CA-125 Levels Are Predictive of Survival in Low-Grade Serous Ovarian Cancer—A Multicenter Analysis

Christoph Wohlmuth; Vladimir Djedovic; Susanne K. Kjaer; Allan Jensen; Rosalind Glasspool; Patricia Roxburgh; Anna DeFazio; Sharon E. Johnatty; Penelope M. Webb; Francesmary Modugno; Diether Lambrechts; Joellen M. Schildkraut; Andrew Berchuck; Liv Cecilie Vestrheim Thomsen; Line Bjorge; Estrid Høgdall; Claus K. Høgdall; Ellen L. Goode; Stacey J. Winham; Keitaro Matsuo; Beth Y. Karlan; Jenny Lester; Marc T. Goodman; Pamela J. Thompson; Tanja Pejovic; Marjorie J. Riggan; Katherine Lajkosz; Alicia Tone; Taymaa May

doi:10.3390/cancers14081954

Cancers (Apr 2022)

CA-125 Levels Are Predictive of Survival in Low-Grade Serous Ovarian Cancer—A Multicenter Analysis

Christoph Wohlmuth,
Vladimir Djedovic,
Susanne K. Kjaer,
Allan Jensen,
Rosalind Glasspool,
Patricia Roxburgh,
Anna DeFazio,
Sharon E. Johnatty,
Penelope M. Webb,
Francesmary Modugno,
Diether Lambrechts,
Joellen M. Schildkraut,
Andrew Berchuck,
Liv Cecilie Vestrheim Thomsen,
Line Bjorge,
Estrid Høgdall,
Claus K. Høgdall,
Ellen L. Goode,
Stacey J. Winham,
Keitaro Matsuo,
Beth Y. Karlan,
Jenny Lester,
Marc T. Goodman,
Pamela J. Thompson,
Tanja Pejovic,
Marjorie J. Riggan,
Katherine Lajkosz,
Alicia Tone,
Taymaa May

Affiliations

Christoph Wohlmuth: Division of Gynecologic Oncology, Princess Margaret Hospital, University Health Network, Toronto, ON M5G 2M9, Canada
Vladimir Djedovic: Division of Gynecologic Oncology, Princess Margaret Hospital, University Health Network, Toronto, ON M5G 2M9, Canada
Susanne K. Kjaer: Department of Lifestyle, Reproduction and Cancer, Danish Cancer Society Research Center, DK-2100 Copenhagen, Denmark
Allan Jensen: Department of Lifestyle, Reproduction and Cancer, Danish Cancer Society Research Center, DK-2100 Copenhagen, Denmark
Rosalind Glasspool: Beatson West of Scotland Cancer Centre, University of Glasgow, Glasgow G12 0YN, UK
Patricia Roxburgh: Beatson West of Scotland Cancer Centre, University of Glasgow, Glasgow G12 0YN, UK
Anna DeFazio: Centre for Cancer Research, The Westmead Institute for Medical Research, Sydney, NSW 2145, Australia
Sharon E. Johnatty: Department of Genetics and Computational Biology, QIMR Berghofer Medical Research Institute, Brisbane, QLD 4006, Australia
Penelope M. Webb: Population Health Department, QIMR Berghofer Medical Research Institute, Brisbane, QLD 4006, Australia
Francesmary Modugno: Women’s Cancer Research Center, Magee-Womens Research Institute and Hillman Cancer Center, Pittsburgh, PA 15213, USA
Diether Lambrechts: Laboratory for Translational Genetics, Department of Human Genetics, KU Leuven, 3000 Leuven, Belgium
Joellen M. Schildkraut: Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA 30322, USA
Andrew Berchuck: Department of Gynecologic Oncology, Duke University Hospital, Durham, NC 27710, USA
Liv Cecilie Vestrheim Thomsen: Department of Obstetrics and Gynecology, Haukeland University Hospital, 5021 Bergen, Norway
Line Bjorge: Department of Obstetrics and Gynecology, Haukeland University Hospital, 5021 Bergen, Norway
Estrid Høgdall: Department of Pathology, Herlev Hospital, University of Copenhagen, DK-2100 Copenhagen, Denmark
Claus K. Høgdall: Department of Gynaecology, Rigshospitalet, University of Copenhagen, DK-2100 Copenhagen, Denmark
Ellen L. Goode: Division of Epidemiology, Department of Quantitative Health Sciences, Mayo Clinic, Rochester, MN 55905, USA
Stacey J. Winham: Division of Computational Biology, Department of Quantitative Health Sciences, Mayo Clinic, Rochester, MN 55905, USA
Keitaro Matsuo: Division of Cancer Epidemiology and Prevention, Aichi Cancer Center Research Institute, Nagoya 464-8681, Japan
Beth Y. Karlan: Department of Obstetrics and Gynecology, David Geffen School of Medicine, University of California at Los Angeles, Los Angeles, CA 90095, USA
Jenny Lester: Department of Obstetrics and Gynecology, David Geffen School of Medicine, University of California at Los Angeles, Los Angeles, CA 90095, USA
Marc T. Goodman: Cancer Prevention and Control Program, Cedars-Sinai Cancer, Cedars-Sinai Medical Center, Los Angeles, CA 90048, USA
Pamela J. Thompson: Samuel Oschin Comprehensive Cancer Institute, Cancer Prevention and Genetics Program, Cedars-Sinai Medical Center, Los Angeles, CA 90048, USA
Tanja Pejovic: Department of Obstetrics and Gynecology, Oregon Health & Science University, Portland, OR 97239, USA
Marjorie J. Riggan: Department of Gynecologic Oncology, Duke University Hospital, Durham, NC 27710, USA
Katherine Lajkosz: Biostatistics, Princess Margaret Cancer Centre, University of Toronto, Toronto, ON M5G 2C1, Canada
Alicia Tone: Division of Gynecologic Oncology, Princess Margaret Hospital, University Health Network, Toronto, ON M5G 2M9, Canada
Taymaa May: Division of Gynecologic Oncology, Princess Margaret Hospital, University Health Network, Toronto, ON M5G 2M9, Canada

