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上皮性卵巢癌患者第三次化疗周期后 CA-125 水平正常化对化疗方案选择的可能作用:简短报告。

Possible use of CA-125 level normalization after the third chemotherapy cycle in deciding on chemotherapy regimen in patients with epithelial ovarian cancer: brief report.

机构信息

University of Pittsburgh Medical Center, Pittsburgh, PA, USA.

出版信息

Int J Gynecol Cancer. 2011 Aug;21(6):1013-7. doi: 10.1097/IGC.0b013e31821ce903.

Abstract

BACKGROUND

Cancer antigen (CA)-125 is a biomarker widely used in the monitoring of response to chemotherapy in patients with epithelial ovarian cancer (EOC). We hypothesize that normalization of the CA-125 after the third cycle of chemotherapy is an independent prognostic indicator of prolonged progression-free survival (PFS) and overall survival (OS).

METHODS

A retrospective analysis of patients with a diagnosis of advanced-stage (III-IV) EOC who were treated with cytoreductive surgery and adjuvant platinum-based chemotherapy from January 1999 to June 2009 was conducted. Patient demographics and the prognostic significance of CA-125 level above the discrimination value of 35 U/mL were assessed by univariate and multivariate analyses.

RESULTS

A total of 124 women met the study inclusion criteria. The median PFS for all patients with a CA-125 level of less than 35 U/mL (n = 72) after the third chemotherapy cycle was 18 months versus that of the patients with a CA-125 level of 35 U/mL or greater (n = 52) was 9 months (P < 0.0001). The median OS was 42 and 22 months, respectively (P < 0.0001). Optimal microscopically debulked patients with normalization of CA-125 after the third cycle did significantly better than those who did not normalize (PFS, 48 vs 8.3 months; OS, 59 vs 23.8 months; P < 0.0001). When patients with macroscopic disease and normalization of CA-125 after the third cycle were compared with those with CA-125 of 35 U/mL or greater, a significant difference in OS was seen between the 2 groups (47 vs 29 months, respectively; P < 0.0001). On multivariate analysis, only 2 variables were associated with poor prognosis: (1) the failure of CA-125 level to normalize after the third chemotherapy cycle (hazard ratio, 2.5; confidence interval, 1.3-4.6) and (2) the grade of the tumor (hazard ratio, 7.7; confidence interval, 1.6-37.6).

CONCLUSIONS

Although hypothesis generating at this point, normalization of CA-125 level after the third chemotherapy cycle is an independent predictor of survival for patients with advanced EOC regardless of debulking status. We would propose future trials that consider switching regimens in patients who do not normalize their CA-125 after the third cycle to see if such a switch can improve PFS and OS.

摘要

背景

癌抗原(CA)-125 是一种广泛用于监测上皮性卵巢癌(EOC)患者化疗反应的生物标志物。我们假设化疗后第三个周期 CA-125 正常化是无进展生存期(PFS)和总生存期(OS)延长的独立预后指标。

方法

对 1999 年 1 月至 2009 年 6 月接受减瘤手术和辅助铂类化疗的诊断为晚期(III-IV 期)EOC 的患者进行回顾性分析。通过单因素和多因素分析评估患者的人口统计学特征和 CA-125 水平高于 35U/mL 诊断值的预后意义。

结果

共有 124 名女性符合研究纳入标准。化疗后第三个周期 CA-125 水平低于 35U/mL(n=72)的所有患者的中位 PFS 为 18 个月,而 CA-125 水平为 35U/mL 或更高(n=52)的患者为 9 个月(P<0.0001)。中位 OS 分别为 42 和 22 个月(P<0.0001)。最佳显微镜下减瘤患者化疗后 CA-125 正常化者的预后明显优于未正常化者(PFS,48 与 8.3 个月;OS,59 与 23.8 个月;P<0.0001)。与化疗后第三个周期 CA-125 为 35U/mL 或更高的患者相比,具有宏观疾病和 CA-125 正常化的患者之间的 OS 存在显著差异(47 与 29 个月,分别;P<0.0001)。多因素分析显示,仅 2 个变量与预后不良相关:(1)化疗后第三个周期 CA-125 水平未正常化(风险比,2.5;置信区间,1.3-4.6)和(2)肿瘤分级(风险比,7.7;置信区间,1.6-37.6)。

结论

尽管目前这只是一个假设,但无论减瘤状态如何,化疗后第三个周期 CA-125 水平正常化是晚期 EOC 患者生存的独立预测因子。我们建议未来的试验考虑在第三个周期后 CA-125 未正常化的患者中更换方案,以观察这种转换是否可以改善 PFS 和 OS。

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