Monday, January 21, 2013
U.S. Cancer statistics, 2013 - A Cancer Journal for Clinicians - Wiley Online Library
Cancer statistics, 2013 - Siegel - 2013 - CA: A Cancer Journal for Clinicians - Wiley Online Library
| Ovary | estimated new cases 22,240 |
Sunday, January 20, 2013
Phase II clinical trial of bevacizumab with albumin-bound paclitaxel in patients with recurrent, platinum-resistant primary epithelial ovarian or primary peritoneal carcinoma
Phase II clinical trial of bevacizumab with albumin-bound paclitaxel in patients with recurrent, platinum-resistant primary epithelial ovarian or primary peritoneal carcinoma
Highlights
►
Ab-paclitaxel with bevacizumab demonstrated substantial antitumor
activity with response rate of 50% and median PFS of 8.08 months.
► Toxicity profile was manageable with the most common grade 3–4 adverse events including gastrointestinal disorders, neutropenia, and hypertension.
► Toxicity profile was manageable with the most common grade 3–4 adverse events including gastrointestinal disorders, neutropenia, and hypertension.
Abstract
Objective
We
examined the safety and efficacy of combining bevacizumab with
albumin-bound (ab-) paclitaxel to treat patients with recurrent,
platinum-resistant primary epithelial ovarian or peritoneal carcinoma.
Methods
Patients
had measurable disease per RECIST guidelines, progressing within
6 months after a prior course of platinum-based treatment. Patients
received ab-paclitaxel 100 mg/m2 given by intravenous
infusion over 30 min on days 1, 8, and 15 of a 28-day cycle with
bevacizumab 10 mg/kg given on days 1 and 15.
Results
Forty-eight
patients with an average 1.8 prior lines of treatment participated. The
overall response rate was 50% (24/48) (95% CI, 34.8% – 65.1%), with 4
complete and 20 partial responses. Fourteen patients (29%) had stable
disease, whereas eight (17%) had progressive disease, and two (4%) were
not evaluable. Patients received a median of 6 treatment cycles (range, 1
– 31 cycles). The median progression-free survival was 8.08 months (95%
CI, 5.78 – 10.15 months); 6 month progression-free rate was 62.5% (95%
CI, 47.8%–77.2%); median overall survival was 17.15 months (95% CI,
13.57 – 23.82 months). Grade 3–4 adverse events included
gastrointestinal disorders (18.8%), neutropenia (8.3%), and hypertension
(6.3%).
Conclusions
Ab-paclitaxel
with bevacizumab clearly demonstrates antitumor activity and manageable
toxicity profile in patients with recurrent, platinum-resistant ovarian
carcinoma. This regimen should be evaluated in a larger randomized
trial.
Comparison of methods to estimate health state utilities for ovarian cancer using quality of life data: A Gynecologic Oncology Group study
Comparison of methods to estimate health state utilities for ovarian cancer using quality of life data: A Gynecologic Oncology Group study
Highlights
►
Cost analyses of ovarian cancer treatment could be biased if estimation
methods are used to measure quality-adjusted life years.
► Comparisons of several utility-estimation methods found significant differences (p < 0.001) between the utility values from these methods. ► There's a need to validate utility estimation methods before they can be recommended for cost analyses in ovarian cancer.
► Comparisons of several utility-estimation methods found significant differences (p < 0.001) between the utility values from these methods. ► There's a need to validate utility estimation methods before they can be recommended for cost analyses in ovarian cancer.
Abstract
Background
Cost-effectiveness/cost-utility
analyses are increasingly needed to inform decisions about care.
Algorithms have been developed using the Functional Assessment of Cancer
Therapy (FACT) quality of life instrument to estimate utility weights
for cost analyses. This study was designed to compare these algorithms
in the setting of ovarian cancer.
