using preoperative CA-125 levels of <100 and >100 U/ml. A subset of women from January 2012 to December 2013 was followed to June 2015 for evidence of any recurrence to determine survival outcomes. Results: About 56% women had R > 95 and 44% had R < 95. As compared to R < 95, R > 95 group was more likely to have complete cytoreduction (P = 0.00). Furthermore, women with R > 95 had significant better progression-free survival (PFS) as compared to women with R < 95 (P = 0.009) but no difference in overall survival (OS) (P = 0.28). Women with preoperative CA-125 <100 had significant higher number of complete cytoreduction (55% vs. 40%; P = 0.00) and were associated with both PFS (P = 0.007) and OS benefit (P = 0.02). Conclusion: Our data showed that >95% fall in CA-125 and an absolute preoperative CA-125 value of <100 U/ml is associated with better surgical and survival outcome in women with advanced EOC. These data are important in patient counseling and treatment planning.

scholarly journals Evaluation of various kinetic parameters of CA-125 in patients with advanced-stage ovarian cancer undergoing neoadjuvant chemotherapy

PLoS ONE ◽  
2018 ◽  
Vol 13 (9) ◽  
pp. e0203366
Author(s):  
Yong Jae Lee ◽  
In Ha Lee ◽  
Yun-Ji Kim ◽  
Young Shin Chung ◽  
Jung-Yun Lee ◽  
...  
Keyword(s):  
Ovarian Cancer ◽  
Neoadjuvant Chemotherapy ◽  
Kinetic Parameters ◽  
Ca 125 ◽  
Advanced Stage

Predictors for optimal cytoreduction following neoadjuvant chemotherapy in advanced epithelial ovarian carcinoma

2009 ◽  
Vol 27 (15_suppl) ◽  
pp. 5512-5512
Author(s):  
D. de Jong ◽  
J. E. Dodge ◽  
O. Freedman ◽  
E. Lo ◽  
B. P. Rosen ◽  
...  
Keyword(s):  
Ovarian Cancer ◽  
Neoadjuvant Chemotherapy ◽  
Independent Predictor ◽  
Residual Tumor ◽  
Multivariate Regression Analysis ◽  
Ca 125 ◽  
Advanced Stage ◽  
Optimal Cytoreduction ◽  
Primary Tumors ◽  
Predictive Parameters

5512 Background: Neoadjuvant chemotherapy (NAC) is increasingly used to treat patients (pts) with presumed advanced-stage epithelial ovarian cancer (EOC) who are deemed ineligible for upfront debulking surgery (DS). DS following NAC offers a survival benefit to those pts in whom optimal cytoreduction (< 1 cm residual tumor) is achieved. However, not all women who commence NAC have a subsequent attempt at DS. The aims of this study were to identify, in pts planned for NAC, predictive parameters for attempting DS and for achieving optimal cytoreduction in those undergoing surgery. Methods: Pts with presumed stage IIIC or IV EOC who started NAC between 1998 and 2004 were selected for chart review from our institutional ovarian cancer database. Pts with synchronous primary tumors or final pathology inconsistent with EOC were excluded. Age, presence of ascites, Pre NAC hemoglobin (Hb), platelet count (Pls), and CA-125 were explored as possible predictors of attempting DS and of optimal cytoreduction using Kruskal-Wallis analysis and multivariate regression analysis with backward elimination. Results: 212 pts met inclusion criteria. 164 pts (77.4%) had an attempt at DS after NAC; of these 109 pts (66.4%) were optimally cytoreduced. Age and pre-NAC Pls were independent predictors for attempting DS. Median age of pts undergoing DS was 65 years (range 42–82 yrs) compared to 77 yrs (range 54–89 yrs) in those in whom there was no DS attempt, p < 0.01. Median pre NAC Pls of pts undergoing DS was 398 (range 220–685) *109/L, compared to 298 (178–519) for those not proceeding to DS, p < 0.001. Pre NAC Hb, CA125, and ascites were not predictors of DS. Among pts undergoing DS, age was the only independent predictor of optimal cytoreduction identified: median age of pts (optimal vs. suboptimal cytoreduction) was 57yrs (range 42–73 yrs) vs. 67 yrs (49–82yrs), p < 0.001. Presence of ascites, pre-NAC Hb, pre-NAC Pls, and pre-NAC CA-125 were not predictors of optimal cytoreduction. Conclusions: At our centre, pt age and pre-NAC Pls are independent predictors for attempting DS following NAC for advanced stage EOC. In pts undergoing DS age was the only independent predictor of optimal cytoreduction identified. Further investigation of these findings is warranted. No significant financial relationships to disclose.

scholarly journals RETROSPECTIVE ANALYSIS OF LONG-TERM SURVIVAL OUTCOMES OF PRIMARY CYTOREDUCTION AND NEOADJUVANT CHEMOTHERAPY IN PATIENTS WITH OVARIAN CANCER STAGE IIIC–IV

