Predictors of residual disease after debulking surgery in advanced stage ovarian cancer.

Optimal debulking with no macroscopic residual disease strongly predicts ovarian cancer survival. The ability to predict likelihood of optimal debulking, which may be partially dependent on tumor biology, could inform clinical decision-making regarding use of neoadjuvant chemotherapy. Thus, we developed a prediction model including epidemiological factors and tumor markers of residual disease after primary debulking surgery. Univariate analyses examined associations of 11 pre-diagnosis epidemiologic factors (n=593) and 24 tumor markers (n=204) with debulking status among incident, high-stage, epithelial ovarian cancer cases from the Nurses' Health Studies and New England Case Control study. We used Bayesian model averaging (BMA) to develop prediction models of optimal debulking with 5x5-fold cross-validation and calculated the area under the curve (AUC). Current aspirin use was associated with lower odds of optimal debulking compared to never use (OR=0.52, 95%CI=0.31-0.86) and two tissue markers, ADRB2 (OR=2.21, 95%CI=1.23-4.41) and FAP (OR=1.91, 95%CI=1.24-3.05) were associated with increased odds of optimal debulking. The BMA selected aspirin, parity, and menopausal status as the epidemiologic/clinical predictors with the posterior effect probability ≥20%. While the prediction model with epidemiologic/clinical predictors had low performance (average AUC=0.49), the model adding tissue biomarkers showed improved, but weak, performance (average AUC=0.62). Addition of ovarian tumor tissue markers to our multivariable prediction models based on epidemiologic/clinical data slightly improved the model performance, suggesting debulking status may be in part driven by tumor characteristics. Larger studies are warranted to identify those at high risk of poor surgical outcomes informing personalized treatment.

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Copyright © 2023 Abbas-Aghababazadeh, Sasamoto, Townsend, Huang, Terry, Vitonis, Elias, Poole, Hecht, Tworoger and Fridley.

Déclaration de conflit d'intérêts

NS reports grants from NCI, DOD, Marsha Rivkin Center for Ovarian Cancer Research. TH report grants from NHLBI. KLT reports grants from NIH. KE reports funding from Abcam; royalties from Aspira Women’s Health; consultant of Bluestar Genomics; personal fees from Expert Institute; and is a member of the Enhanced Recovery After Surgery USA unpaid. EP reports grants from NIH. SST reports grants from NIH/NCI, DOD, Rivkin Center, State of Florida, BMS; personal fees from AACR, Ponce Health Science University, Ovarian Cancer Research Alliance, German Cancer Research Center, Harvard T.H. Chan School of Public Health, and NIH outside of submitted work; and is a member of external advisory committee of California Teachers Study City of Hope and The Tomorrow Project Alberta Cancer Center. The remaining authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.