Potential effect of the risk of ovarian cancer algorithm (ROCA) on the mortality outcome of the Prostate, Lung, Colorectal and Ovarian (PLCO) trial.
Recently, the Prostate, Lung, Colorectal and Ovarian (PLCO) Trial reported no mortality benefit for annual screening with CA-125 and transvaginal ultrasound (TVU). Currently ongoing is the UK Collaborative Trial of Ovarian Cancer Screening (UKCTOCS), which utilizes the risk of ovarian cancer algorithm (ROCA), a statistical tool that considers current and past CA125 values to determine ovarian cancer risk. In contrast, PLCO used a single cutoff for CA125, based on current levels alone. We investigated whether having had used ROCA in PLCO could have, under optimal assumptions, resulted in a significant mortality benefit by applying ROCA to PLCO CA125 screening values. A best-case scenario assumed that all cancers showing a positive screen result earlier with ROCA than under the PLCO protocol would have avoided mortality; under a stage-shift scenario, such women were assigned survival equivalent to Stage I/II screen-detected cases. Updated PLCO data show 132 intervention arm ovarian cancer deaths versus 119 in usual care (relative risk, RR = 1.11). Forty-three ovarian cancer cases, 25 fatal, would have been detected earlier with ROCA, with a median (minimum) advance time for fatal cases of 344 (147) days. Best-case and stage-shift scenarios gave 25 and 19 deaths prevented with ROCA, for RRs of 0.90 (95% CI: 0.69-1.17) and 0.95 (95% CI: 0.74-1.23), respectively. Having utilized ROCA in PLCO would not have led to a significant mortality benefit of screening. However, ROCA could still show a significant effect in other screening trials, including UKCTOCS.
Division of Cancer Prevention, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA. pp4f@nih.gov
Paul F
PF
Pinsky
Claire
C
Zhu
Steve J
SJ
Skates
Amanda
A
Black
Edward
E
Partridge
Saundra S
SS
Buys
Christine D
CD
Berg
D018262:Adenocarcinoma, Clear Cell / Q000401:mortality / Q000517:prevention & control; D002288:Adenocarcinoma, Mucinous / Q000401:mortality / Q000517:prevention & control; D000368:Aged; D000465:Algorithms; D018394:CA-125 Antigen / Q000097:blood; D002986:Clinical Trials as Topic; D018284:Cystadenocarcinoma, Serous / Q000401:mortality / Q000517:prevention & control; D055088:Early Detection of Cancer; D016889:Endometrial Neoplasms / Q000401:mortality / Q000517:prevention & control; D005185:Fallopian Tube Neoplasms / Q000401:mortality* / Q000517:prevention & control; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008565:Membrane Proteins / Q000097:blood; D008875:Middle Aged; D009367:Neoplasm Staging; D010051:Ovarian Neoplasms / Q000401:mortality* / Q000517:prevention & control; D010534:Peritoneal Neoplasms / Q000401:mortality* / Q000517:prevention & control; D011379:Prognosis; D012189:Retrospective Studies; D018570:Risk Assessment; D015996:Survival Rate
D018394:CA-125 Antigen; C451759:MUC16 protein, human; D008565:Membrane Proteins