Methods
GOG-0152
was a 550-patient randomized phase III trial of interval cytoreduction,
and GOG-0172 was a 415-patient randomized phase III trial comparing
intravenous versus intraperitoneal therapy among women with advanced
ovarian cancer. QOL data were collected via the FACT at four time points
in each study. Two published mapping algorithms (Cheung and Dobrez) and
a linear transformation method were applied to these data. The
agreement between measures was assessed by the concordance correlation
coefficient (rCCC), and paired t-tests were used to compare means.
Results
While agreement between the estimation algorithms was good (ranged from 0.72 to 0.81), there were statistically significant (p < 0.001)
and clinically meaningful differences between the scores: mean scores
were higher with Dobrez than with Cheung or the linear transformation
method. Scores were also statistically significantly different (p < 0.001) between studies.
Conclusions
In
the absence of prospectively collected utility data, the use of mapping
algorithms is feasible, however, the optimal algorithm is not clear.
There were significant differences between studies, which highlight the
need for validation of these algorithms in specific settings. If cost
analyses incorporate mapping algorithms to obtain utility estimates,
investigators should take the variability into account.
Clinicopathologic features of brain metastases from gynecologic malignancies: A retrospective study of 139 cases (KCOG-G1001s trial)
Clinicopathologic features of brain metastases from gynecologic malignancies: A retrospective study of 139 cases (KCOG-G1001s trial)
Highlights
►
Brain metastases from ovarian/tubal/peritoneal cancer revealed better
prognosis compared to those from corpus cancer or cervical cancer. ►
Ovarian/tubal/peritoneal origin, KPS > 70, single metastasis, absence
of extracranial disease, cranial surgery, radiotherapy, and
chemotherapy are independent favorable prognostic factors. ► Aggressive
multimodal therapy is warranted in the treatment of brain metastases
from gynecologic malignancies in carefully selected patients.
Abstract
Objective
Although
brain metastases from gynecologic malignancies are rare, such cases
have been gradually increasing in number. The aim of the present study
was to evaluate the clinicopathologic features and prognostic factors of
brain metastases from gynecologic malignancies.
Methods
Retrospective
analysis of 139 patients with brain metastases from gynecologic
malignancies was carried out as a multi-institutional study. The
clinicophathological data of the patients were collected from medical
records.
Results
Median survival
time of the patients with brain metastases was 12.5 months for the
ovarian cancer group, 6.2 months for the corpus cancer group, and
5.0 months for the cervical cancer group; two-year overall survival
rates were 19.7%, 6.1%, and 4.8%, respectively. Multivariate analysis
revealed ovarian/tubal/peritoneal origin, KPS > 70, single brain
metastasis, absence of extracranial disease, cranial surgery, cranial
radiotherapy, and chemotherapy to be independent favorable prognostic
factors associated with overall survival.
Conclusion
It
is considered that aggressive multimodal therapy is warranted in the
treatment of brain metastases from gynecologic malignancies in carefully
selected patients. The present study may provide a platform for the
discussion of management strategies in these rare clinical scenarios.
Is perioperative visual estimation of intra-abdominal tumor spread reliable in ovarian cancer surgery after neoadjuvant chemotherapy?
Is perioperative visual estimation of intra-abdominal tumor spread reliable in ovarian cancer surgery after neoadjuvant chemotherapy?
Highlights
►
Visual estimation of tumor spread in advanced epithelial ovarian cancer
is impaired by the use of neoadjuvant chemotherapy. ► This may lead to
leaving microscopic residual tumor in the patient in interval debulking
surgery.
► This hypothesis should be tested in prospective studies specifically designed to address this issue.
► This hypothesis should be tested in prospective studies specifically designed to address this issue.
Abstract
Objective
Most
cases of epithelial ovarian cancer (EOC) are diagnosed in an advanced
stage. When the disease has spread intra-abdominally, complete surgical
tumor debulking is the single most important prognostic factor.
Neoadjuvant chemotherapy (NACT) before surgery can cause fibrosis and
adhesions in the peritoneal cavity and may interfere with the
perioperative evaluation of tumor spread. In this prospective study, we
evaluated whether perioperative visual assessment of tumor dissemination
is similar in patients undergoing primary and interval surgery for EOC.
