Brigham and Women's Hospital, Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Harvard Medical School, Boston, MA, USA.
Gynecol Oncol. 2012 May;125(2):362-6. doi: 10.1016/j.ygyno.2012.02.006. Epub 2012 Feb 12.
To evaluate the predictive power of serum CA-125 changes in the management of patients undergoing neoadjuvant chemotherapy followed by interval debulking surgery (NACT-IDS) for a new diagnosis of epithelial ovarian carcinoma (EOC).
Using the Cancer Registry databases from our institutions, a retrospective review of patients with FIGO stage IIIC and IV EOC who were treated with platinum-based NACT-IDS between January 2006 and December 2009 was conducted. Demographic data, CA-125 levels, radiographic data, chemotherapy, and surgical-pathologic information were obtained. Continuous variables were evaluated by Student's t test or Wilcoxon-Mann-Whitney test.
One hundred-three patients with stage IIIC or IV EOC met study criteria. Median number of neoadjuvant cycles was 3. Ninety-nine patients (96.1%) were optimally cytoreduced. Forty-seven patients (47.5%) had resection to no residual disease (NRD). The median CA-125 at diagnosis and before interval debulking was 1749U/mL and 161U/mL, respectively. Comparing patients with NRD v. optimal macroscopic disease (OMD), there was no statistical difference in the mean CA-125 at diagnosis (1566U/mL v. 2077U/mL, p=0.1). There was a significant difference in the mean CA-125 prior to interval debulking, 92 v. 233U/mL (p=0.001). In the NRD group, 38 patients (80%) had preoperative CA-125≤100U/mL compared to 33 patients (63.4%) in the OMD group (p=0.04).
Patients who undergo NACT-IDS achieve a high rate of optimal cytoreduction. In our series, after treatment with taxane and platinum-based chemotherapy, patients with a preoperative CA-125 of ≤100U/mL were highly likely to be cytoreduced to no residual disease.
评估新诊断上皮性卵巢癌（EOC）患者接受新辅助化疗后行间隔减瘤术（NACT-IDS）治疗时血清 CA-125 变化在管理中的预测能力。
使用我们机构的癌症登记数据库，对 2006 年 1 月至 2009 年 12 月期间接受基于铂类的 NACT-IDS 治疗的 FIGO 分期 IIIC 和 IV 期 EOC 患者进行回顾性分析。获得人口统计学数据、CA-125 水平、影像学数据、化疗和手术病理信息。连续变量采用 Student's t 检验或 Wilcoxon-Mann-Whitney 检验进行评估。
103 例 IIIC 或 IV 期 EOC 患者符合研究标准。新辅助周期中位数为 3 个。99 例（96.1%）患者获得最佳减瘤。47 例（47.5%）患者行无残留疾病（NRD）切除。诊断时和间隔减瘤前的中位 CA-125 分别为 1749U/mL 和 161U/mL。与 NRD 相比，最佳宏观疾病（OMD）患者的 CA-125 平均值在诊断时无统计学差异（1566U/mL 比 2077U/mL，p=0.1）。间隔减瘤前的 CA-125 平均值有显著差异，分别为 92U/mL 和 233U/mL（p=0.001）。在 NRD 组中，38 例（80%）患者术前 CA-125≤100U/mL，而在 OMD 组中，33 例（63.4%）患者术前 CA-125≤100U/mL（p=0.04）。
接受 NACT-IDS 治疗的患者达到了很高的最佳减瘤率。在我们的研究中，接受紫杉醇和铂类化疗治疗后，术前 CA-125≤100U/mL 的患者极有可能达到无残留疾病的减瘤效果。
