Bădulescu Fl, Bădulescu Adriana, Schenker M, Popescu Carmen Florina, Stoica Zoia
Department of Oncology, Faculty of Medicine, University of Medicine and Pharmacy of Craiova, and Department of Pathology, Emergency County Hospital, Romania.
Rom J Morphol Embryol. 2005;46(4):329-34.
The purpose of this study is to compare the predicted value of the blood levels variations of CA 125 antigen and the imunohistochemical expression of CA 125, with imagistic criteria (The Response Evaluation Criteran in Solid Tumor--RECIST) regarding the survival estimation of female patients with relapsed ovarian carcinoma which undergo to second line chemotherapy.
We included in this study 40 female patients diagnosed with ovarian carcinoma in the Oncology Clinic of the Emergency County Hospital Craiova, in a period of two years (from 2000 to 2002), which have fulfilled the following criteria: ovarian carcinoma IC-IV stage, according to FIGO system, first line treatment represented by the association between paclitaxel and a platinum salt, refractory or recurrent disease, indications for beginning the second line chemotherapy represented by topotecan or paclitaxel and carboplatin. The serial CA 125 antigen was determined in all patients before starting the chemotherapy and after each two sequences of chemotherapy, and the imunohistochemical expression of CA 125 was evaluated from surgery extracts before the second line chemotherapy (11 cases). The imagistic evaluation of the treatment response was done after 4 sequences of chemotherapy.
All patients had measurable disease according to RECIST criteria and had high values (at least double) of the CA 125 antigen blood level at the time of diagnosis. The imunohistochemically expression of CA 125 was correlated in most cases with the blood level of CA 125. The evaluation criterion of the CA 125 antigen has been shown to be more efficient in estimation the survival rate compared with the RECIST system. In a various analysis, which included numerous potential prognostic factors, only the variation of blood levels of these antigen and the free disease interval from the finalization of the first line chemotherapy have been identified as predictive factors of survival, while the other variables, including the RECIST criteria, had no impact on the prognosis regarding the survival.
The response evaluation criteria based on the blood levels variations of CA 125 antigen are a better instrument for the estimation of the compared prognosis with the RECIST criteria, for patients on second line chemotherapy for relapsed ovarian carcinoma.
本研究旨在比较CA 125抗原血药浓度变化的预测值及CA 125的免疫组化表达，并结合影像学标准（实体瘤疗效评价标准——RECIST）对接受二线化疗的复发性卵巢癌女性患者的生存情况进行评估。
本研究纳入了2000年至2002年期间在克拉约瓦县急诊医院肿瘤诊所诊断为卵巢癌的40例女性患者，这些患者符合以下标准：根据国际妇产科联盟（FIGO）系统为IC-IV期卵巢癌，一线治疗采用紫杉醇与铂盐联合方案，疾病难治或复发，二线化疗指征为拓扑替康或紫杉醇与卡铂联合。在所有患者开始化疗前及每两个化疗疗程后测定血清CA 125抗原，并从二线化疗前的手术提取物中评估CA 125的免疫组化表达（11例）。化疗4个疗程后进行治疗反应的影像学评估。
根据RECIST标准，所有患者均有可测量的疾病，且诊断时CA 125抗原血药浓度较高（至少翻倍）。多数情况下，CA 125的免疫组化表达与CA 125血药浓度相关。与RECIST系统相比，CA 125抗原评估标准在生存率评估方面更有效。在一项包含众多潜在预后因素的多因素分析中，仅这些抗原血药浓度变化及一线化疗结束后的无病间期被确定为生存预测因素，而其他变量，包括RECIST标准，对生存预后无影响。
对于接受二线化疗的复发性卵巢癌患者，基于CA 125抗原血药浓度变化的反应评估标准是一种比RECIST标准更好的生存预后评估工具。