Methods
Systematic visual evaluation of tumor spread was performed at the start of primary surgery/diagnostic laparoscopy (n = 39) or interval surgery (n = 16).
Peritoneal cavity was divided into 22 anatomical regions. The carefully
documented results of the visual assessment were compared with the
histopathological analysis of 220 biopsies from primary and 92 biopsies
from interval surgery.
Results
In
primary surgery, perioperative visual estimation of tumor spread showed
98% sensitivity, 76% specificity and 95% accuracy compared to
histopathology. The corresponding figures after NACT were 86%, 76% and
84%, respectively. The difference in sensitivity and accuracy in primary
and interval operations was statistically significant (p < 0.001).
Conclusions
In
advanced EOC, microscopically carcinomatous areas have a benign visual
appearance more often after NACT than at primary surgery. NACT may
interfere with the perioperative visual evaluation of tumor spread and
thus lead to incomplete resection of tumor in potentially resectable
areas.
Platinum resistance after neoadjuvant chemotherapy compared to primary surgery in patients with advanced epithelial ovarian carcinoma
Platinum resistance after neoadjuvant chemotherapy compared to primary surgery in patients with advanced epithelial ovarian carcinoma
Highlights
►
In patients that have a recurrence and are treated with platinum
chemotherapy, neoadjuvant chemotherapy increased the risk of platinum
resistance.
► The timing of interval surgery should be based on the chemotherapy response not in a fixed number of chemotherapy cycles.
► The timing of interval surgery should be based on the chemotherapy response not in a fixed number of chemotherapy cycles.
Abstract
Objective
Primary
debulking surgery (PDS) has historically been the standard treatment
for advanced ovarian cancer. Recent data appear to support a paradigm
shift toward neoadjuvant chemotherapy with interval debulking surgery
(NACT-IDS) for a subset of women with advanced ovarian cancer. It
remains unresolved whether NACT-IDS increases the risk of platinum
resistance. We compared response to chemotherapy in patients that
received NACT-IDS vs. PDS.
Methods
From
our Cancer Registry database we identified patients with stage IIIC and
IV epithelial ovarian cancer who underwent treatment from January, 2005
to December, 2010. Standard univariate analyses were performed, as were
multivariable analysis with logistic regression. The Kaplan-Meier
method was used to generate survival data.
Results
The
study population consisted of 425 patients, 95 (22.3%) underwent
NACT-IDS and 330 (77.6%) PDS. After the initial platinum-based
chemotherapy, 42 (44.2%) women in the NACT-IDS group were considered to
have platinum resistant disease, compared to 103 (31.2%) in the PDS
group (P = 0.01). When multivariate logistic regression was used to
control for factors independently associated with platinum resistance,
NACT-IDS was no longer associated with an initial increased risk.
However, in women that had a recurrence and were retreated with
platinum-based chemotherapy, 32 (88.8%) in the NACT-IDS group had
developed a recurrence within in six months and were considered platinum
resistance, compared to 62 (55.3%) in the PDS (P < 0.001).
Conclusion
In
women with EOC that have a recurrence and are treated again with
platinum-based chemotherapy, NACT-IDS appears to increase the risk of
platinum resistance.
A Phase II Evaluation of Motesanib (AMG 706) in the Treatment of Persistent or Recurrent Ovarian, Fallopian Tube and Primary Peritoneal Carcinomas: A Gynecologic Oncology Group Study.
A Phase II Evaluation of Motesanib (AMG - PubMed Mobile
A Phase II Evaluation of Motesanib (AMG 706) in the Treatment of Persistent or Recurrent Ovarian, Fallopian Tube and Primary Peritoneal Carcinomas: A Gynecologic Oncology Group Study.
Abstract
OBJECTIVES: Vascular
endothelial growth factors (VEGF) and their receptors have a critical
role in stimulating the growth of ovarian cancer cells. Motesanib is a
small molecule inhibitor of multiple receptor tyrosine kinases including
VEGF receptors 1-3, as well as c-KIT and platelet-derived growth factor
which are related to the VEGF family.
