Prognostic significance of pretreatment clinical and laboratory features in patients with ovarian cancer receiving neoadjuvant chemotherapy
, 1, 1, 1, 1, 1
Abstract
Introduction. In this study, we aimed to investigate the effects of pre-treatment clinical and laboratory characteristics on prognosis in ovarian cancer patients diagnosed in our clinic. In all patients, surgery was not possible, and they were qualified for neoadjuvant treatment.
Material and methods. Records of 96 patients diagnosed with ovarian carcinoma, who were not eligible for the surgery at the time of diagnosis and who were qualified for neoadjuvant treatment, were reviewed retrospectively.
Results. For the prognosis of OS, we analyzed age (p = 0.106), ECOG (p = 0.007), menstrual status (p = 0.211), FIGO stage (p = 0.314), ovarian origin of cancer (p = 0.571), albumin (p = 0.496), LDH (p = 0.940), CA- 125 (p = 0.032), neutrophil-lymphocyte ratio (NLR) (p = 0.194), platelet-lymphocyte ratio (PLR) (p = 0.002), systemic immune-inflammation index (SII) (p = 0.028), prognostic nutritional index (PNI) (p = 0.042), Charlson Comorbidity Index (ACCI) (p = 0.008), Cumulative Illness Rating Scale (CIRS) (p = 0.769), chemotherapy response score (CRS) (p = 0.235), cytoreduction (p = 0.006), the number of cycles of neoadjuvant chemotherapy (NACT) (p = 0.749), and the total number of cycles of both neoadjuvant and adjuvant treatment (p = 0.014). For the prognosis of DFS, we analyzed age (p = 0.697), ECOG (p = 0.088), menstrual status (p = 0.912), FIGO stage (p = 0.728), ovarian origin of cancer (p = 0.463), albumin (0.688), LDH (p = 0.028), CA-125 (p = 0.160), NLR (p = 0.417), PLR (p = 0.442), SII (p = 0.069), PNI (p = 0.779), ACCI (p = 0.487), CIRS (p = 0.858), CRS (p = 0.235) cytoreduction (p < 0.001), the number of cycles of NACT (p = 0.849), and the total number of cycles of both neoadjuvant and adjuvant treatment (p = 0.188).
Conclusions. ECOG status, pre-treatment CA-125 level, pre-treatment immune-based markers PLR, SII, and PNI, among comorbidity scores: the ACCI score, total number of cycles of neoadjuvant and adjuvant treatment, and cytoreduction type were found to be factors affecting OS. Serum LDH level and cytoreduction type were the factors affecting DFS.
Keywords: neoadjuvant treatmentovarian cancersurvivalimmune-based markerscomorbidity indexes
References
- Bray F, Ferlay J, Soerjomataram I, et al. Global cancer statistics 2018: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin. 2018; 68(6): 394–424.
- Ghisoni E, Katsaros D, Maggiorotto F, et al. A predictive score for optimal cytoreduction at interval debulking surgery in epithelial ovarian cancer: a two- centers experience. J Ovarian Res. 2018; 11(1): 42.
- Prat J. New insights into ovarian cancer pathology. Ann Oncol. 2012; 23 Suppl 10: x111–x117.
- Vergote I, Tropé C, Amant F, et al. Neoadjuvant Chemotherapy or Primary Surgery in Stage IIIC or IV Ovarian Cancer. N Engl J Med. 2010; 363(10): 943–953.
- Onda T, Satoh T, Saito T, et al. Comparison of treatment invasiveness between upfront debulking surgery versus interval debulking surgery following neoadjuvant chemotherapy for stage III/IV ovarian, tubal, and peritoneal cancers in a phase III randomised trial: Japan Clinical Oncology Group Study JCOG0602. Eur J Cancer. 2016; 64: 22–31.
- Cooke SL, Brenton JD. Evolution of platinum resistance in high-grade serous ovarian cancer. Lancet Oncol. 2011; 12(12): 1169–1174.
- Suidan RS, Leitao MM, Zivanovic O, et al. Predictive value of the Age-Adjusted Charlson Comorbidity Index on perioperative complications and survival in patients undergoing primary debulking surgery for advanced epithelial ovarian cancer. Gynecol Oncol. 2015; 138(2): 246–251.
- Liontos M, Sotiropoulou M, Kaparelou M, et al. Lymphocytic infiltration and Chemotherapy Response Score as prognostic markers in ovarian cancer patients treated with Neoadjuvant chemotherapy. Gynecol Oncol. 2020; 157(3): 599–605.
- Huang QT, Zhou L, Zeng WJ, et al. Prognostic Significance of Neutrophil-to-Lymphocyte Ratio in Ovarian Cancer: A Systematic Review and Meta-Analysis of Observational Studies. Cell Physiol Biochem. 2017; 41(6): 2411–2418.
- You B, Robelin P, Tod M, et al. CA-125 ELIMination Rate Constant K (KELIM) Is a Marker of Chemosensitivity in Patients with Ovarian Cancer: Results from the Phase II CHIVA Trial. Clin Cancer Res. 2020; 26(17): 4625–4632.
- Yoshikawa K, Fukuda T, Uemura R, et al. Age-related differences in prognosis and prognostic factors among patients with epithelial ovarian cancer. Mol Clin Oncol. 2018; 9(3): 329–334.
- Deng F, Xu X, Lv M, et al. Age is associated with prognosis in serous ovarian carcinoma. J Ovarian Res. 2017; 10(1): 36.
- Cioffi R, Bergamini A, Rabaiotti E, et al. Neoadjuvant chemotherapy in high-risk ovarian cancer patients: Role of age. Tumori. 2019; 105(2): 168–173.