2018 ◽  
Vol 8 (3) ◽  
pp. 86-94 ◽  
Author(s):  
A. S. Tjulandina ◽  
A. A. Rumyantsev ◽  
K. Y. Morkhov ◽  
V. M. Nechushkina ◽  
S. A. Tjulandin
Keyword(s):  
Ovarian Cancer ◽  
Neoadjuvant Chemotherapy ◽  
Retrospective Analysis ◽  
Low Frequency ◽  
Progression Free Survival ◽  
Long Term Results ◽  
Survival Outcomes ◽  
Stage Iiic ◽  
Term Survival

The choice of treatment strategy in patients with stage IIIC‑IV ovarian cancer (OC) remains the subject of numerous discussions. The reason for this is the unsatisfactory results of randomized trials and the low frequency of primary complete debulking surgery in these studies. We conducted a retrospective analysis to evaluate the survival outcomes in patients with OC stage IIIC–IV (n=314) who underwent treatment between 1995 and 2017. The median progression free survival for primary surgery was 15.6 months, after interval debulking – 11.5 months (p=0.002, HR 0.61: 95 % CI 0.39–0.81). The primary cytoreduction significantly increased the median of overall survival by 19.6 months: from 38.0 months after interval debulking up to 57.6 months after primary cytoreduction (p=0.04, HR 0.64: 95 % CI 0.41–0.99). An increase in the number of optimal interval debulking does not lead to an improvement in the long-term results of treatment in the group of patients after neoadjuvant chemotherapy. Our analysis over the past 20 years has shown that improvement in treatment outcomes is only observed in the primary cytoreduction group due to an increase in the number of complete optimal cytoreductive surgery.

scholarly journals Impact of Underweight after Treatment on Prognosis of Advanced-Stage Ovarian Cancer

2014 ◽  
Vol 2014 ◽  
pp. 1-8 ◽  
Author(s):  
Se Ik Kim ◽  
Hee Seung Kim ◽  
Tae Hun Kim ◽  
Dong Hoon Suh ◽  
Kidong Kim ◽  
...  
Keyword(s):  
Ovarian Cancer ◽  
Progression Free Survival ◽  
Mean Value ◽  
Normal Weight ◽  
Ca 125 ◽  
Advanced Stage ◽  
Poor Prognostic Factor ◽  
Body Mass Indexes ◽  
The Impact ◽  
Overweight Or Obesity

This study aimed to investigate the impact of underweight status on the prognosis of advanced-stage ovarian cancer. A total of 360 patients with stage III-IV epithelial ovarian cancer were enrolled and divided into three groups by body mass indexes (BMIs): underweight (BMI < 18.5 kg/m2); normal weight to overweight (18.5 kg/m2 BMI < 27.5 kg/m2); obesity (BMI ≥ 27.5 kg/m2). Progression-free survival (PFS), overall survival (OS), CA-125, and neutrophil to lymphocyte ratio (NLR) as a marker reflecting host inflammation and immunity were compared among the three groups according to the three treatment times: at diagnosis; after surgery; and after treatment. Only underweight status after treatment was associated with poor OS in comparison with normal weight to overweight or obesity (mean value, 44.9 versus 78.8 or 67.4 months;P=0.05); it was also an unfavorable factor for OS (adjusted HR, 2.29; 95% CI, 1.08–4.85). Furthermore, NLR was higher in patients with underweight than in those with obesity after treatment (median value, 2.15 versus 1.47;P=0.03), in spite of no difference in CA-125 among the three groups at the three treatment times. In conclusion, underweight status after treatment may be a poor prognostic factor in patients with advanced-stage ovarian cancer, which accompanies increased host inflammation and decreased immunity.

Changes in serum CA-125 can predict optimal cytoreduction to no gross residual disease in patients with advanced stage ovarian cancer treated with neoadjuvant chemotherapy

2012 ◽  
Vol 125 (2) ◽  
pp. 362-366 ◽  
Author(s):  
Noah Rodriguez ◽  
J. Alejandro Rauh-Hain ◽  
Melina Shoni ◽  
Ross S. Berkowitz ◽  
Michael G. Muto ◽  
...  
Keyword(s):  
Ovarian Cancer ◽  
Neoadjuvant Chemotherapy ◽  
Residual Disease ◽  
Ca 125 ◽  
Advanced Stage ◽  
Optimal Cytoreduction

scholarly journals Preoperative serum CA-125 level as a predictor for the extent of cytoreduction in patients with advanced stage epithelial ovarian cancer

2021 ◽  
Vol 0 (0) ◽  
Author(s):  
Sebastjan Merlo ◽  
Nikola Besic ◽  
Eva Drmota ◽  
Nina Kovacevic
Keyword(s):  
Ovarian Cancer ◽  
Epithelial Ovarian Cancer ◽  
Progression Free Survival ◽  
Patient Characteristics ◽  
Serum Levels ◽  
Primary Treatment ◽  
Ca 125 ◽  
Advanced Stage ◽  
Debulking Surgery ◽  
Preoperative Serum

