A new prognostic model for FIGO stage 1 epithelial ovarian cancer.
BACKGROUND
No consensus exists which patients with surgical stage 1 epithelial ovarian should receive postoperative chemotherapy. The purpose of this study was to evaluate the prognostic impact of preoperative CA-125 and to establish a prognostic index to identify patients in different risk categories.


METHODS
Data of 600 surgically staged patients with FIGO stage 1 EOC treated in eleven gynecological cancer centers in Australia, the USA and Europe were analyzed. Eligible patients include those with invasive EOC where a preoperative CA-125 was obtained and standard surgical staging performed. Overall survival (OS) was chosen as study endpoint. Preoperative CA-125 values were compared with other prognostic factors, and univariate and multivariate Cox models were calculated.


RESULTS
Two hundred and one patients (33.5%) had preoperative CA-125 < or =30 U/ml and CA-125 levels < or =30 U/ml were associated with lower grade, sub-stage 1A and mucinous histologic cell type. Patients with elevated CA-125 levels were more likely to receive chemotherapy. OS probability was 95% and 85% for patients with pretreatment CA-125 < or =30 U/ml and >30 U/ml, respectively (p 0.003). Multivariate analysis confirmed preoperative serum CA-125 >30 U/ml (OR 2.7) and age at diagnosis >70 years (OR 2.6) as the only independent predictors for overall survival.


CONCLUSIONS
Pretreatment of CA-125 < or =30 U/ml dominates over histologic cell type, sub-stage and grade to identify a subgroup of FIGO stage 1 patients with a genuinely good prognosis with extremely good survival and who could possibly be spared with adjuvant chemotherapy.
Obermair
Andreas
A
Queensland Centre for Gynaecological Cancer, Medical School University of Queensland, Royal Brisbane Hospital, Brisbane, Australia. andreas_obermair@health.qld.gov.au
Fuller
Arlan
A
Lopez-Varela
Elisa
E
van Gorp
Toon
T
Vergote
Ignace
I
Eaton
Lynne
L
Fowler
Jeff
J
Quinn
Michael
M
Hammond
Ian
I
Marsden
Donald
D
Proietto
Anthony
A
Carter
Jonathan
J
Davy
Margaret
M
Tripcony
Lee
L
Abu-Rustum
Nadeem
N
D000328:Adult; D000368:Aged; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use; D018394:CA-125 Antigen / Q000096:biosynthesis; D016190:Carboplatin / Q000008:administration & dosage; D017024:Chemotherapy, Adjuvant; D002945:Cisplatin / Q000008:administration & dosage; D003520:Cyclophosphamide / Q000008:administration & dosage; D005260:Female; D006801:Humans; D008875:Middle Aged; D009367:Neoplasm Staging; D010051:Ovarian Neoplasms / Q000097:blood / Q000188:drug therapy / Q000473:pathology* / Q000601:surgery; D011379:Prognosis
D018394:CA-125 Antigen; D003520:Cyclophosphamide; D016190:Carboplatin; D002945:Cisplatin