The value of neoadjuvant chemotherapy for advanced epithelial ovarian cancer:the role of CA125 and cytoreductive surgery
Yang Wen,Song Lei,Li Li'an.Department of Obstetrics and Gynecology,PLA General Hospital,Beijing 100853,China
Objective:To examine the prognostic significance of CA125 and interval surgical cytoreduction after neoadjuvant chemotherapy(NACT)in patients with advanced epithelial ovarian carcinoma(stageⅢC andⅣ). Methods:Retrospective analysis was carried out on 46 nonresectable epithelial ovarian cancer patients treated with platinum-based NACT.Cox multivariate analysis was carried out to investigate the relationship among various clinical results including the CA125 half-life,CA125 normalization,optimal surgical cytoreduction rate,and other well known prognostic factors and overall survival rate.Results:After NACT and interval surgical cytoreduction, the estimated mean survival time for the cohort of the whole study was 33 months.Only the satisfactory residual disease status after NACT was the independent risk factor(HR 0.41,95%CI 0.20—0.84,P = 0.021 2).In patients with residual tumor larger than 1 cm,the estimated mean overall survival time was 22 months.In the patients who received optimal cytoreduction the estimated mean overall survival time was 34 months.CA125 half-life (HR 1.02,95%CI 0.99—1.04,P = 0.131 3)was not significantly predictive of overall survival,but it was a predictive factor of optimal cytoreduction(OR 0.896,95%CI 0.82—0.98,P = 0.018).The estimated mean survival time was 34.3 months in patients with normal CA125 in the process of therapy,whereas in those with persistently elevated CA125 the corresponding estimated mean survival time was 30.4 months(HR 0.45,95%CI 0.22—0.89, P = 0.024).Conclusions:CA125 half-life and CA125 normalization after neoadjuvant chemotherapy are not the independent predictors of survival.Patients with persistently elevated CA125 after the completion of primary treatment have significantly poor survival rate compared with those who showed normalized CA125.All patients treated with neoadjuvant chemotherapy should undergo optimal cytoreduction surgery.
【CateGory Index】： R737.31