AbstractBackgroundOvarian cancer is the seventh most common cancer in women worldwide and the eighth most common cause of cancer death. Due to the lack of effective early detection strategies and the unspecific onset of symptoms, it is diagnosed at an advanced stage in 75% of cases. The cancer antigen (CA) 125 is used as a prognostic marker and its level is elevated in more than 85% of women with advanced stages of epithelial ovarian cancer (EOC). The standard treatment is primary debulking surgery (PDS) followed by adjuvant chemotherapy (ACT), but the later approach is neoadjuvant chemotherapy (NACT) followed by interval debulking surgery (IDS). Several studies have been conducted to find out whether preoperative CA-125 serum levels influence treatment choice, surgical resection and survival outcome. The aim of our study was to analyse experience of single institution as Cancer comprehensive center with preoperative usefulness of CA-125.Patients and methodsAt the Institute of Oncology Ljubljana a retrospective analysis of 253 women with stage FIGO IIIC and IV ovarian cancer was conducted. Women were divided into two groups based on their primary treatment. The first group was the NACT group (215 women) and the second the PDS group (38 women). The differences in patient characteristics were compared using the Chi-square test and ANOVA and the Kaplan-Meier method was used for calculating progression-free survival (PFS) and overall survival (OS).ResultsThe median serum CA-125 level was higher in the NACT group than in the PDS group, 972 IU/ml and 499 IU/ ml, respectively. The PFS in the NACT group was 8 months (95% CI 6.4–9.5) and 18 months (95% CI 12.5–23.4) in the PDS group. The median OS was lower in the NACT group than in the PDS group, 25 months (95% CI 20.6–29.5) and 46 months (95% CI 32.9–62.1), respectively.ConclusionsPreoperative CA-125 cut off value of 500 IU/ml is a promising threshold to predict a successful PDS.

Survival outcomes after delayed cytoreduction surgery following neoadjuvant chemotherapy in advanced epithelial ovarian cancer

2020 ◽  
Vol 30 (12) ◽  
pp. 1935-1942
Author(s):  
Shih-Ern Yao ◽  
Lee Tripcony ◽  
Karen Sanday ◽  
Jessica Robertson ◽  
Lewis Perrin ◽  
...  
Keyword(s):  
Ovarian Cancer ◽  
Overall Survival ◽  
Neoadjuvant Chemotherapy ◽  
Epithelial Ovarian Cancer ◽  
Cancer Patients ◽  
Residual Disease ◽  
Complete Cytoreduction ◽  
Survival Outcomes ◽  
Advanced Epithelial Ovarian Cancer ◽  
Interval Cytoreduction

ObjectiveInterval cytoreduction following neoadjuvant chemotherapy is a well-recognized treatment alternative to primary debulking surgery in the treatment of advanced epithelial ovarian cancer where patient and/or disease factors prevent complete macroscopic disease resection to be achieved. More recently, the strain of the global COVID-19 pandemic on hospital resources has forced many units to alter the timing of interval surgery and extend the number of neoadjuvant chemotherapy cycles. In order to support this paradigm shift and provide more accurate counseling during these unprecedented times, we investigated the survival outcomes in advanced epithelial ovarian cancer patients with the intent of maximal cytoreduction following neoadjuvant chemotherapy with respect to timing of surgery and degree of cytoreduction.MethodsA retrospective review of all patients aged 18 years and above with FIGO (2014) stage III/IV epithelial ovarian cancer treated with neoadjuvant chemotherapy and the intention of interval cytoreduction surgery between January 2008 and December 2017 was conducted. Overall and progression-free survival outcomes were analyzed and compared with patients who only received chemotherapy. Outcome measures were correlated with the number of neoadjuvant chemotherapy cycles and amount of residual disease following surgery.ResultsSix hundred and seventy-one patients (median age 67 (range 20–91) years) were included in the study with 572 patients treated with neoadjuvant chemotherapy and surgery and 99 patients with chemotherapy only. There was no difference in the proportion of patients in whom complete cytoreduction was achieved based on number of cycles of neoadjuvant chemotherapy (2–4 cycles: 67.7%, n=337/498); ≥5 cycles: 62.2%, n=46/74). Patients undergoing cytoreduction surgery after neoadjuvant chemotherapy had a median 5-year progression-free and overall survival of 24 and 38 months, respectively. No significant difference in overall survival between surgical groups was observed (interval cytoreduction: 41 months vs delayed cytoreduction: 43 months, p=0.52). Those who achieved complete cytoreduction to R0 (no macroscopic disease) had a significant median overall survival advantage compared with those with any macroscopic residual disease (R0: 49–51 months vs R<1: 22–39 months, p<0.001 vs R≥1: 23–26 months, p<0.001).ConclusionsSurvival outcomes do not appear to be worse for patients treated with neoadjuvant chemotherapy if cytoreduction surgery is delayed beyond three cycles. In advanced epithelial ovarian cancer patients the imperative to achieve complete surgical cytoreduction remains gold standard, irrespective of surgical timing, for best survival benefit.

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