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Does tumour biology determine surgical success in the treatment of epithelial ovarian cancer? A systematic literature review
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Abstract
BACKGROUND:
Ovarian cancer is the most lethal gynaecological cancer. Progression-
free and overall survival is significantly related to surgical success
and residual disease volume. It is unclear whether this survival
advantage is due to an intrinsic biological element of the tumour cells
which enables successful surgery and improved prognosis, or
alternatively the number of tumour sustaining cells remaining
irrespective of differences in biology.
METHODS: A systematic review of
the literature was performed identifying studies that have investigated
the association between biomarkers and surgical outcomes. We attempted
validation of these results using The Cancer Genome Atlas ovarian cancer
data sets.
RESULTS: Thirty studies were identified of which sixteen
determined protein expression, eight gene expression and one DNA
methylation in association with surgical debulking. Individualised
linear models adjusting for batch, stage and age identified only
expression of the genes MTDH and insulin-like growth factor-1 receptor
(IGFIR) to be significantly associated with debulking surgery (P <
0.05, false discovery rate (FDR) < 5%), although in the case of IGFIR
this was in the opposite direction to previous findings.
CONCLUSION:
The majority of studies are limited by design, include heterogeneous
samples and lack adjustment for major confounding factors. High quality
detailed clinical annotations should be routinely collected in future to
more accurately evaluate biomarkers of surgical outcome.
British
Journal of Cancer (2012) 107, 1069-1074. doi:10.1038/bjc.2012.376
www.bjcancer.com Published online 30 August 2012 (c) 2012 Cancer
Research UK
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