Patients and Methods Twenty-two
eligible patients with recurrent ovarian, fallopian tube or primary
peritoneal carcinoma were treated with an oral daily dose of 125mg of
motesanib. Peripheral blood was analyzed for circulating tumor cells
(CTC) and circulating endothelial cells/circulating endothelial
progenitors (CEC/CEP), VEGF levels and cell-free circulating DNA
(cfDNA).
RESULTS: The
study was abruptly halted after four patients developed posterior
reversible encephalopathy syndrome. One patient had a partial response
and seven patients had stable disease at the time they were removed from
study treatment. Twelve of the 22 patients (50%) had indeterminate
responses at trial closure. Early closure without clinical efficacy data
precludes meaningful correlative studies.
CONCLUSIONS: The
serious central nervous system toxicity observed in patients with
recurrent ovarian cancer precluded full examination of this agent in
this population. There were no clear cut explanations for the high
incidence of this known class effect in the study population compared
with patients with other cancers.
Saturday, January 19, 2013
Quality of life in ICON7: need for patients' perspectives : The Lancet Oncology
Blogger's Note: open access after registration (free)
Quality of life in ICON7: need for patients' perspectives : The Lancet Oncology
"Stark and coworkers' findings about quality of life are highly relevant to clinicians treating women with ovarian cancer, particularly in view of the absence of overall survival benefits in the study population. Is the noted quality-of-life decrement during both primary and maintenance bevacizumab treatment outweighed by the roughly 2 month improvement in progression-free survival? This question is especially difficult to answer because ICON7 did not assess quality of life at the time of disease progression. Although quality of life was assessed at 36 months, these data are not reported by Stark and colleagues."
"It is up to the oncology community to establish where the balance of benefit and harm with bevacizumab lies, as expanded upon by Stark and colleagues. Women with ovarian cancer, however, will ultimately bear the burden of interpretations of such trials, and thus should be asked to assess the inherent tradeoffs implicated in new treatments."
Standard chemotherapy with or without bevacizumab in advanced ovarian cancer: quality-of-life outcomes from the International Collaboration on Ovarian Neoplasms (ICON7) phase 3 randomised trial : The Lancet Oncology
Blogger's Note: open access after registration (free)
Standard chemotherapy with or without bevacizumab in advanced ovarian cancer: quality-of-life outcomes from the International Collaboration on Ovarian Neoplasms (ICON7) phase 3 randomised trial : The Lancet Oncology
Longitudinal Screening Algorithm That Incorporates Change Over Time in CA125 Levels Identifies Ovarian Cancer Earlier Than a Single-Threshold Rule
Longitudinal Screening Algorithm That Incorporates Change Over Time in CA125 Levels Identifies Ovarian Cancer Earlier Than a Single-Threshold Rule
Abstract
Purpose Longitudinal
algorithms incorporate change over time in biomarker levels to
individualize screening decision rules. Compared
with a single-threshold (ST) rule, smaller
deviations from baseline biomarker levels are required to signal
disease. We demonstrated
improvement in ovarian cancer early detection by
using a longitudinal algorithm to monitor annual CA125 levels.
Patients and Methods
We retrospectively evaluated serial preclinical serum CA125 values
measured annually in 44 incident ovarian cancer cases
identified from participants in the PLCO
(Prostate Lung Colorectal and Ovarian) Cancer Screening Trial to
determine how frequently
and to what extent the parametric empirical
Bayes (PEB) longitudinal screening algorithm identifies ovarian cancer
earlier
than an ST rule.
Results The PEB
algorithm detected ovarian cancer earlier than an ST rule in a
substantial proportion of cases. At 99% specificity,
which corresponded to the ST-rule CA125 cutoff ≥
35 U/mL that was used in the PLCO trial, 20% of cases were identified
earlier
by using the PEB algorithm. Among these cases,
the PEB signaled abnormal CA125 values, on average, 10 months earlier
and at
a CA125 concentration 42% lower (20 U/mL) than
the ST-rule cutoff. The proportion of cases detected earlier by the PEB
algorithm
and the earliness of detection increased as the
specificity of the screening rule was reduced.
