CA-125水平可预测低级别浆液性卵巢癌的生存率——一项多中心分析
CA-125 Levels Are Predictive of Survival in Low-Grade Serous Ovarian Cancer-A Multicenter Analysis.
作者信息
Wohlmuth Christoph, Djedovic Vladimir, Kjaer Susanne K, Jensen Allan, Glasspool Rosalind, Roxburgh Patricia, DeFazio Anna, Johnatty Sharon E, Webb Penelope M, Modugno Francesmary, Lambrechts Diether, Schildkraut Joellen M, Berchuck Andrew, Thomsen Liv Cecilie Vestrheim, Bjorge Line, Høgdall Estrid, Høgdall Claus K, Goode Ellen L, Winham Stacey J, Matsuo Keitaro, Karlan Beth Y, Lester Jenny, Goodman Marc T, Thompson Pamela J, Pejovic Tanja, Riggan Marjorie J, Lajkosz Katherine, Tone Alicia, May Taymaa
机构信息
Division of Gynecologic Oncology, Princess Margaret Hospital, University Health Network, Toronto, ON M5G 2M9, Canada.
Department of Obstetrics and Gynecology, Paracelsus Medical University, 5020 Salzburg, Austria.
出版信息
Cancers (Basel). 2022 Apr 13;14(8):1954. doi: 10.3390/cancers14081954.
OBJECTIVE
Studies on low-grade serous ovarian cancer (LGSC) are limited by a low number of cases. The aim of this study was to define the prognostic significance of age, stage, and CA-125 levels on survival in a multi-institutional cohort of women with pathologically confirmed LGSC.
METHODS
Women with LGSC were identified from the collaborative Ovarian Cancer Association Consortium (OCAC). Cases of newly diagnosed primary LGSC were included if peri-operative CA-125 levels were available. Age at diagnosis, FIGO stage, pre- and post-treatment CA-125 levels, residual disease, adjuvant chemotherapy, disease recurrence, and vital status were collected by the participating institutions. Progression-free (PFS) and overall survival (OS) were calculated. Multivariable (MVA) Cox proportional hazard models were used and hazard ratios (HR) calculated.
RESULTS
A total of 176 women with LGSC were included in this study; 82% had stage III/IV disease. The median PFS was 2.3 years and the median OS was 6.4 years. Age at diagnosis was not significantly associated with worse PFS ( = 0.23) or OS ( = 0.3) (HR per year: 0.99; 95%CI, 0.96-1.01 and 0.98; 95%CI 0.95-1.01). FIGO stage III/IV was independently associated with PFS (HR 4.26, 95%CI 1.43-12.73) and OS (HR 1.69, 95%CI 0.56-5.05). Elevated CA-125 (≥35 U/mL) at diagnosis was not significantly associated with worse PFS ( = 0.87) or OS ( = 0.78) in MVA. Elevated CA-125 (≥35 U/mL) after completion of primary treatment was independently associated with worse PFS (HR 2.81, 95%CI 1.36-5.81) and OS (HR 6.62, 95%CI 2.45-17.92). In the MVA, residual disease was independently associated with PFS (0.022), but not OS (0.85).
CONCLUSION
Advanced LGSC was associated with poor long-term prognosis. FIGO stage and abnormal post-treatment CA-125 level are key prognostic factors inversely associated with PFS and OS.
HIGHLIGHTS
- Through a multi-center collaborative effort, data from 176 women with low-grade serous ovarian cancer were analyzed. 2. Although low-grade serous ovarian cancer is often considered indolent, the progression-free and overall survival are poor. 3. Elevated post-treatment CA-125 levels are independently associated with poor survival.
目的
低度浆液性卵巢癌（LGSC）的研究因病例数量较少而受到限制。本研究的目的是在一个多机构队列中，确定年龄、分期和CA-125水平对经病理确诊的LGSC女性患者生存情况的预后意义。
方法
从卵巢癌协作组（OCAC）中识别出患有LGSC的女性。如果有围手术期CA-125水平数据，则纳入新诊断的原发性LGSC病例。参与机构收集诊断时的年龄、国际妇产科联盟（FIGO）分期、治疗前后的CA-125水平、残留病灶、辅助化疗、疾病复发和生存状态。计算无进展生存期（PFS）和总生存期（OS）。使用多变量（MVA）Cox比例风险模型并计算风险比（HR）。
结果
本研究共纳入176例LGSC女性患者；82%患有III/IV期疾病。中位PFS为2.3年，中位OS为6.4年。诊断时的年龄与较差的PFS（P = 0.23）或OS（P = 0.3）无显著相关性（每年HR：0.99；95%CI，0.96 - 1.01和0.98；95%CI 0.95 - 1.01）。FIGO III/IV期与PFS（HR 4.26，95%CI 1.43 - 12.73）和OS（HR 1.69，95%CI 0.56 - 5.05）独立相关。在MVA中，诊断时CA-125升高（≥35 U/mL）与较差的PFS（P = 0.87）或OS（P = 0.78）无显著相关性。初次治疗完成后CA-125升高（≥35 U/mL）与较差的PFS（HR 2.81，95%CI 1.36 - 5.81）和OS（HR 6.62，95%CI 2.45 - 17.92）独立相关。在MVA中，残留病灶与PFS独立相关（P = 0.022），但与OS无关（P = 0.85）。
结论
晚期LGSC与不良的长期预后相关。FIGO分期和治疗后CA-125水平异常是与PFS和OS呈负相关的关键预后因素。
要点
- 通过多中心协作努力，分析了176例低度浆液性卵巢癌女性患者的数据。2. 尽管低度浆液性卵巢癌通常被认为生长缓慢，但无进展生存期和总生存期较差。3. 治疗后CA-125水平升高与不良生存独立相关。
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