A Novel Clinical Nomogram for Predicting Lymph Node Metastasis in Ovarian Cancer: A SEER Analysis and External Validation in a Tertiary Center

Introduction The aim of the study is to investigate the risk factors for developing lymph node metastases (LNM) in cases diagnosed as a presumed early-stage ovarian carcinoma (OC). Methodology Information of patients who had been diagnosed as OC in 2018 was obtained from the SEER database. We enrolled 104 OC patients in General Hospital of Northern Theatre Command for external validation. A logistic regression was conducted to determine the independent predictors for LNM, which were used for establishing a nomogram. In order to evaluate the reliability of nomogram, we applied a receiver operating characteristic curve (ROC) analysis, calibration curves and plotted decision curves. Results We found that age(≥70, OR=0.544, p=0.022), histology type (Mucinous carcinoma, OR=0.390, p=0.001; Endometrioid carcinoma, OR=7.946, p=0.053; Others, OR=2.400, p=0.040), histology grade (Grade II, OR=2.423, p=0.028; Grade III, OR=1.982, p=0.152; Grade IV, OR=1.594, p=0.063) and preoperative serum CA125 level (positive, OR=2.236, p=0.001) were all significant predictors of LNM. The AUC of the model training cohort, internal validation cohort, and external validation cohort were 0.78, 0.79 and 0.76 respectively. The calibration curves showed that the predicted outcome fitted well to the observed outcome in the training cohort (p=0.825) internal validation cohort (p=0.503), and external validation cohort (p=0.108). The decision curves showed the nomogram had more benefits than the All or None scheme if the threshold probability is >50% and <100% in training cohort and internal validation cohort, >30% and <90% in the external validation cohort. Conclusion The multivariate logistic regression showed that age, histology type, histology grade and preoperative serum CA125 level were all significant predictors of LNM. The nomogram established using the above variables had great performance for clinical applying.

Predictive value of preoperative inflammatory markers and serum CA 125 level for surgical outcome in Indonesian women with epithelial ovarian cancer

BACKGROUND: It is essential in the management of ovarian cancers to identify the patients who will benefit from primary complete cytoreductive surgery and those who will rather benefit from neoadjuvant chemotherapy. OBJECTIVE: To evaluate the predictive value of preoperative inflammatory markers, i.e. platelet to lymphocyte ratio (PLR), neutrophil to lymphocyte ratio (NLR), monocyte to lymphocyte ratio (MLR), red cell distribution width (RDW), and serum CA125 level for surgical outcome in epithelial ovarian cancer. METHODS: A retrospective study was carried out in Sanglah Hospital, Denpasar, Bali. A total of 54 patients with epithelial ovarian cancer who underwent primary exploratory laparotomy from January 2018 to November 2019 was recruited. Data about clinical characteristics, preoperative inflammatory markers, serum CA125 level, and surgical outcome (optimal vs. suboptimal) was collected from the medical records. Predictive value of the markers were evaluated using ROC curve to determine their accuracy (area under the curve, sensitivity, specificity, positive and negative predictive value). RESULTS: Mean age, parity, and tumor size did not differ between the study groups (p> 0.05). The group with suboptimal outcome had significantly higher PLR, NLR, MLR, and RDW value (p< 0.05). Using the ROC curve, a cut off value was determined for each predictor, i.e. PLR: 196.50, NLR: 3.34, MLR: 0.24, RDW: 13.19, CA125: 300.85. AUC for each predictor were as follows: PLR 0.718 (95% CI: 0.578–0.859), NLR 0.676 (95% CI: 0.529–0.823), MLR 0.700 (95% CI: 0.560–0.839), RDW 0.712 (95% CI: 0.572–0.852), CA125 0.593 (95% CI: 0.436–0.750). Sensitivity, specificity, and accuracy for predicting suboptimal outcome were as follows: PLR (74.2%, 69.6%, 72.2%), NLR (64.5%, 60.9%, 62.9%), MLR (74.2%, 59.1%, 66.7%), RDW (74.2%, 60.9%, 68.5%), CA125 (54.8%, 60.9%, 57.4%). We have some limitations such as small numbers of sample, we generalized whole kinds of ovarian cancer, and this study does not describe follow-up features. CONCLUSION: Preoperative serum inflammatory markers (PLR, MLR, and RDW) may serve as useful markers to predict the surgical outcome with fair accuracy in patients with epithelial ovarian cancer.

