Abstract
BackgroundWomen with advanced-stage high-grade serous ovarian cancer (HGSOC) are likely to have a bad prognosis. Relapses are common in patients even with no evidence of disease after primary treatment. We aimed to identify the prognostic factors for disease recurrence in these patients.MethodsA nested case-control study was conducted in a large medical center in Southwest China. The primary outcome was recurrence of disease within 3 years after clinical remission (CR). Cox regression was used to calculate the time to event analysis in different groups.ResultsNinety-seven patients were finally included. Fifty-seven patients (58.8%) relapsed within 3 years after CR. Among all the variables, the difference in posttreatment CA-125 level was statistically significant (P <0.05) between the recurrent group and the progression-free group in both univariate and multivariable analysis. A cutoff value was set at the median level in the recurrent group (10 U/ml) to categorize patients into two arms. In Cox regression, the posttreatment CA-125 level was identified as a prognostic factor for recurrence with an OR of 1.05 (95% CI: 1.02–1.10, P = 0.033). The median time (from initiation of treatment) until relapse was 25 months for patients whose posttreatment CA-125 levels were higher than 10 U/ml, while it was undefined for patients whose posttreatment CA-125 level were ≤ 10 U/ml. Patients with a higher posttreatment CA-125 level showed an increased risk for OC relapse compared to those with a lower posttreatment CA-125 level. Furthermore, as shown in line graphs recording serum CA-125 levels during follow-up in each recurrent case, the increments of serum CA-125 levels were delayed in recurrent OC patients who had a posttreatment CA125 level ≤ 10 U/ml compared with those with a higher CA-125 level.ConclusionA low serum CA-125 level after primary treatment was a potential prognostic factor in women with advanced HGSOC.
Highlights
Ovarian cancer remains one of the Top 10 most common cancers for global women in global cancer statistics 2020, and is the leading cause of death among all gynecologic malignancy [1]
There was no significant difference in age, body mass index (BMI), family history of cancer, Federation of Gynecology and Obstetrics (FIGO) stage, sign of pleural/ascitic fluid, diagnostic approach, outcome of primary surgery, lymph node metastasis, regimen/number of cycles of chemotherapy, posttreatment serum HE4 level, or application of postremission treatment between the recurrent group and progression-free group
We found the proportion of neoadjuvant chemotherapy (NACT) with interval debulking surgery (IDS) and the posttreatment cancer antigen 125 (CA-125) level were higher in recurrent patients than those in control group (P
Summary
Ovarian cancer remains one of the Top 10 most common cancers for global women in global cancer statistics 2020, and is the leading cause of death among all gynecologic malignancy [1]. Over two-thirds of advanced-stage OC patients might relapse within the subsequent 3 years after primary treatment [4]. The well-known factors with prognostic value for disease recurrence in OC patients included International Federation of Gynecology and Obstetrics (FIGO) staging, pathological type, outcome of debulking surgery, and platinum sensitivity [5]. Woman with high-grade serous ovarian cancer (HGSOC), which is the most aggressive histologic subtype and accounts for the majority of advanced-stage diseases, is more likely to have a bad prognosis [6]. In order to identify more valuable prognostic factors for disease recurrence, we conducted this nested case-control study to evaluate further characteristics of relapsed HGSOC patients with advanced disease who had achieved complete clinical remission (CR) after primary treatment. Women with advanced-stage high-grade serous ovarian cancer (HGSOC) are likely to have a bad prognosis. We aimed to identify the prognostic factors for disease recurrence in these patients
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