Bouvarel Barnabe, Colomban Oliver, Frenel Jean-Sebastien, Loaec Cécile, Bourgin Charlotte, Berton Dominique, Freyer Gilles, You Benoit, Classe Jean-Marc
Surgical Oncology, Institut de Cancerologie de l'Ouest, Saint Herblain, France.
University Claude Bernard Lyon 1, Lyon, France.
Int J Gynecol Cancer. 2024 Apr 1;34(4):574-580. doi: 10.1136/ijgc-2023-004872.
The modeled CA-125 elimination constant K (KELIM) is a pragmatic early marker of tumor chemosensitivity in ovarian cancer patients treated with neoadjuvant chemotherapy before interval surgery. The primary objective of this study was to assess the prognostic value of KELIM regarding the feasibility of complete surgery, and secondary objectives were to assess the prognostic value of KELIM for the risk of a platinum resistant relapse, progression free survival, and overall survival.
The study was based on a retrospective cohort of 284 patients treated for an advanced serous high grade ovarian cancer, International Federation of Gynecology and Obstetrics (FIGO) stages III-IV, with neoadjuvant chemotherapy, followed by interval surgery, in a comprehensive cancer center. CA-125 concentrations at baseline and during neoadjuvant chemotherapy were collected. The KELIM predictive value regarding the tumor radiological response rate, likelihood of complete surgery, risk of subsequent platinum resistant relapse, progression free survival, and overall survival were assessed with univariate and multivariate tests.
In 232 patients, KELIM was an independent and major predictor of the probability of complete surgery and survival. The final logistic regression model, including KELIM (odds ratio (OR) 0.36, 95% confidence interval (CI)0.16 to 0.73, p=0.006) and complete surgery (no vs yes, OR 0.29, 95% CI 0.15 to 0.53, p<0.001), highlighted the complementary impact of chemosensitivity and surgical outcome relative to the complete surgery. In the multivariate analysis, KELIM and complete surgery were significantly associated with a lower risk of early relapse. In the case of an unfavorable KELIM, when surgical efforts allowed complete cytoreduction, median overall survival was similar to that reported in the case of a favorable KELIM (46.3 months (range 34.6-60.3) vs 46.5 months (range 40.6-68.7), respectively).
Primary tumor chemosensitivity, assessed by the modeled CA-125 KELIM, calculated during neoadjuvant chemotherapy, is a major parameter to consider for decision making regarding interval surgery. Complementary to the RECIST score and laparoscopy, this non-invasive tool, available online, helps tailor the interval surgery strategy according to patient tumor chemosensitivity.
在接受间隔手术前接受新辅助化疗的卵巢癌患者中，模拟的CA - 125消除常数K（KELIM）是肿瘤化疗敏感性的实用早期标志物。本研究的主要目的是评估KELIM对完全手术可行性的预后价值，次要目的是评估KELIM对铂耐药复发风险、无进展生存期和总生存期的预后价值。
该研究基于一个回顾性队列，纳入了284例在综合癌症中心接受晚期浆液性高级别卵巢癌（国际妇产科联盟（FIGO）分期III - IV期）新辅助化疗并随后接受间隔手术的患者。收集了基线和新辅助化疗期间的CA - 125浓度。通过单变量和多变量检验评估KELIM对肿瘤放射学反应率、完全手术可能性、后续铂耐药复发风险、无进展生存期和总生存期的预测价值。
在232例患者中，KELIM是完全手术概率和生存的独立且主要的预测指标。最终的逻辑回归模型，包括KELIM（比值比（OR）0.36，95%置信区间（CI）0.16至0.73，p = 0.006）和完全手术（否 vs 是，OR 0.29，95% CI 0.15至0.53，p < 0.001），突出了化疗敏感性和手术结果相对于完全手术的互补影响。在多变量分析中，KELIM和完全手术与早期复发风险较低显著相关。在KELIM不利的情况下，当手术努力实现了完全细胞减灭时，中位总生存期与KELIM有利的情况相似（分别为46.3个月（范围34.6 - 60.3）和46.5个月（范围40.6 - 68.7））。
在新辅助化疗期间计算的模拟CA - 125 KELIM评估的原发性肿瘤化疗敏感性，是间隔手术决策时要考虑的主要参数。作为RECIST评分和腹腔镜检查的补充，这种可在线获取的非侵入性工具有助于根据患者肿瘤化疗敏感性调整间隔手术策略。
