Predictive Value of the CA-125 Elimination Rate Constant K (KELIM) in Predicting Progression-Free Survival and Overall Survival in Epithelial Ovarian Cancer

Abstract

Background: It is crucial to predict the response to chemotherapy and identify prognostic markers for recurrence and survival in patients with epithelial ovarian cancer (EOC), in order to effectively manage patient care. The CA-125 elimination rate constant K (KELIM) has recently been developed as a means of assessing the chemotherapy response and has been tested mainly in patients enrolled in randomized controlled trials. The objective of this study was to investigate whether the KELIM score is a prognostic marker for progression-free survival (PFS) and overall survival (OS) in EOC, utilizing its role in predicting the chemotherapy response in real-life settings. Method: Demographic, surgical, and survival data of patients with EOC operated on in Antalya Training and Research Hospital between January 2015 and December 2021 were obtained from the electronic gynecological oncology clinic database system and analyzed retrospectively. Results: A total of 102 patients with EOC were included; 30 patients (29.4%) had a KELIM score ≥ 1 and 72 (70.6%) patients had a KELIM score < 1. In the group with a KELIM score < 1, recurrence and refractory disease occurred in 49 patients, while it was 11 patients in the group with a KELIM score ≥ 1 (p = 0.004). PFS was 12 months and 32 months in the groups with KELIM scores of <1 and ≥1, respectively (p = 0.012). There was no difference between groups regarding OS (p = 0.139). In the whole group, KELIM score (<1 vs. ≥1) and type of surgery (IDS vs. PDS) were found to be independent prognostic factors for PFS (RR = 0.44; 95%CI: 0.22-0.88; p = 0.021 and RR = 2.97; 95%CI: 1.76-5.01; p < 0.001, respectively). Conclusion: We found that a favorable KELIM score was associated with better PFS in all groups of patients undergoing surgery for EOC in a real-life setting. With the increasing number of studies, the KELIM score will play an important role in providing better guidance to clinicians at the initial presentation of patients and in subsequent treatment planning.

Keywords: epithelial ovarian cancer; interval debulking; overall survival; primary debulking; progression-free survival.

Figure 1

(A). OS curves for patients with Stage III–IV disease and KELIM scores of <1 and ≥1 in groups without neoadjuvant chemotherapy. (B). Survival curves for patients with KELIM scores of <1 and ≥1 in groups with neoadjuvant chemotherapy (p = 0.603).

Figure 2

(A). PFS curves for patients with Stage III–IV disease and KELIM scores of <1 and ≥1 in groups without neoadjuvant chemotherapy. (B). Survival curves for patients with KELIM scores of <1 and ≥1 in groups with neoadjuvant chemotherapy (p = 0.440).