Conclusion The PEB
longitudinal algorithm identifies ovarian cancer earlier and at lower
biomarker concentrations than an ST screening
algorithm adjusted to the same specificity.
Longitudinal biomarker assessment by using the PEB algorithm may have
application
for screening other solid tumors in which
biomarkers are available.
Involvement of pelvic inflammation-related mismatch repair abnormalities and microsatellite instability (Lynch syndrome) in the malignant transformation of ovarian endometriosis
Involvement of pelvic inflammation-rela - PubMed Mobile
Involvement of pelvic inflammation-related mismatch repair abnormalities and microsatellite instability in the malignant transformation of ovarian endometriosis.
Abstract
Inflammation
in the ovary, including ovulation and pelvic inflammatory disease, has
been proposed to play a role in the pathogenesis of ovarian cancer.
Endometriotic lesions trigger a local inflammatory reaction and have
been reported to be associated with an increased risk of epithelial
ovarian cancer. However, the precise molecular mechanisms of ovarian
cancer arising from endometriosis are still to be elucidated. To clarify
the involvement of mismatch repair (MMR) abnormalities in the
inflammation-associated malignant transformation of endometriosis, the
immunohistochemical expression of mismatch repair proteins (human mutL
homolog 1 [hMLH1] and human mutS homolog 2 [hMSH2]) was examined in 27
cases of ovarian endometriosis, 25 cases of ovarian carcinoma
accompanied by endometriosis, and 39 cases of solitary ovarian
carcinoma. In addition, the relationship between mismatch repair
abnormalities including the microsatellite instability, PTEN
(phosphatase and tensin homolog) mutation, and clinicopathologic
parameters was analyzed. The expression of mismatch repair proteins was
stepwisely decreased in endometriosis, ovarian carcinoma accompanied by
endometriosis, and ovarian carcinoma. Tumors harboring multiple
microsatellite instability (high-frequency microsatellite instability
[MSI-H]) were detected in 4 (14.8%) of 27 cases of endometriosis and 7
(30.4%) of 23 cases of ovarian carcinomas. The frequency of PTEN
mutations was higher in MSI-H cases than in microsatellite
instability-stable (MSI-S) cases. In 2 cases of ovarian carcinoma
accompanied by endometriosis, the decreased expression of mismatch
repair proteins and MSI-H was observed in both the endometriosis and
carcinoma lesions. Clinicopathologically, the MSI-H cases were
associated with elevated serum levels of C-reactive protein and higher
white blood cell counts. These findings suggest that mismatch repair
abnormalities might be involved in the malignant transformation of
ovarian endometriosis and that inflammation induces mismatch repair
abnormalities during ovarian carcinogenesis arising from endometriosis.
High impact of FDG-PET/CT in diagnostic strategies for ovarian cancer
High impact of FDG-PET/CT in diagnostic strategies for ovarian cancer
Abstract
Background Ovarian
cancer has the highest mortality of all gynecologic malignancies.
FDG-PET/CT was proven to be accurate for identification
of primary ovarian tumors, regional lymph nodes,
and distant metastases.
Purpose To evaluate ovarian masses at FDG-PET/CT in correlation with histopathologic findings.
Material and Methods Ninety-eight patients underwent whole body FDG-PET/CT examination. Eighty-six patients with primary ovarian cancer and 12
patients with metastatic disease to the ovaries were included.
Results PET/CT imaging
was true-positive in 87/94 patients with malignant tumors. In 4/4
patients with benign tumors, PET/CT results
were true-negative, with sensitivity of 92.6%,
specificity 100%, total test accuracy 92.9%. Fifty-seven patients were
diagnosed
as stage IV ovarian cancer with distant
metastasis.
Conclusion The anatomical/functional examination by FDG-PET/CT was proven to be valuable in increasing the diagnostic accuracy that
can help improve patient management.
Considerations Regarding the Administration of Systemic Therapy for Elderly Patients With Ovarian Cancer.
