Clinical remission criteria for epithelial carcinoma of the ovary

CA125 nadir concentration is an independent predictor of tumor recurrence in patients with ovarian cancer: a population-based study. Gynecol Oncol. 2010;119:265-269. [PMID: 20797777 DOI: 10.1016/j.ygyno.2010.07.025]

OBJECTIVE

Previous reports described the prognostic value of the serum CA125 level after primary treatment (CA125 nadir) in a selection of ovarian cancer patients. Our primary objective was to determine whether the CA125 nadir level is of prognostic value on the progression-free survival (PFS) and on overall survival (OS) in epithelial ovarian cancer (EOC) patients in all stages of disease who reached complete remission (CR).

METHODS

Patients were selected from a population-based study on EOC patients diagnosed between 1996 and 2006 in 11 Dutch hospitals. All 331 patients who reached CR (i.e. no physical or radiological signs of residual disease and CA125 values ≤35 kU/L) after primary treatment were included. The Kaplan-Meier survival curves of PFS and OS in CA125 nadir ≤5 kU/L and >5 kU/L were compared using the log-rank test. Multivariate Cox regression analyses were performed to study the factors that independently influence survival.

RESULTS

A CA125 nadir ≤5 kU/L (n=69) was significantly associated with both a longer PFS and longer OS (log-rank test P<0.01 and P=0.03, respectively). The CA125 nadir was an independent prognostic variable (HR=1.51, 95% CI: 1.04-2.31) for PFS next to histological type, FIGO stage and residual tumor after surgery.

CONCLUSIONS

EOC patients who were in CR after standard primary treatment and attained CA125 nadir values of ≤5 kU/L had a significantly longer PFS and OS. Moreover, the CA125 nadir of ≤5 kU/L is an independent predictor of tumor recurrence.

Randomized trial of cisplatin and carboplatin versus cisplatin, vinblastine and bleomycin in ovarian cancer

Between January 1992 and July 1997, 202 cases of epithelial ovarian cancer were registered and assigned randomly to a combination of cisplatin and carboplatin (PP group), or cisplatin, vinblastine and bleomycin (PVB group). We analyzed 189 patients whose clinical records were available. The PP chemotherapeutic regimen was advantageous in terms of overall survival compared to the PVB regimen until 4 years after the initial operation. However, the 5-year survival rates were almost the same in both groups. However, in stage III patients, the mean survival time in the PP group was 51.4 months and that in the PVB group was 23.3 months, and there was a statistically significant difference in the survival curves between the two groups (p = 0.0158). The 5-year survival rates were 31.1 and 20.4% in the PP and PVB groups, respectively, in stage III patients. The PP regimen was also significantly superior in patients with macroscopic residual tumor after the initial operation, and the 5-year survival rates were 25.7 and 10.1% in the PP and PVB groups, respectively (p = 0.0128). However, there was no significant difference between the two regimens in patients without macroscopic residual tumor. Cox's proportional hazards regression analysis showed that tumor stage, presence of macroscopic residual tumor, and the chemotherapeutic regimen used were significant prognostic factors. In conclusion, the PP chemotherapeutic regimen is superior to the PVB regimen especially in the treatment of advanced ovarian cancer.

Clinical behavior of borderline ovarian tumors: a study of 150 cases

BACKGROUND

We evaluated the clinical features, treatment, and survival status of the patients with borderline ovarian tumors.

METHODS

A retrospective review of the charts of 150 patients with borderline ovarian tumor registered at the Tokai Ovarian Tumor Study Group from January 1, 1980, to December 31, 1994, was conducted to obtain clinical and pathological information.

RESULTS

In stage II and III disease, the numbers of patients with no residual tumor, residual tumor of <2 cm, 2-5 cm, and >5 cm were 9, 10, 3, and 3, respectively. The sizes of residual tumors and corresponding clinical response to chemotherapy were as follows: residual tumor of <2 cm, complete response (CR), 6 patients; no change (NC), 2; progressive disease (PD), 2; tumors 2-5 cm, NC, 1 patient, PD, 2; tumors >5 cm, PD, 3 patients. The survival for patients with residual tumor <2 cm was significantly better than for those with residual tumor from 2-5 cm and of >5 cm (P < 0.05). The survival for patients with stage II and III serous tumor was significantly longer than that for patients with stage II and III mucinous tumor (P < 0.05).

CONCLUSION

In advanced borderline ovarian tumor, the prognosis of patients with gross residual tumor after initial surgery, and especially with mucinous tumor, was poor.

