Department of Obstetrics and Gynecology, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan, ROC. ; Department of Biological Sciences, National Sun Yat-sen University, Kaohsiung, Taiwan, ROC. ; Department of Pharmacy and Graduate Institute of Pharmaceutical Technology, Ta-Jen University, Pingtung, Taiwan, ROC.
Multidisciplinary Science Research Center, Taiwan, ROC.
J Gynecol Oncol. 2014 Jan;25(1):51-7. doi: 10.3802/jgo.2014.25.1.51. Epub 2014 Jan 8.
The objective of this study was to explore the association of longitudinal CA-125 measurements with overall survival (OS) time by developing a flexible model for patient-specific CA-125 profiles, and to provide a simple and reliable prediction of OS.
A retrospective study was performed on 275 patients with ovarian cancer who underwent at least one cycle of primary chemotherapy in our institute. Serial measurements of patients' CA-125 levels were performed at different frequencies according to their clinical plans. A statistical model coupling the Cox proportional hazards and the mixed-effects models was applied to determine the association of OS with patient-specific longitudinal CA-125 values. Stage and residual tumor size were additional variables included in the analysis.
A total of 1,601 values of CA-125 were included. Longitudinal CA-125 levels, stage, and the residual tumor size were all significantly associated with OS. A patient-specific survival probability could be calculated. Validation showed that, in average, 85.4% patients were correctly predicted to have a high or low risk of death at a given time point. Comparison with a traditional model using CA-125 half-life and time to reach CA-125 nadir showed that the longitudinal CA-125 model had an improved predicative value.
Longitudinal CA-125 values, measured from the diagnosis of ovarian cancer to the completion of primary chemotherapy, could be used to reliably predict OS after adjusting for the stage and residual tumor disease. This model could be potentially useful in clinical counseling of patients with ovarian cancer.
本研究旨在通过建立一个针对患者特异性 CA-125 曲线的灵活模型，探讨纵向 CA-125 测量值与总生存（OS）时间的相关性，并为 OS 提供简单可靠的预测。
本研究对在我院接受至少一个周期一线化疗的 275 例卵巢癌患者进行了回顾性研究。根据患者的临床计划，以不同的频率对患者的 CA-125 水平进行了连续测量。应用结合 Cox 比例风险和混合效应模型的统计模型，确定 OS 与患者特异性纵向 CA-125 值的相关性。在分析中还纳入了分期和残留肿瘤大小等变量。
共纳入 1601 个 CA-125 值。纵向 CA-125 水平、分期和残留肿瘤大小均与 OS 显著相关。可以计算出患者的特异性生存概率。验证表明，平均而言，在给定时间点，85.4%的患者的高或低死亡风险预测结果正确。与使用 CA-125 半衰期和达到 CA-125 最低点时间的传统模型相比，纵向 CA-125 模型具有更好的预测价值。
在调整分期和残留肿瘤疾病后，从卵巢癌诊断到一线化疗结束时测量的纵向 CA-125 值可用于可靠地预测 OS。该模型可能对卵巢癌患者的临床咨询具有潜在的应用价值。
