Abstract
Various kinetic parameters of serum CA-125 have been reported to have better correlation with outcomes for patients treated with neoadjuvant chemotherapy (NAC). This study aimed to compare the available kinetic parameters of serum CA-125 in an external cohort of advanced-stage ovarian cancer. Using the cancer registry databases from the Yonsei Cancer Hospital, we retrospectively reviewed 210 patients with advanced-stage ovarian cancer, treated with NAC followed by interval debulking surgery. We compared area under the receiver-operating characteristics curves (AUCs), false negative rate, and negative predictive value (NPV) using 10 different models for optimal cytoreduction and platinum resistance. In addition, we compared incremental AUC for progression-free survival (PFS) and overall survival (OS). No gross residual tumor was observed in 37.0% and residual tumors <1 cm in 82.2% of patients. No model using CA-125 kinetic parameters had an AUC higher than >0.6 for predicting optimal cytoreduction. After adjusting for age, BMI, disease stage, and histologic subtypes, all models had an AUC >0.70 for predicting platinum resistance. However, no model had a high enough NPV (highest value = 82.0%) to avoid chemotherapy futility. For survival outcomes, no model had an incremental AUC >0.70 for predicting either PFS or OS. None of the proposed serum CA-125 kinetic parameters showed high accuracy in predicting optimal cytoreduction, platinum resistance, or survival in patients receiving NAC. For advanced-stage ovarian cancer treated with NAC, there is a need to discover reliable biomarkers to better stratify patient response groups for optimal treatment decision-making.
Highlights
Epithelial ovarian cancer is the leading cause of death among all gynecological malignancies in Korea [1, 2]
Several phase 3 clinical trials showed that neoadjuvant chemotherapy (NAC) followed by interval debulking surgery (IDS), was not an inferior treatment course compared to PDS for treating advanced-stage ovarian cancer [3,4,5,6]
Ten models developed to predict optimal cytoreduction, platinum resistance, and survival were identified from the medical literature using PubMed
Summary
Epithelial ovarian cancer is the leading cause of death among all gynecological malignancies in Korea [1, 2]. The standard therapy of advanced-stage ovarian cancer includes primary. CA-125 in advanced-stage ovarian cancer debulking surgery (PDS), followed by platinum-based combination chemotherapy. Several phase 3 clinical trials showed that neoadjuvant chemotherapy (NAC) followed by interval debulking surgery (IDS), was not an inferior treatment course compared to PDS for treating advanced-stage ovarian cancer [3,4,5,6]. A potential advantage of the NAC approach is that it can provide the treating clinician with early information regarding chemotherapy response using clinical, radiological, and tumor markers. As chemo-sensitivity during NAC has been a well-known prognostic factor for survival in advanced-stage ovarian cancer [7, 8], identifying a patient as either a good responder or poor responder to NAC before IDS is important to triage further adjuvant treatment
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