Lymphadenectomy in stage-III serous cystadenocarcinoma of the ovary

OBJECTIVE

To elucidate the effects of lymphadenectomy on the prognosis for ovarian cancer.

METHOD

A retrospective study of 69 patients with stage-III serous cystadenocarcinoma was performed.

RESULTS

Among the 69 patients, 36 were not treated by lymphadenectomy. Both pelvic and para-aortic lymphadenectomies were performed on 13 patients at the initial operation and on 11 at the second operation. The group (n = 13) treated by both pelvic and para-aortic lymphadenectomies at the initial operation had a disease-free survival rate that was significantly higher than the non-lymphadenectomy group (n = 36) or the group (n = 5) treated by pelvic or para-aortic lymphadenectomy alone (P < 0.04). These 54 patients were subjected to multivariate analysis for lymphadenectomy at the initial operation, and a significant correlation was found between disease-free survival rate and both pelvic and para-aortic lymphadenectomies (P < 0.05).

CONCLUSION

These results suggest that systematic lymphadenectomy can reduce the rate of recurrence.

Prognostic evaluation of lymphadenectomy for epithelial ovarian cancer

Between 1989 and 1991, 150 patients with ovarian cancer were treated with chemotherapy, including cisplatin, in the Tokai Ovarian Tumor Study Group. Of these patients, 25 underwent cytoreductive surgery with lymphadenectomy, including removal of either pelvic or para-aortic lymph nodes, and 36 underwent both lymphadenectomies. A significant difference was observed between survival curves of the groups with positive and negative lymph nodes, respectively (P = 0.0049). The overall survival was longer in the lymphadenectomy group than in the nonlymphadenectomy group (P = 0.0842), and a significantly longer survival time was noted for stage III patients who underwent lymphadenectomy compared with those who did not (P = 0.0185). Multivariate analysis demonstrated that lymphadenectomy is a positive prognostic factor. The authors conclude that both pelvic and para-aortic lymph nodes should be resected to improve survival as well as to assess exact staging in patients with ovarian cancer.

A novel human monoclonal antibody against cervical cancer: its immunoreactivity with normal tube and ovary and with ovarian tumor tissue

1-1-2D, a novel human monoclonal antibody (MAb) raised against cervical cancer, was examined for its immunohistochemical reactivity with ovarian cancer. Six of 10 ovarian cancer cell lines showed positive staining, while 3 of 5 cervical cancer cell lines were positive. Among tumor tissues, 15 of 18 (83%) ovarian serous cystadenocarcinomas and 10 of 12 (83%) ovarian clear cell adenocarcinomas were positive. We also performed immunohistochemical staining of the same cancer specimens with OC 125 and compared their reactivity. The frequency of positivity was similar, but the reactivity of the two MAbs was different. 1-1-2D stained the apical surface of the glandular epithelial cells and secretory products of the gland. On the other hand, OC 125 stained the cytoplasm as well as the plasma membrane of the glandular epithelial cells. These results suggest that 1-1-2D MAb recognizes a different antigen from that recognized by OC 125.

Second-look laparotomy

The second-look laparotomy has become an important means of assessing therapy response in ovarian cancer patients. This procedure enables the gynecologic oncologist to diligently search for small volume persistent disease, which often escapes detection by less invasive means. Subsequent treatment, if required, may then be tailored to the initial biologic response to therapy. However, many patients with negative findings at second look will develop recurrent disease, dampening enthusiasm for the operation. Although controversial, this procedure remains the gold standard for the detection of disease status following chemotherapy for ovarian cancer.

Long-term follow-up of patients with epithelial carcinoma of the ovary

OBJECTIVES

To determine the long-term outcomes of patients with epithelial ovarian cancer.

METHODS

A group of 298 patients with epithelial ovarian cancer were treated with combination chemotherapy between July 1979 and January 1986 at the Tokai Ovarian Tumor Study Group. Long-term results of these patients were analyzed.

RESULTS

Five-year survival and 10-year survival rates of all the patients were 53% and 47%, respectively. Five-year survival and 10-year survival rates for stage I were 89% and 79%, 59% and 56% for stage II, 27% and 22% for stage III, and 9% and 9% for stage IV, respectively. Survival of mucinous and endometrioid cell types were decreased after 5 or more years. In stages II-IV, cisplatin-based chemotherapy produced better results than mitomycin-C, 5-Fu, cytarabine (MFC) therapy.

CONCLUSIONS

Long-term results of epithelial ovarian cancer were not favorable even in mucinous and endometrioid cell types. For long-term results, cisplatin-based chemotherapy was effective in advanced ovarian cancer. Long-term follow-up of ovarian cancer is important and necessary.