JCO Early Release, published online ahead of print Sep 13 2004
Journal of Clinical Oncology, 10.1200/JCO.2004.10.028
Received October 3, 2003
Accepted April 29, 2004
Should CA-125 Response Criteria Be Preferred to Response Evaluation Criteria in Solid Tumors (RECIST) for Prognostication During Second-Line Chemotherapy of Ovarian Carcinoma?
Bo Gronlund *, Claus Høgdall , Jørgen Hilden , Svend A. Engelholm , Estrid V.S. Høgdall , and Heine H. Hansen
From the Departments of Oncology and Gynecology, Rigshospitalet, Copenhagen University Hospital; Department of Biostatistics, University of Copenhagen; the Department of Clinical Biochemistry, Statens Serum Institute; and Institute of Cancer Epidemiology, Danish Cancer Society, Copenhagen, Denmark.
* To whom correspondence should be addressed. E-mail: bo.gronlund{at}dadlnet.dk
Purpose: The aim of the study was to compare the prognostic value of a response by the Gynecologic Cancer Intergroup (GCIG) Cancer Antigen (CA) -125 response criteria and the Response Evaluation Criteria in Solid Tumors (RECIST) on survival in patients with ovarian carcinoma receiving second-line chemotherapy.
Patients and Methods: From a single-institution registry of 527 consecutive patients with primary ovarian carcinoma, 131 records satisfied the inclusion criteria: ovarian carcinoma of International Federation of Gynecology and Obstetrics stage IC to IV, first-line chemotherapy with paclitaxel and a platinum compound, refractory or recurrent disease, and second-line chemotherapy consisting of topotecan or paclitaxel plus carboplatin. Univariate and multivariate analyses of survival were performed using the landmark method.
Results: In patients with measurable disease by RECIST and with assessable disease by the CA-125 criteria (n = 68), the CA-125 criteria were 2.6 times better than the RECIST at disclosing survival. In a multivariate Cox analysis with inclusion of nine potential prognostic parameters, CA-125 response (responders v nonresponders; hazard ratio, 0.21; P < .001) and number of relapse sites (solitary v multiple; hazard ratio, 0.47; P = .020) were identified as contributory prognostic factors for survival, whereas the parameters of RECIST (responders v nonresponders), as well as the remaining variables, had nonsignificant prognostic impact.
Conclusion: The GCIG CA-125 response criteria are a better prognostic tool than RECIST in second-line treatment with topotecan or paclitaxel plus carboplatin in patients with ovarian carcinoma.
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