A prognostic nomogram to predict overall survival in women with recurrent ovarian cancer treated with bevacizumab and chemotherapy

R A Previs; K S Bevis; W Huh; T Tillmanns; L Perry; K Moore; J Chapman; C McClung; T Kiet; J Java; J Chan; A Alvarez Secord

doi:10.1016/j.ygyno.2014.01.036

A prognostic nomogram to predict overall survival in women with recurrent ovarian cancer treated with bevacizumab and chemotherapy

Gynecol Oncol. 2014 Mar;132(3):531-6. doi: 10.1016/j.ygyno.2014.01.036. Epub 2014 Jan 25.

Authors

R A Previs¹, K S Bevis², W Huh², T Tillmanns³, L Perry⁴, K Moore⁴, J Chapman⁵, C McClung⁶, T Kiet⁷, J Java⁸, J Chan⁷, A Alvarez Secord⁹

Affiliations

¹ Duke University Medical Center, Durham, NC, USA. Electronic address: rebecca.previs@gmail.com.
² University of Alabama at Birmingham, Birmingham, AL, USA.
³ West Clinic and University of Tennessee Health Science Center, Memphis, TN, USA.
⁴ Stevenson Oklahoma Cancer Center at the University of Oklahoma, Oklahoma City, OK, USA.
⁵ UCSF Helen Diller Family Comprehensive Cancer Center, San Francisco, CA, USA; Stanford Women's Cancer Center, Stanford Hospital and Clinics, Palo Alto, CA, USA.
⁶ Stanford Women's Cancer Center, Stanford Hospital and Clinics, Palo Alto, CA, USA.
⁷ UCSF Helen Diller Family Comprehensive Cancer Center, San Francisco, CA, USA.
⁸ Gynecologic Oncology Group Statistical and Data Center, Roswell Park Cancer Institute, Buffalo, New York, USA.
⁹ Duke University Medical Center, Durham, NC, USA.

PMID: 24472410
DOI: 10.1016/j.ygyno.2014.01.036

Abstract

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).

Conclusion: 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.

Keywords: Bevacizumab; Nomogram; Recurrent epithelial ovarian cancer.

Publication types

Multicenter Study

MeSH terms

Adult
Aged
Aged, 80 and over
Antibodies, Monoclonal, Humanized / administration & dosage
Antineoplastic Combined Chemotherapy Protocols / therapeutic use*
Bevacizumab
Carcinoma, Ovarian Epithelial
Disease-Free Survival
Female
Humans
Middle Aged
Neoplasm Recurrence, Local
Neoplasms, Glandular and Epithelial / drug therapy*
Nomograms*
Ovarian Neoplasms / drug therapy*
Proportional Hazards Models
Retrospective Studies
Survival Analysis
Young Adult

Substances

Antibodies, Monoclonal, Humanized
Bevacizumab