- Carey MS, Bacon M, Tu D, et al. The prognostic effects of performance status and quality of life scores on progression-free survival and overall survival in advanced ovarian cancer. Gynecol Oncol. 2008; 108(1): 100–105.
- Chen JP, Huang QD, Wan T, et al. Combined score of pretreatment platelet count and CA125 level (PLT-CA125) stratified prognosis in patients with FIGO stage IV epithelial ovarian cancer. J Ovarian Res. 2019; 12(1): 72.
- Ikeda A, Yamaguchi K, Yamakage H, et al. Serum lactate dehydrogenase is a possible predictor of platinum resistance in ovarian cancer. Obstet Gynecol Sci. 2020; 63(6): 709–718.
- Liontos M, Andrikopoulou A, Koutsoukos K, et al. Neutrophil-to-lymphocyte ratio and chemotherapy response score as prognostic markers in ovarian cancer patients treated with neoadjuvant chemotherapy. J Ovarian Res. 2021; 14(1): 148.
- Böhm S, Le N, Lockley M, et al. Histopathologic response to neoadjuvant chemotherapy as a prognostic biomarker in tubo-ovarian high-grade serous carcinoma: updated Chemotherapy Response Score (CRS) results. Int J Gynecol Cancer. 2019; 29(2): 353–356.
- Chen JH, Zhai ET, Yuan YJ, et al. Systemic immune-inflammation index for predicting prognosis of colorectal cancer. World J Gastroenterol. 2017; 23(34): 6261–6272.
- Kos FT, Hocazade C, Kos M, et al. Assessment of Prognostic Value of "Neutrophil to Lymphocyte Ratio" and "Prognostic Nutritional Index" as a Sytemic Inflammatory Marker in Non-small Cell Lung Cancer. Asian Pac J Cancer Prev. 2015; 16(9): 3997–4002.
- Geng Y, Qi Q, Sun M, et al. Prognostic nutritional index predicts survival and correlates with systemic inflammatory response in advanced pancreatic cancer. Eur J Surg Oncol. 2015; 41(11): 1508–1514.
- Kim YJ, Lee I, Chung YS, et al. Pretreatment neutrophil-to-lymphocyte ratio and its dynamic change during neoadjuvant chemotherapy as poor prognostic factors in advanced ovarian cancer. Obstet Gynecol Sci. 2018; 61(2): 227–234.
- Zhu Y, Zhou S, Liu Y, et al. Prognostic value of systemic inflammatory markers in ovarian Cancer: a PRISMA-compliant meta-analysis and systematic review. BMC Cancer. 2018; 18(1): 443.
- Ceran MU, Tasdemir U, Colak E, et al. Can complete blood count inflammatory parameters in epithelial ovarian cancer contribute to prognosis? - a survival analysis. J Ovarian Res. 2019; 12(1): 16.
- Mao H, Yang F. Prognostic significance of systemic immune-inflammation index in patients with ovarian cancer: a meta-analysis. Front Oncol. 2023; 13: 1193962.
- Dai Y, Liu M, Lei Li, et al. Prognostic significance of preoperative prognostic nutritional index in ovarian cancer: A systematic review and meta-analysis. Medicine (Baltimore). 2020; 99(38): e21840.
- Komura N, Mabuchi S, Yokoi E, et al. Prognostic significance of the pretreatment prognostic nutritional index in patients with epithelial ovarian cancer. Oncotarget. 2019; 10(38): 3605–3613.
- Ening G, Osterheld F, Capper D, et al. Charlson comorbidity index: an additional prognostic parameter for preoperative glioblastoma patient stratification. J Cancer Res Clin Oncol. 2015; 141(6): 1131–1137.
- Kang S, Kim HS, Kim W, et al. Comorbidity is independently associated with poor outcome in extremity soft tissue sarcoma. Clin Orthop Surg. 2015; 7(1): 120–130.
- Kahl A, du Bois A, Harter P, et al. Prognostic Value of the Age-Adjusted Charlson Comorbidity Index (ACCI) on Short- and Long-Term Outcome in Patients with Advanced Primary Epithelial Ovarian Cancer. Ann Surg Oncol. 2017; 24(12): 3692–3699.
- Tetsche MS, Dethlefsen C, Pedersen L, et al. The impact of comorbidity and stage on ovarian cancer mortality: a nationwide Danish cohort study. BMC Cancer. 2008; 8: 31.
- Prader S, Vollmar N, du Bois A, et al. Prognostic impact of debulking surgery and residual tumor in patients with epithelial ovarian cancer FIGO stage IV. Gynecol Oncol. 2016; 140(2): 215–220.
- Bristow R, Tomacruz R, Armstrong D, et al. Survival Effect of Maximal Cytoreductive Surgery for Advanced Ovarian Carcinoma During the Platinum Era: A Meta-Analysis. J Clin Oncol. 2002; 20(5): 1248–1259.
- Xu X, Deng F, Lv M, et al. The number of cycles of neoadjuvant chemotherapy is associated with prognosis of stage IIIc-IV high-grade serous ovarian cancer. Arch Gynecol Obstet. 2017; 295(2): 451–458.
- Minareci Y, Sozen H, Ak N, et al. Prolongation of Neoadjuvant Chemotherapy before Surgery: Seeking the Optimal Number of Cycles in Serous Ovarian Cancer. Chemotherapy. 2022; 67(1): 1–11.
- Akladios C, Baldauf JJ, Marchal F, et al. Does the Number of Neoadjuvant Chemotherapy Cycles before Interval Debulking Surgery Influence Survival in Advanced Ovarian Cancer? Oncology. 2016; 91(6): 331–340.
- Chung YS, Kim YJ, Lee I, et al. Impact of neoadjuvant chemotherapy and postoperative adjuvant chemotherapy cycles on survival of patients with advanced-stage ovarian cancer. PLoS One. 2017; 12(9): e0183754.