CA125 动力学、半衰期和最低点在卵巢上皮性癌治疗中的预后价值：系统评价和荟萃分析。
Prognostic value of CA125 kinetics, half-life, and nadir in the treatment of epithelial ovarian cancer: a systematic review and meta-analysis.
机构信息
Center for Gynecologic Cancer, National Cancer Center, Goyang, Korea (the Republic of).
Obstetrics and Gynecology, Korea University Guro Hospital, Seoul, Korea (the Republic of).
出版信息
Int J Gynecol Cancer. 2023 Dec 4;33(12):1913-1920. doi: 10.1136/ijgc-2023-004825.
OBJECTIVE
To investigate the prognostic value of cancer antigen 125 (CA125) related variables on progression free survival and overall survival in primary and recurrent ovarian cancers.
METHOD
A comprehensive review of the Medline, Embase, and Cochrane Library databases was conducted to identify relevant literature on survival outcomes according to the ELIMination Rate Constant K (KELIM), Gynecologic Cancer InterGroup (GCIG) CA125 response criteria, CA125 half-life, and CA125 nadir levels during first line or later line chemotherapy. The search included articles published before February 2023. Cut-off values determining the favorable/unfavorable score of each study were extracted, and pooled hazard ratios (HRs) and 95% confidence intervals (CIs) were analyzed using a random effects model to identify the relationship between survival outcomes of the favorable/unfavorable groups, which was determined by an individual model using CA125 kinetics.
RESULTS
A total of 27 studies with 14 444 patients with epithelial ovarian cancer were included in this meta-analysis. In primary ovarian cancer, a favorable KELIM score, determined by individual modeled cut-off values, was associated with a significant progression free survival (HR 0.53, 95% CI 0.45 to 0.62) and overall survival (HR 0.51, 95% CI 0.43 to 0.62) benefit in the primary setting. The favorable KELIM scored group also correlated with a better progression free survival (HR 0.54, 95% CI 0.47 to 0.62) in relapsed disease. We failed to demonstrate a better prognostic value of the GCIG response criteria and the CA125 half-life for progression free survival and overall survival.
CONCLUSION
Novel chemotherapy response scores, such as KELIM, may be more clinically relevant than other prognostic models using CA125 kinetics, being directly associated with a more favorable survival in both the primary and relapsed setting in patients with epithelial ovarian cancer.
STUDY REGISTRATION
The systemic review and meta-analysis were registered in PROSPERO (CRD42023385512).
目的
探讨癌症抗原 125（CA125）相关变量对原发性和复发性卵巢癌无进展生存期和总生存期的预后价值。
方法
通过对 Medline、Embase 和 Cochrane 图书馆数据库的全面回顾，确定了根据消除率常数 K（KELIM）、妇科癌症协作组（GCIG）CA125 反应标准、CA125 半衰期以及一线或二线化疗期间 CA125 最低点对生存结果的相关文献。检索包括 2023 年 2 月之前发表的文章。提取确定每个研究有利/不利评分的截止值，并使用随机效应模型分析汇总风险比（HRs）和 95%置信区间（CIs），以确定通过 CA125 动力学的个体模型确定的有利/不利组之间的生存结果之间的关系。
结果
这项荟萃分析共纳入了 27 项研究，共有 14444 例上皮性卵巢癌患者。在原发性卵巢癌中，通过个体模型确定的有利 KELIM 评分与显著的无进展生存期（HR 0.53，95%CI 0.45 至 0.62）和总生存期（HR 0.51，95%CI 0.43 至 0.62）相关原发性疾病。有利的 KELIM 评分组在复发性疾病中也与更好的无进展生存期相关（HR 0.54，95%CI 0.47 至 0.62）。我们未能证明 GCIG 反应标准和 CA125 半衰期对无进展生存期和总生存期的预后价值更好。
结论
新型化疗反应评分，如 KELIM，可能比其他使用 CA125 动力学的预后模型更具临床相关性，与上皮性卵巢癌患者原发性和复发性疾病中更有利的生存直接相关。
研究注册
系统评价和荟萃分析在 PROSPERO（CRD42023385512）中进行了注册。
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