Prognostic value of KELIM in Japanese patients with advanced high-grade serous ovarian carcinoma and its association with pathological absence of malignancy at interval debulking surgery: A retrospective study
Yuki Kochi, Daito Noguchi, Chie Nagata, Midori Ogasawara, Risako Nonaka, Ryuko Sugita, Satoshi Hosoya, Motoaki Saito, Hiroshi Tanabe, Hirokuni Takano, Kyosuke Yamada, Aikou Okamoto, Nozomu YanaiharaBackground
The CA-125 ELIMination rate constant K (KELIM) has been reported to predict prognosis and chemosensitivity in patients with high-grade serous ovarian carcinoma (HGSOC); however, Japanese data are limited. Dose-dense paclitaxel-carboplatin (ddTC) may benefit patients with high-risk features compared with conventional paclitaxel-carboplatin (cTC). Conversely, some patients receiving effective neoadjuvant chemotherapy (NAC) show no pathological malignancy at interval debulking surgery (IDS).
Objectives
To evaluate the prognostic value of KELIM in Japanese HGSOC, and explore its association with outcomes according to chemotherapy and pathological findings at IDS.
Design
Multicenter retrospective observational study.
Methods
Patients with FIGO stage III/IV HGSOC treated between 2012 and 2021 were included. KELIM was calculated using at least three CA-125 values obtained during the first 100 days of first-line chemotherapy, including values from the first three cycles when available. First, we evaluated KELIM as a prognostic indicator using the conventional threshold of 1.0. Second, patients were stratified into “Good” (favorable KELIM plus complete cytoreduction) and “Poor” (unfavorable KELIM and/or residual tumor) cohorts, and survival outcomes were compared between ddTC and cTC within these cohorts. Third, among patients who underwent complete IDS, we evaluated the association between KELIM during NAC and absence of residual pathological malignancy.
Results
Among 309 patients, the median KELIM was 1.1. Using the conventional cut-off of 1.0, KELIM stratified progression-free survival (PFS) and overall survival (OS) with significant difference. The Good cohort showed better PFS/OS than the Poor cohort. Overall, ddTC was associated with longer PFS than cTC in multivariable analysis (adjusted HR 0.72, 95% CI 0.54-0.98). In the Poor cohort, ddTC improved OS (HR 0.65, 95% CI 0.43-0.99). Among 98 patients who underwent complete IDS, 24 had no residual malignancy and showed higher KELIM than those with residual disease (median 1.65 vs. 1.25,
Conclusion
KELIM provided prognostic information in Japanese HGSOC patients. Moreover, higher KELIM may identify greater chemosensitivity and absence of residual malignancy at IDS; prospective validation is required before clinical application.