Considerations Regarding the Administration of Systemic Therapy for Elderly Patients With Ovarian Cancer.
Source
Gynecologic Medical Oncology Service, Department of Medicine, Memorial Sloan-Kettering Cancer Center, 300 East 66th Street, New York, NY, 10065, USA, teww@mskcc.org.Abstract
OPINION STATEMENT: To improve the benefit and tolerability of cancer treatment, we must develop new geriatric-specific trials, better assessment tools, and encourage enrollment of older patients in clinical trials. Age is a strong predictor of survival in ovarian cancer and often influences the treatment plan. Elderly patients, broadly defined as older than age 65 years, are commonly not offered participation in clinical research or provided with substandard chemotherapy or surgical options. Because first-line, platinum-based chemotherapy with cytoreductive surgery is a potentially curative modality, all standard treatment options should be explored (intravenous, neoadjuvant, and/or intraperitoneal chemotherapy). However, one must balance the specific needs of the older patient and be aware of the increased risk of side effects. To be mindful and respectful, the oncologist should clearly define the goals (palliative vs. curative) and specific risks of treatment to patients and their families. As the field of geriatric oncology evolves and prospective trials tailored to older women with ovarian cancer are developed, specific guidelines will ultimately assist in these difficult decisions.open access: PROGNOSTIC VALUE OF SERUM CA-125 IN PATIENTS WITH ADVANCED EPITHELIAL OVARIAN CANCER FOLLOWED BY COMPLETE REMISSION AFTER ADJUVANT CHEMOTHERAPY (study of 120 patients)
PROGNOSTIC VALUE OF SERUM CA-125 IN PATIENTS WITH ADVANCED EPITHELIAL OVARIAN CANCER FOLLOWED BY COMPLETE REMISSION AFTER ADJUVANT CHEMOTHERAPY
Jong Ho Moon, Hyo Jin Lee, Woo Dae Kang, Chul Hong Kim, Ho Sun Choi, Seok Mo Kim
Department of Obstetrics and Gynecology, Chonnam National University Medical School, Gwangju, Korea
open access: BJC - Quaternary cytoreductive surgery in ovarian cancer: does surgical effort still matter[quest]
Quaternary: four things collectively; a group of four facts or circumstances.
British Journal of Cancer - Quaternary cytoreductive surgery in ovarian cancer: does surgical effort still matter
Reproductive characteristics in relation to ovarian cancer risk by histologic pathways
Reproductive characteristics in relation to ovarian cancer risk by histologic pathways
Author Affiliations
Abstract
STUDY QUESTION Do reproductive risk factor associations differ across subgroups of invasive epithelial ovarian cancer (EOC) defined by the
dualistic model (type I/II) or a histologic pathway-based classification?
SUMMARY ANSWER Associations with parity, history of endometriosis, tubal ligation and hysterectomy were found to differ in the context of
the type I/II and the histologic pathways classification of ovarian cancer.
WHAT IS KNOWN ALREADY Shared molecular alterations and candidate precursor lesions suggest that tumor histology and grade may be used to classify
ovarian tumors into likely etiologic pathways.
DESIGN This
case–control study included 1571 women diagnosed with invasive EOC and
2100 population-based controls that were enrolled
from 1992 to 2008. Reproductive risk factors as
well as other putative risk factors for ovarian cancer were assessed
through
in-person interviews.
PARTICIPANTS/MATERIALS, SETTING, METHODS
Eligible cases were diagnosed with incident ovarian cancer, were aged
18 and above and resided in eastern Massachusetts or
New Hampshire, USA. Controls were identified
through random digit dialing, drivers' license and town resident lists
and were
frequency matched with the cases based on age
and study center.
