A prognostic nomogram to predict overall survival in women with recurrent ovarian cancer treated with bevacizumab and chemotherapy.
OBJECTIVE
To develop a nomogram to predict overall survival (OS) in women with recurrent ovarian cancer treated with bevacizumab and chemotherapy.


METHODS
A multicenter retrospective study was conducted. Potential prognostic variables included age; stage; grade; histology; performance status; residual disease; presence of ascites and/or pleural effusions; number of chemotherapy regimens, treatment-free interval (TFI) prior to bevacizumab administration, and platinum sensitivity. Multivariate analysis was performed using Cox proportional hazards regression. The predictive model was developed into a nomogram to predict five-year OS.


RESULTS
312 women with recurrent ovarian cancer treated with bevacizumab and chemotherapy were identified; median age was 59 (range: 19-85); 86% women had advanced stage (III-IV) disease. The majority had serous histology (74%), high grade cancers (93.5%), and optimal cytoreductions (69.5%). Fifty-one percent of women received greater than two prior chemotherapeutic regimens. TFI (AHR=0.98, 95% CI 0.97-1.00, p=0.022) was the only statistically significant predictor in a multivariate progression-free survival (PFS) analysis. In a multivariate OS analysis, prior number of chemotherapy regimens, TFI, platinum sensitivity, and presence of ascites were significant. A nomogram to predict five-year OS was constructed and internally validated (bootstrap-corrected concordance index=0.737).


CONCLUSIONS
Our multivariate model identified prior number of chemotherapy regimens, TFI, platinum sensitivity, and the presence of ascites as prognostic variables for OS in women with recurrent ovarian cancer treated with bevacizumab combined with chemotherapy. Our nomogram to predict five-year OS may be used to identify women who may benefit from bevacizumab and chemotherapy, but further validation is needed.
Duke University Medical Center, Durham, NC, USA. Electronic address: rebecca.previs@gmail.com.
R A
RA
Previs
University of Alabama at Birmingham, Birmingham, AL, USA.
K S
KS
Bevis
University of Alabama at Birmingham, Birmingham, AL, USA.
W
W
Huh
West Clinic and University of Tennessee Health Science Center, Memphis, TN, USA.
T
T
Tillmanns
Stevenson Oklahoma Cancer Center at the University of Oklahoma, Oklahoma City, OK, USA.
L
L
Perry
Stevenson Oklahoma Cancer Center at the University of Oklahoma, Oklahoma City, OK, USA.
K
K
Moore
UCSF Helen Diller Family Comprehensive Cancer Center, San Francisco, CA, USA; Stanford Women's Cancer Center, Stanford Hospital and Clinics, Palo Alto, CA, USA.
J
J
Chapman
Stanford Women's Cancer Center, Stanford Hospital and Clinics, Palo Alto, CA, USA.
C
C
McClung
UCSF Helen Diller Family Comprehensive Cancer Center, San Francisco, CA, USA.
T
T
Kiet
Gynecologic Oncology Group Statistical and Data Center, Roswell Park Cancer Institute, Buffalo, New York, USA.
J
J
Java
UCSF Helen Diller Family Comprehensive Cancer Center, San Francisco, CA, USA.
J
J
Chan
Duke University Medical Center, Durham, NC, USA.
A Alvarez
AA
Secord
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D061067:Antibodies, Monoclonal, Humanized / Q000008:administration & dosage; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D000068258:Bevacizumab; D000077216:Carcinoma, Ovarian Epithelial; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local; D009375:Neoplasms, Glandular and Epithelial / Q000188:drug therapy*; D049451:Nomograms; D010051:Ovarian Neoplasms / Q000188:drug therapy*; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D016019:Survival Analysis; D055815:Young Adult
D061067:Antibodies, Monoclonal, Humanized; D000068258:Bevacizumab
Bevacizumab; Nomogram; Recurrent epithelial ovarian cancer