[Application of CA125 elimination rate constant K score in prognostic forecast of patients undergoing interval debulking surgery for high grade serous ovarian cancer]
- PMID: 40582969
- DOI: 10.3760/cma.j.cn112141-20250102-00001
[Application of CA125 elimination rate constant K score in prognostic forecast of patients undergoing interval debulking surgery for high grade serous ovarian cancer]
Abstract
Objective: To investigate the predictive value of the cancer antigen 125 (CA125) elimination rate constant K (KELIM) score for no visible residual disease (R0) and prognosis in high-grade serous ovarian carcinoma (HGSOC) patients undergoing neoadjuvant chemotherapy (NACT)+interval debulking surgery (IDS). Methods: A retrospective analysis was conducted on 78 HGSOC patients treated with NACT+IDS at Beijing Hospital, from June 2014 to June 2024. The KELIM score was calculated, and its predictive value for R0 resection, chemotherapy response score (CRS), platinum-free interval (PFI), progression-free survival (PFS) time, and overall survival (OS) time was analyzed. Results: (1) The mean age at diagnosis was (61.9±9.9) years. The mean KELIM score was 1.1±0.4, with 44 patients having KELIM score≥1 and 34 having KELIM score <1. (2) Patients with KELIM score ≥1 had significantly higher rates of R0 resection (84% vs 56%; P=0.006), CRS3 grading (41% vs 0; P<0.001), and PFI ≥6 months (84% vs 53%; P=0.04) compared to those with KELIM score <1. Additionally, the median PFS time (18.7 vs 13.2 months; P<0.001) and OS time (34.8 vs 29.9 months; P=0.007) were significantly longer in the KELIM score ≥1 group. Chemosensitivity: patients with PFI <6 months had a significantly lower median KELIM score than those with PFI ≥6 months (0.8 vs 1.2; P=0.005). Surgical outcome: patients achieving R0 resection had a significantly higher median KELIM score than those without R0 (1.2 vs 0.7; P<0.001). (3) Univariate analysis identified non-R0 resection, CRS3 grading, lack of poly adenosine diphosphate ribose polymerase (PARP) inhibitor maintenance therapy, and KELIM score <1 as significant risk factors for OS time (all P<0.05). Multivariate analysis confirmed non-R0 resection (HR=3.78,95%CI: 1.13-12.66; P=0.031), no PARP inhibitor maintenance (HR=7.41,95%CI:1.82-30.15; P=0.005), and KELIM score <1 (HR=5.14,95%CI:1.41-18.72; P=0.013) as independent risk factors for OS time. Conclusions: The KELIM score may serve as a predictive marker for chemosensitivity, R0 resection, PFS time, and OS time in HGSOC patients undergoing NACT+IDS. KELIM score<1 is an independent risk factor for OS.
目的： 探讨癌抗原125（CA125）消除速率常数K（KELIM）评分对高级别卵巢浆液性癌（HGSOC）行间歇性肿瘤细胞减灭术（IDS）患者预后的预测作用。 方法： 回顾性分析2014年6月至2024年6月北京医院收治的78例接受新辅助化疗（NACT）+IDS治疗的HGSOC患者的临床病理资料及随访资料，计算其NACT期间的KELIM评分，分析KELIM评分对IDS达到无肉眼可见残留灶（R0）切除、化疗反应分级（CRS）、无铂间期（PFI）、无进展生存（PFS）和总生存（OS）时间的预测作用，并对影响患者预后的相关因素进行单因素和多因素Cox回归模型分析。 结果： （1）78例患者的首诊年龄为（61.9±9.9）岁；KELIM评分为（1.1±0.4）分，其中44例KELIM评分≥1分、34例KELIM评分<1分。（2）KELIM评分≥1分患者的IDS达到R0切除率（分别为84%、56%）、CRS分级（CRS3的比例分别为41%、0）、PFI≥6个月的比例（分别为84%、53%）均高于KELIM评分<1分者，分别比较，差异均有统计学意义（P均<0.01）。与KELIM评分<1分患者比较，KELIM评分≥1分患者的中位PFS时间（13.2、18.7个月；P<0.001）和中位OS时间（29.9、34.8个月；P=0.007）均显著延长。在化疗敏感性方面，PFI<6个月患者的中位KELIM评分显著低于PFI≥6个月的患者（0.8、1.2分；P=0.005）；在IDS的手术结局方面，IDS达到R0切除患者的中位KELIM评分显著高于未达到R0切除的患者（1.2、0.7分；P<0.001）。（3）单因素分析显示，IDS未达到R0切除、CRS分级为CRS3、未使用聚二磷酸腺苷核糖聚合酶（PARP）抑制剂维持治疗、KELIM评分<1分均为显著影响接受NACT+IDS治疗的HGSOC患者OS时间的危险因素（P均<0.05）；多因素分析显示，IDS未达到R0切除（HR=3.78，95%CI为1.13~12.66；P=0.031）、未使用PARP抑制剂维持治疗（HR=7.41，95%CI为1.82~30.15；P=0.005）、KELIM评分<1分（HR=5.14，95%CI为1.41~18.72；P=0.013）均为影响接受NACT+IDS治疗的HGSOC患者OS时间的独立危险因素。 结论： KELIM评分可作为接受NACT+IDS治疗的HGSOC患者的化疗敏感性、IDS能否达到R0切除、中位PFS和OS时间的预测指标，且KELIM评分<1分为影响患者OS时间的独立危险因素。.
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