MAIN RESULTS AND THE ROLE OF CHANCE
We used polytomous logistic regression to estimate odds ratios (ORs)
and 95% confidence intervals (CIs) for type I/II EOC
or using a pathway-based grouping of histologic
subtypes. In multivariate analyses, we observed that having a history of
endometriosis
(OR = 1.92, 95% CI: 1.36–2.71) increased the
risk for a type I tumor. Factors that were strongly inversely associated
with
risk for a type I tumor included parity (≥3
versus 0 children, OR = 0.15, 95% CI: 0.11–0.21), having a previous
tubal ligation
(OR = 0.40, 95% CI: 0.26–0.60) and more weakly
hysterectomy (OR = 0.71, 95% CI: 0.45–1.13). In analyses of histologic
pathways,
parity (≥3 versus 0 children, OR = 0.13, 95% CI:
0.10–0.18) and having a previous tubal ligation (OR = 0.41, 95% CI:
0.28–0.60)
or hysterectomy (OR = 0.54, 95% CI: 0.34–0.86)
were inversely associated with risk of endometrioid/clear cell tumors.
Having
a history of endometriosis strongly increased
the risk for endometrioid/clear cell tumors (OR = 2.41, 95% CI:
1.78–3.26).
We did not observe significant differences in
the risk associations across these tumor classifications for age at
menarche,
menstrual cycle length or infertility.
LIMITATIONS, REASONS FOR CAUTION
A potential limitation of this study is that dividing the cases into
subgroups may limit the power of these analyses, particularly
for the less common tumor types. Since cases
were enrolled after their diagnosis, it is possible that the most
aggressive
cases were not included in the study.
WIDER IMPLICATIONS OF THE FINDINGS
This study provides insights about the role of reproductive factors in
relation to risk of pathway-based subgroups of ovarian
cancer that with further confirmation may assist
with the development of improved strategies for the prevention of these
different
tumor types.
STUDY FUNDING/COMPETING INTEREST(S) This research is funded by grants from the National Cancer Institute, the Department of Defense Ovarian Cancer Research Program
and the Ovarian Cancer Research Fund. The authors have no competing interests to declare.
TRIAL REGISTRATION NUMBER Not applicable.
Prospective Studies of Total and Ionized Serum Calcium in Relation to Incident and Fatal Ovarian Cancer.
Prospective Studies of Total and Ionized Serum Calcium in Relation to Incident and Fatal Ovarian Cancer.
Source
Departments of Cancer Biology, Urology, and Epidemiology and Prevention, Wake Forest School of Medicine, Winston-Salem, North Carolina. Electronic address: gschwart@wakehealth.edu.Abstract
OBJECTIVE:
Biological markers that could aid in the detection of ovarian cancer are urgently needed. Many ovarian cancers express parathyroid hormone-related protein, which acts to raise calcium levels in serum. Thus, we hypothesized that high serum calcium levels might predict ovarian cancer.METHODS:
We examined associations between total and ionized serum calcium and ovarian cancer mortality in the Third National Health and Nutrition Survey (NHANES III) using Cox proportional hazard models. We then examined associations of serum calcium with incident ovarian cancer in a second prospective cohort, the NHANES Epidemiological Follow-up Study (NHEFS).RESULTS:
There were eleven deaths from ovarian cancer over 95,556 person-years of follow-up in NHANES III. After multivariable adjustment, the risk for fatal ovarian cancer was 52% higher for each 0.1mmol/L increase in total serum calcium (RH=1.52, 95% CI 1.06 - 2.19) and 144% higher for each 0.1mmol/L increase in ionized serum calcium (RH=2.44, 95% CI=1.45 - 4.09). Associations persisted after adjusting for nulliparity and the use of oral contraceptives. Eight incident ovarian cancers occurred over 31,089 person-years of follow-up in the NHEFS. After adjusting for covariates, there was a 63% higher risk for ovarian cancer with each 0.1mmol/L increase in total serum calcium (95% CI 1.14 - 2.34). Similar results were observed for albumin-adjusted serum calcium.CONCLUSIONS:
Higher serum calcium may be a biomarker of ovarian cancer. This is the first report of prospective positive associations between indices of calcium in serum and ovarian cancer. Our findings require confirmation in other cohorts.Comparative effectiveness of platinum-based chemotherapy versus taxane and other regimens for ovarian cancer.