Malignant Gastric Neoplasms: A Clinicopathological Study with Special Reference to Serum CA125 Level with Peritoneal Dissemination

Introduction: Gastric cancer is a malignant tumour with a fifth position amid all cancers and its mortality rate is third globally. The most common distant mode of metastasis is Peritoneal Dissemination (PD). There is a positive correlation between serum Cancer Antigen 125 (CA125) level and PD in cases of malignant gastric neoplasm. Aim: To study the demographic features, the macroscopic and microscopic features of malignant gastric neoplasm and the relation of serum CA125 level with PD in cases of gastric cancer. Materials and Methods: This cross-sectional observational study was conducted for two years from January, 2018 to January, 2020 on 120 cases at Institute of Post Graduate Medical Education and Research, Kolkata, West Bengal (India). Detailed history taking, clinical examination, routine investigation was done. Peripheral blood sample for CA125 assay was collected. PD was identified through Ultrasonography (USG) or Computed Tomography (CT) or intraoperatively during open surgery. The gastrectomy specimens were sent for gross examination, staging and histopathology. Microsoft excel 2016 and SPSS 18 was used. Chi-square test was used for the comparison between the groups. A p-value of <0.05 was considered significant. The sensitivity, specificity, Positive Predictive Value (PPV), and Negative Predictive Value (NPV) were used for elective assessment. Results: This study comprised 120 cases with mean age of presentation as 54.3 years and male: female ratio of 2.3:1. Fifty cases (41.6%) were identified as tubular (solid)-poorly differentiated adenocarcinoma with 59 cases (49.2%) of stage IIIA and 52 cases (43.3%) of stage IV. The sensitivity and specificity of CA125 was 81.8% and 85.7%. The PPV and NPV were 56.2% and 95.4%. Conclusion: Early detection of peritoneal disease will help the clinicians to stratify the treatment of gastric cancers. Higher sensitivity suggests that preoperative serum CA125 is a promising tool to predict PD which aids in subsequent alternative mode of treatment, lesser morbidity and better survival of patients.

Elevated Preoperative Serum CA125 Predicts Larger Tumor Diameter in Patients with Hepatocellular Carcinoma and Low AFP Levels

Aim. Little is known about the association between cancer antigen 125 (MUC16/CA125) concentrations and tumor diameter of patients with hepatocellular carcinoma (HCC) and low AFP levels. To fill this gap in our knowledge, we conducted a retrospective study of 427 patients with HCC with AFP ≤200 ng/mL who underwent R0 resection at our center. Methods. The associations between CA125 concentrations and patients’ clinicopathological characteristics were analyzed. Survival vs CA125 levels was also evaluated between patient groups with CA125 ≤30 U/mL or CA125 >30 U/mL. Independent risk factors of disease-free survival (DFS) and overall survival (OS) were analyzed with Cox hazard regression model. Results. Elevated preoperative serum CA125 was significantly associated with maximal tumor diameter (MTD) >5 cm and female sex (P<0.001 and P=0.044, respectively). The DFS and OS of patients with CA125 ≤30 U/mL (n = 392) were significantly higher compared with those with CA125 >30 U/mL (n = 35) (P=0.003 and P=0.001 respectively). Multivariate analysis revealed that MTD >5 cm was an independent risk factor of DFS (HR = 1.891, 95% CI: 1.379–2.592, P<0.001) and OS (2.709, 1.848–3.972, P<0.001). Conclusions. In conclusion, elevated preoperative serum CA125 predicted larger tumor diameter and poor prognosis after patients with HCC with AFP ≤200 ng/mL underwent R0 resection, which may be explained by the elevation of the preoperative serum CA125 level significantly associated with MTD>5 cm.

Diagnostic value of risk malignancy index (RMI) for detection of malignancies in clinically diagnosed ovarian masses and to evaluate the validity of individual constituent parameter of risk malignancy index

Background: Pre-operative knowledge regarding the nature of ovarian mass is necessary in order to plan surgery. Risk malignancy index (RMI) is a simple scoring system based on three factors serum CA 125, USG score and menopausal status. The RMI was interpreted as 1) score >250=high risk, 2) 25-250=intermediate risk, 3) score <25=low risk. The objective of the study was to evaluate risk malignancy index (RMI) in pre-operatively clinically diagnosed ovarian mass and to compare the validity of individual parameter in RMI i.e. menopausal status, serum CA 125 and USG score to differentiate the nature of clinically diagnosed ovarian masses as benign or malignant.Methods: This was an observational study conducted in the Department of obstetrics and gynaecology, Trichy SRM Medical College and Research Centre, Trichy from January 2017 to January 2018 with a sample size of 77 cases with clinical diagnosis of ovarian mass admitted for surgery. The validity of RMI and validity of individual parameters were calculated and compared.Results: A total of 77 patients with ovarian tumors were enrolled in this study. According to the histological examination of the surgical specimens of the 77 women, 27.3% (n=21) had malignant tumors and 67.7% (n=56) had benign disease. Most common benign tumour was serous cystadenoma and the most common malignant tumour was mucinous cystadenocarcinoma. Among 77 patients, 42.85% (n=33) were postmenopausal, 44.15% (n=34) had USG score of 4, 27.27% (n=21) had serum CA125 level >cut-off values and 27.27% (n=21) had RMI >250. In cases where RMI>250, 18 out of 21 were malignant. In cases where USG score was 4, 19 out of 34 were malignant. Of the cases where serum CA125 level was > cut-off values 16 out of 21 were found to be malignant. RMI showed better sensitivity of 85.71%, specificity of 94.64%, PPV of 85.71%, NPV of 94.64% and diagnostic accuracy of 92.20%.Conclusions: RMI is highly valuable and reliable in differentiating benign and malignant ovarian lesions and facilitates selection of cases for conservative management and oncology referral.