A preoperative low cancer antigen 125 level (≤25.8 mg/dl) is a useful criterion to determine the optimal timing of interval debulking surgery following neoadjuvant chemotherapy in epithelial ovarian cancer

• Published in: Japanese journal of clinical oncology 2016-06, Vol.46 (6), p.517-521
• Main Authors: Morimoto, Akemi, Nagao, Shoji, Kogiku, Ai, Yamamoto, Kasumi, Miwa, Maiko, Wakahashi, Senn, Ichida, Kotaro, Sudo, Tamotsu, Yamaguchi, Satoshi, Fujiwara, Kiyoshi
• Format: Article
• Language: English
• Subjects: Adult; Aged; Antineoplastic Agents - therapeutic use; Area Under Curve; Ascites; CA-125 Antigen - analysis; Carcinoma, Ovarian Epithelial; Cytoreduction Surgical Procedures; Fallopian Tube Neoplasms - complications; Fallopian Tube Neoplasms - drug therapy; Fallopian Tube Neoplasms - surgery; Female; Humans; Kaplan-Meier Estimate; Membrane Proteins - analysis; Middle Aged; Neoadjuvant Therapy; Neoplasm Staging; Neoplasms, Glandular and Epithelial - complications; Neoplasms, Glandular and Epithelial - drug therapy; Neoplasms, Glandular and Epithelial - surgery; Neoplasms, Multiple Primary - drug therapy; Neoplasms, Multiple Primary - surgery; Ovarian Neoplasms - complications; Ovarian Neoplasms - drug therapy; Ovarian Neoplasms - surgery; Peritoneal Neoplasms - drug therapy; Peritoneal Neoplasms - surgery; Remission Induction; Retrospective Studies; Risk Factors; ROC Curve
• ISSN: 0368-2811; 1465-3621
• DOI: 10.1093/jjco/hyw029

The purpose of this study is to investigate the clinical characteristics to determine the optimal timing of interval debulking surgery following neoadjuvant chemotherapy in patients with advanced epithelial ovarian cancer. We reviewed the charts of women with advanced epithelial ovarian cancer, fallopian tube cancer or primary peritoneal cancer who underwent interval debulking surgery following neoadjuvant chemotherapy at our cancer center from April 2006 to April 2014. There were 139 patients, including 91 with ovarian cancer [International Federation of Gynecology and Obstetrics (FIGO) Stage IIIc in 56 and IV in 35], two with fallopian tube cancers (FIGO Stage IV, both) and 46 with primary peritoneal cancer (FIGO Stage IIIc in 27 and IV in 19). After 3-6 cycles (median, 4 cycles) of platinum-based chemotherapy, interval debulking surgery was performed. Sixty-seven patients (48.2%) achieved complete resection of all macroscopic disease, while 72 did not. More patients with cancer antigen 125 levels ≤25.8 mg/dl at pre-interval debulking surgery achieved complete resection than those with higher cancer antigen 125 levels (84.7 vs. 21.3%; P< 0.0001). Patients with no ascites at pre-interval debulking surgery also achieved a higher complete resection rate (63.5 vs. 34.1%; P< 0.0001). Moreover, most patients (86.7%) with cancer antigen 125 levels ≤25.8 mg/dl and no ascites at pre-interval debulking surgery achieved complete resection. A low cancer antigen 125 level of ≤25.8 mg/dl and the absence of ascites at pre-interval debulking surgery are major predictive factors for complete resection during interval debulking surgery and present useful criteria to determine the optimal timing of interval debulking surgery.