Chee Khoon Lee1, Rebecca Asher2, Michael Friedlander3, Val Gebski2, Antonio Gonzalez-Martin4, Alain Lortholary5, Anne Lesoin6, Christian Kurzeder7, Remy Largillier8, Felix Hilpert9, Anne-Claire Hardy-Bessard10, Marie-Christine Kaminsky11, Andres Poveda12, Eric Pujade-Lauraine13. 1. National Health and Medical Research Council Clinical Trials Centre, University of Sydney, Sydney, Australia. Electronic address: chee.lee@ctc.usyd.edu.au. 2. National Health and Medical Research Council Clinical Trials Centre, University of Sydney, Sydney, Australia. 3. Medical Oncology, Prince of Wales Hospital, Sydney, Australia. 4. Grupo Español de Investigación en Cáncer de Ovario (GEICO) and MD Anderson Cancer Center Spain, Madrid, Spain; Clínica Universidad de Navarra, Madrid, Spain. 5. Groupe d'Investigateurs Nationaux pour l'Etude des Cancers Ovariens (GINECO) and Medical Oncology, Hôpital Privé du Confluent S.A.S., Nantes, France. 6. GINECO and Medical Oncology, Centre Oscar Lambret, Lille, France. 7. Arbeitsgemeinschaft Gynäkologische Onkologie (AGO) and Dept. of Gynecology & Gynecologic Oncology, Klinikum Essen Mitte, Essen, Germany. 8. Centre Azuréen de Cancérologie, Mougins, France. 9. AGO and Dept. of Gynecology and Obstetrics, University Hospital Kiel, Kiel, Germany; Mammazentrum am Krankenhaus Jerusalem, Hamburg, Germany. 10. GINECO and Medical Oncology, Centre Armoricain d'Oncologie, CARIO, Plérins sur mer, France. 11. GINECO and Medical Oncology, Institut de Cancérologie de Lorraine, Vandoeuvre-Lès-Nancy, France. 12. GEICO and Instituto Valenciano de Oncología, Valencia, Spain. 13. ARCAGY-GINECO.
Abstract
BACKGROUND:Platinum-resistant ovarian cancer (PROC) is associated with a variable prognosis and unpredictable survival times. We have developed and validated a prognostic nomogram with the objective of improving the prediction of overall survival (OS) in patients treated with chemotherapy. METHODS: The nomogram was developed using data from a training cohort of patients from two trials, including the chemotherapy-only arm in AURELIA and all randomised patients in CARTAXHY. Multivariable proportional hazards models were generated based on pretreatment characteristics to develop a nomogram that classifies patients based on OS. We subsequently assessed the performance of the nomogram in terms of discrimination and calibration in independent validation patient cohorts: PENELOPE and the bevacizumab-chemotherapy arm of AURELIA. RESULTS: The nomogram included six significant OS predictors, in order of importance: performance status, ascites, size of the largest tumour, CA-125, platinum-free interval and primary platinum resistance (C-statistic 0.69). In the training cohort, the median OS in the good, intermediate and poor prognosis groups was 25.3, 15.2 and 7.4 months, respectively. In the PENELOPE validation cohort (C-statistic 0.59), the median OS in the good, intermediate and poor prognosis groups was 18.5, 10.3 and 5.8 months, respectively. In the AURELIA bevacizumab-chemotherapy validation cohort (C-statistic 0.67), the median OS in good, intermediate and poor prognosis groups was 26.7, 13.8 and 10.0 months, respectively. CONCLUSIONS: This nomogram with six pretreatment characteristics allows prediction of OS in PROC and could be used for stratification of patients in clinical trials as well as for counselling patients about prognosis.
RCT Entities:
BACKGROUND:Platinum-resistant ovarian cancer (PROC) is associated with a variable prognosis and unpredictable survival times. We have developed and validated a prognostic nomogram with the objective of improving the prediction of overall survival (OS) in patients treated with chemotherapy. METHODS: The nomogram was developed using data from a training cohort of patients from two trials, including the chemotherapy-only arm in AURELIA and all randomised patients in CARTAXHY. Multivariable proportional hazards models were generated based on pretreatment characteristics to develop a nomogram that classifies patients based on OS. We subsequently assessed the performance of the nomogram in terms of discrimination and calibration in independent validation patient cohorts: PENELOPE and the bevacizumab-chemotherapy arm of AURELIA. RESULTS: The nomogram included six significant OS predictors, in order of importance: performance status, ascites, size of the largest tumour, CA-125, platinum-free interval and primary platinum resistance (C-statistic 0.69). In the training cohort, the median OS in the good, intermediate and poor prognosis groups was 25.3, 15.2 and 7.4 months, respectively. In the PENELOPE validation cohort (C-statistic 0.59), the median OS in the good, intermediate and poor prognosis groups was 18.5, 10.3 and 5.8 months, respectively. In the AURELIA bevacizumab-chemotherapy validation cohort (C-statistic 0.67), the median OS in good, intermediate and poor prognosis groups was 26.7, 13.8 and 10.0 months, respectively. CONCLUSIONS: This nomogram with six pretreatment characteristics allows prediction of OS in PROC and could be used for stratification of patients in clinical trials as well as for counselling patients about prognosis.
Authors: Roman O Kowalchuk; Michael R Waters; K Martin Richardson; Kelly Spencer; James M Larner; William P Irvin; Charles R Kersh Journal: Radiat Oncol Date: 2020-05-13 Impact factor: 3.481