title: Ascites regression following neoadjuvant chemotherapy in prediction of treatment outcome among stage IIIc to IV high-grade serous ovarian cancer.
abstract: BACKGROUND
  No consensus exists on the outcome-related factors of interval debulking surgery (IDS) in patients with advanced high-grade serous ovarian cancer (HG-SOC) who underwent neoadjuvant chemotherapy (NAC). This study aimed to explore the optimal timing for IDS and the prognosis-associated factors of International Federation of Gynecology and Obstetrics stage IIIc to IV HG-SOC patients.
  
  
  METHODS
  A total of 160 IIIc to IV stage HG-SOC patients were retrospectively analyzed. Patients with large volume ascites underwent NAC and subsequent IDS from the Jiangsu Institute of Cancer Research between 1993 and 2013. The outcome of IDS-associated factors was explored by logistic regression. To predict IDS outcome, the potential values of serum CA-125 levels and CA-125 decreasing kinetics were determined by the receiver operating characteristic curve. The associations between survival durations and covariates were assessed by Cox proportional hazards model and log-rank test.
  
  
  RESULTS
  Optimal IDS was achieved in 80.6% of HG-SOC patients who underwent NAC. Multivariate analyses revealed that ascites regression (p = 0.01), serum CA-125 level (p = 0.02), and CA-125 decreasing kinetics (p = 0.01) were independent optimal IDS predictors. CA-125 decreasing kinetics, IDS outcome, and ascites volume were independently associated with overall survival (OS) (p = 0.04, p < 0.01, p = 0.03, respectively) and progression-free survival (PFS) (p < 0.01, p < 0.01, p = 0.02, respectively). Patients who exhibited disappearance of ascites (<500 ml) had longer PFS (19.7 months vs.14.9 months) and OS (32.1 months vs. 26.0 months) than patients who exhibited residual ascites (≥500 ml). Subsets with higher CA-125 decreasing kinetics (≥2.2) had longer PFS (21.4 months vs.13.1 months) and OS (29.6 months vs.26.8 months) than counterparts (kinetics < 2.2).
  
  
  CONCLUSIONS
  Ascites regression and CA-125 decreasing kinetics were independently associated with surgical outcome and prognosis in advanced HG-SOC patients who underwent NAC.
authors.affiliation: Department of Chemotherapy, Jiangsu Cancer Hospital, Nanjing, Jiangsu, 210009, People's Republic of China.
authors.forename: Xia
authors.initials: X
authors.lastname: Xu
authors.affiliation: Department of Gynecologic Oncology, Jiangsu Cancer Hospital, 42# Baiziting street, Nanjing, Jiangsu, 210009, People's Republic of China.
authors.forename: Fei
authors.initials: F
authors.lastname: Deng
authors.affiliation: Department of Gynecologic Oncology, Jiangsu Cancer Hospital, 42# Baiziting street, Nanjing, Jiangsu, 210009, People's Republic of China.
authors.forename: Mengmeng
authors.initials: M
authors.lastname: Lv
authors.affiliation: Department of Thoracic Oncology, Jiangsu Cancer Hospital, Nanjing, Jiangsu, 210009, People's Republic of China.
authors.forename: Binhui
authors.initials: B
authors.lastname: Ren
authors.affiliation: The Second Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu, 210009, People's Republic of China.
authors.forename: Wenwen
authors.initials: W
authors.lastname: Guo
authors.affiliation: Department of Gynecologic Oncology, Jiangsu Cancer Hospital, 42# Baiziting street, Nanjing, Jiangsu, 210009, People's Republic of China. cxxxxcyd@gmail.com.
authors.forename: Xiaoxiang
authors.initials: X
authors.lastname: Chen
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use; D001201:Ascites / Q000473:pathology*; D014408:Biomarkers, Tumor; D003131:Combined Modality Therapy; D018284:Cystadenocarcinoma, Serous / Q000188:drug therapy / Q000401:mortality* / Q000473:pathology* / Q000601:surgery; D065426:Cytoreduction Surgical Procedures; D018450:Disease Progression; D005260:Female; D006801:Humans; D008875:Middle Aged; D020360:Neoadjuvant Therapy; D060787:Neoplasm Grading; D009367:Neoplasm Staging; D010051:Ovarian Neoplasms / Q000188:drug therapy / Q000401:mortality* / Q000473:pathology* / Q000601:surgery; D011379:Prognosis; D016016:Proportional Hazards Models; D012372:ROC Curve; D012189:Retrospective Studies; D016896:Treatment Outcome
chemical_list: D014408:Biomarkers, Tumor
keywords: Ascites; CA-125; High grade serous ovarian cancer; Interval debulking surgery; Primary debulking surgery