Lin Hao, Ou Yu-Che, Fu Hung-Chun, Tsai Ching-Chou, Wang Ying-Wen, Chen Ying-Yi, Huang Szu-Wei, Wu Chen-Hsuan
Department of Obstetrics and Gynecology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine Kaohsiung 833, Taiwan.
School of Medicine, College of Medicine, National Sun Yat-Sen University Kaohsiung 804, Taiwan.
Am J Cancer Res. 2025 May 25;15(5):2439-2448. doi: 10.62347/XYTZ1766. eCollection 2025.
Homologous recombination (HR) status plays a critical role in selecting advanced epithelial ovarian cancer (EOC) patients for poly (ADP-ribose) polymerase inhibitor (PARPi) therapy. This study aimed to develop a novel nomogram to predict prognosis in these patients in the era of precision medicine. We conducted a single-institute retrospective analysis on patients diagnosed with advanced EOC between January 2021 and January 2024. Clinicopathological factors, HR status, and PARPi use were evaluated for their association with survival outcomes. Multivariate Cox regression analysis identified independent predictors of progression-free survival (PFS), and a nomogram was constructed and validated using bootstrap resampling. Among 128 patients, PARPi maintenance therapy was administered after front-line chemotherapy to 43 patients as indicated. Multivariate analysis identified optimal surgery [hazard ratio 0.47, 95% confidence interval (CI) 0.27-0.83], CA-125 > 10.7 U/mL after front-line chemotherapy [hazard ratio 3.41, 95% CI 1.85-6.31], neoadjuvant chemotherapy [hazard ratio 2.55, 95% CI 1.32-4.91], and PARPi use [hazard ratio 0.22, 95% CI 0.12-0.42] as independent predictors of PFS. Patients with all favorable factors had a predicted 3-year PFS of 100%, compared to 0% for those with none. The nomogram demonstrated strong predictive accuracy, with a concordance index of 0.78, and calibration plots showed excellent agreement. Internal validation confirmed the reliability of the nomogram. Our findings indicate that HR-deficient patients who respond well to upfront optimal debulking surgery and chemotherapy (indicated by a post-treatment CA125 level below 10.7 U/mL) may experience excellent PFS when followed by PARPi maintenance. Our nomogram provides a dependable tool for personalized prognosis assessment, enabling clinicians to optimize treatment strategies in the era of precision medicine.
同源重组（HR）状态在选择晚期上皮性卵巢癌（EOC）患者接受聚（ADP - 核糖）聚合酶抑制剂（PARPi）治疗中起着关键作用。本研究旨在开发一种新型列线图，以预测精准医学时代这些患者的预后。我们对2021年1月至2024年1月期间诊断为晚期EOC的患者进行了单机构回顾性分析。评估临床病理因素、HR状态和PARPi使用情况与生存结局的关联。多因素Cox回归分析确定了无进展生存期（PFS）的独立预测因素，并使用自举重采样构建并验证了列线图。在128例患者中，43例患者按照指征在一线化疗后接受了PARPi维持治疗。多因素分析确定最佳手术[风险比0.47，95%置信区间（CI）0.27 - 0.83]、一线化疗后CA - 125>10.7 U/mL[风险比3.41，95%CI 1.85 - 6.31]、新辅助化疗[风险比2.55，95%CI 1.32 - 4.91]和PARPi使用[风险比0.22，95%CI 0.12 - 0.42]为PFS的独立预测因素。所有有利因素的患者预测3年PFS为100%，而无有利因素的患者为0%。列线图显示出强大的预测准确性，一致性指数为0.78，校准图显示出良好的一致性。内部验证证实了列线图的可靠性。我们的研究结果表明，对 upfront 最佳减瘤手术和化疗反应良好（以治疗后CA125水平低于10.7 U/mL表示）的HR缺陷患者，在接受PARPi维持治疗后可能会有出色的PFS。我们的列线图为个性化预后评估提供了一个可靠的工具，使临床医生能够在精准医学时代优化治疗策略。
