The prognostic factor for recurrence in advanced-stage high-grade serous ovarian cancer after complete clinical remission: a nested case-control study

J Ovarian Res. 2021 Dec 20;14(1):179. doi: 10.1186/s13048-021-00908-8.

Abstract

Background: Women with advanced-stage high-grade serous ovarian cancer (HGSOC) are likely to have a bad prognosis. Relapses are common in patients even with no evidence of disease after primary treatment. We aimed to identify the prognostic factors for disease recurrence in these patients.

Methods: A nested case-control study was conducted in a large medical center in Southwest China. The primary outcome was recurrence of disease within 3 years after clinical remission (CR). Cox regression was used to calculate the time to event analysis in different groups.

Results: Ninety-seven patients were finally included. Fifty-seven patients (58.8%) relapsed within 3 years after CR. Among all the variables, the difference in posttreatment CA-125 level was statistically significant (P <0.05) between the recurrent group and the progression-free group in both univariate and multivariable analysis. A cutoff value was set at the median level in the recurrent group (10 U/ml) to categorize patients into two arms. In Cox regression, the posttreatment CA-125 level was identified as a prognostic factor for recurrence with an OR of 1.05 (95% CI: 1.02-1.10, P = 0.033). The median time (from initiation of treatment) until relapse was 25 months for patients whose posttreatment CA-125 levels were higher than 10 U/ml, while it was undefined for patients whose posttreatment CA-125 level were ≤ 10 U/ml. Patients with a higher posttreatment CA-125 level showed an increased risk for OC relapse compared to those with a lower posttreatment CA-125 level. Furthermore, as shown in line graphs recording serum CA-125 levels during follow-up in each recurrent case, the increments of serum CA-125 levels were delayed in recurrent OC patients who had a posttreatment CA125 level ≤ 10 U/ml compared with those with a higher CA-125 level.

Conclusion: A low serum CA-125 level after primary treatment was a potential prognostic factor in women with advanced HGSOC.

Keywords: Advanced stage; High-grade serous ovarian cancer; Prognostic factor; Recurrence; cancer antigen 125.

MeSH terms

  • Adult
  • Antineoplastic Agents / therapeutic use
  • Biomarkers, Tumor / blood*
  • CA-125 Antigen / blood*
  • Case-Control Studies
  • China / epidemiology
  • Cytoreduction Surgical Procedures
  • Female
  • Humans
  • Kaplan-Meier Estimate
  • Middle Aged
  • Neoplasm Recurrence, Local / blood*
  • Neoplasm Recurrence, Local / epidemiology
  • Neoplasm Recurrence, Local / therapy
  • Ovarian Neoplasms / blood*
  • Ovarian Neoplasms / epidemiology
  • Ovarian Neoplasms / therapy
  • Prognosis
  • Remission Induction

Substances

  • Antineoplastic Agents
  • Biomarkers, Tumor
  • CA-125 Antigen