DOI: https://doi.org/10.3390/cancers14081954
Journal volume & issue: Vol. 14, no. 8
p. 1954

Abstract

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Objective: Studies on low-grade serous ovarian cancer (LGSC) are limited by a low number of cases. The aim of this study was to define the prognostic significance of age, stage, and CA-125 levels on survival in a multi-institutional cohort of women with pathologically confirmed LGSC. Methods: Women with LGSC were identified from the collaborative Ovarian Cancer Association Consortium (OCAC). Cases of newly diagnosed primary LGSC were included if peri-operative CA-125 levels were available. Age at diagnosis, FIGO stage, pre- and post-treatment CA-125 levels, residual disease, adjuvant chemotherapy, disease recurrence, and vital status were collected by the participating institutions. Progression-free (PFS) and overall survival (OS) were calculated. Multivariable (MVA) Cox proportional hazard models were used and hazard ratios (HR) calculated. Results: A total of 176 women with LGSC were included in this study; 82% had stage III/IV disease. The median PFS was 2.3 years and the median OS was 6.4 years. Age at diagnosis was not significantly associated with worse PFS (p = 0.23) or OS (p = 0.3) (HR per year: 0.99; 95%CI, 0.96–1.01 and 0.98; 95%CI 0.95–1.01). FIGO stage III/IV was independently associated with PFS (HR 4.26, 95%CI 1.43–12.73) and OS (HR 1.69, 95%CI 0.56–5.05). Elevated CA-125 (≥35 U/mL) at diagnosis was not significantly associated with worse PFS (p = 0.87) or OS (p = 0.78) in MVA. Elevated CA-125 (≥35 U/mL) after completion of primary treatment was independently associated with worse PFS (HR 2.81, 95%CI 1.36–5.81) and OS (HR 6.62, 95%CI 2.45–17.92). In the MVA, residual disease was independently associated with PFS (0.022), but not OS (0.85). Conclusion: Advanced LGSC was associated with poor long-term prognosis. FIGO stage and abnormal post-treatment CA-125 level are key prognostic factors inversely associated with PFS and OS. Highlights: 1. Through a multi-center collaborative effort, data from 176 women with low-grade serous ovarian cancer were analyzed. 2. Although low-grade serous ovarian cancer is often considered indolent, the progression-free and overall survival are poor. 3. Elevated post-treatment CA-125 levels are independently associated with poor survival.

Published in Cancers

ISSN: 2072-6694 (Online)
Publisher: MDPI AG
Country of publisher: Switzerland
LCC subjects: Medicine: Internal medicine: Neoplasms. Tumors. Oncology. Including cancer and carcinogens
Website: https://www.mdpi.com/journal/cancers/

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