Clinicopathological predictors of chemoresponsiveness in epithelial ovarian cancer: a preliminary institutional study

Rebecca K Chung,Jesus Gonzalez-Bosquet,Sarah L Mott,Andreea Mihai Newtson

doi:10.17077/2154-4751.1284

Abstract

Objective: One-third of women with epithelial ovarian cancer are resistant to standard platinum-based chemotherapy, and insufficient data exist in predicting response to chemotherapy. We describe the clinical and pathological factors of patients with complete and incomplete response to treatment. Method: In this retrospective study, data was reviewed from 75 medical charts of 243 patients with primary epithelial ovarian cancers as a preliminary study. All patients underwent chemotherapy and cytoreductive surgery for primary disease. Fifty-six patients had complete response (CR) to chemotherapy and 19 had incomplete response (IR). Fifty-eight and 17 patients had optimal and suboptimal cytoreductive surgery, respectively. Clinical and pathological factors were compared in patients with complete and incomplete response to treatment, and optimal and suboptimal surgery. Overall survival (OS), cancer-specific survival (CSS), and time to recurrence (TTR) were estimated using the Kaplan-Meier method for patient groups. Results: The majority of patients in both the CR and IR groups were diagnosed at advanced stage ovarian cancer. The CR group had significantly lower preoperative CA125 and was more likely to have optimal chemotherapy. The CR group was also more likely to have lymph nodes removed during cytoreductive surgery. A significantly lower percentage of CR patients died from the disease and had statistically longer disease free survival. Patients who underwent suboptimal surgery had significantly shorter survival, but no difference existed in the time until recurrence between patients with optimal and suboptimal surgery. OS, CSS, and TTR were significantly increased in the CR group and in patients that had optimal surgery. Conclusion: Complete response during treatment and optimal surgery significantly increases OS, CSS, and TTR. Preoperative CA125 and lymph node removal during surgery may be predictive of complete treatment response.

Highlights

The incidence of ovarian cancer has decreased since the 1980s; it remains the second leading cause of malignancy in women and the leading cause of mortality from gynecologic cancers
The majority of patients in both the complete response (CR) and incomplete response (IR) groups were diagnosed at advanced stage ovarian cancer
Preoperative CA125 and lymph node removal during surgery may be predictive of complete treatment response

Summary

Introduction

The incidence of ovarian cancer has decreased since the 1980s; it remains the second leading cause of malignancy in women and the leading cause of mortality from gynecologic cancers. 90% of ovarian cancers are epithelial in nature and about 70% are diagnosed at advanced stage defined as International Federation of Gynecology and Obstetrics (FIGO) stage III and IV. The standard treatment plan for primary epithelial ovarian cancer (EOC) includes debulking surgery and platinum-based chemotherapy. Surgery is an important mainstay of treatment and has been shown to improve patients’ chemoresponsiveness and survival.[2,3] one-third of women are resistant to platinum-based therapy, defined as having evidence of disease within 6 months of treatment. They have worse progression-free and overall survival. Up to 85% of advanced stage EOC relapse, and the median time until recurrence is 18 months.[4]

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Discussion

Conclusion