Med Oncol. 2013 Mar;30(1):440. doi: 10.1007/s12032-012-0440-4. Epub 2013 Jan 10.
Comparative effectiveness of platinum-based chemotherapy versus taxane and other regimens for ovarian cancer.
Source
Division of Epidemiology, Human Genetics, and Environmental Sciences, School of Public Health, University of Texas Health Science Center at Houston, 1200 Herman Pressler Drive, Room RAS-E631, Houston, TX, 77030, USA, xianglin.l.du@uth.tmc.edu.Abstract
The aim was to compare the two most commonly recommended chemotherapy regimens (platinum-based chemotherapy and platinum-taxane combination) with non-platinum-based chemotherapy and those with no chemotherapy in a large nationwide and population-based cohort of patients with ovarian cancer with up to 17 years of follow-up. We studied 12,181 patients diagnosed with stages I-IV ovarian cancer at age ≥65 in 1991-2005 from the 16 areas of the United States. We also performed matched cohort analyses based on conditional probability of receiving platinum chemotherapy in 3,428 patients. In patients with early stage ovarian cancer, those who received platinum-taxane combination had the highest 5-year all-cause (62.5 %) and cancer-specific (65.1 %) survival rates, as compared to 51.5 and 63.7 % in those without chemotherapy. After adjusting for potential confounders, hazard ratios of all-cause mortality (0.66, 95 % CI 0.55-0.79) and cancer-specific mortality (0.74, 0.61-0.90) were significantly lower in patients receiving platinum-taxane combination as compared to those without chemotherapy. Among patients with late-stage ovarian cancer, risks of mortality were significantly reduced in patients who received both platinum and taxane (0.38, 0.36-0.41 for all-cause mortality; 0.40, 0.37-0.42 for cancer-specific mortality). Dose-response relationship appeared strong within each of the three chemotherapy regimens. These results and trends were almost identical in the matched cohort. Platinum-taxane combination chemotherapy and platinum-based chemotherapy without taxane were effective in prolonging survival with a significant dose-response relationship among patients with late-stage ovarian cancer. Among those with early stage tumors, platinum-taxane combination appeared more effective than other chemotherapy regimens.Thursday, January 17, 2013
Cancer of the Ovary - SEER Stat Fact Sheets
Cancer of the Ovary - SEER Stat Fact Sheets
SEER Stat Fact Sheets: Ovary
It is estimated that 22,280 women will be diagnosed with and 15,500 women will die of cancer of the ovary in 20121.
The following information is based on NCI’s SEER Cancer Statistics Review2.Use the links on this page to learn more about each statistic type:
Incidence & Mortality
SEER Incidence
From 2005-2009, the median age at diagnosis for cancer of the ovary was 63 years of age3. Approximately 1.3% were diagnosed under age 20; 3.6% between 20 and 34; 7.4% between 35 and 44; 18.6% between 45 and 54; 23.4% between 55 and 64; 20.1% between 65 and 74; 17.6% between 75 and 84; and 8.1% 85+ years of age.The age-adjusted incidence rate was 12.7 per 100,000 women per year. These rates are based on cases diagnosed in 2005-2009 from 18 SEER geographic areas.
| Race/Ethnicity | Female |
|---|---|
| All Races | 12.7 per 100,000 women |
| White | 13.4 per 100,000 women |
| Black | 9.8 per 100,000 women |
| Asian/Pacific Islander | 9.8 per 100,000 women |
| American Indian/Alaska Native a | 11.2 per 100,000 women |
| Hispanic b | 11.3 per 100,000 women |
US Mortality
From 2005-2009, the median age at death for cancer of the ovary was 71 years of age4. Approximately 0.1% died under age 20; 0.7% between 20 and 34; 2.6% between 35 and 44; 10.9% between 45 and 54; 20.8% between 55 and 64; 24.6% between 65 and 74; 26.6% between 75 and 84; and 13.8% 85+ years of age.The age-adjusted death rate was 8.2 per 100,000 women per year. These rates are based on patients who died in 2005-2009 in the US.....
Tuesday, January 15, 2013
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