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Validation of the KELIM score as a predictor of response to neoadjuvant treatment in patients with advanced high grade serous ovarian cancer

Published:October 27, 2022DOI:https://doi.org/10.1016/j.ygyno.2022.10.014

      Highlights

      • KELIM score may be a marker of chemosensitivity in patients with ovarian cancer treated with neoadjuvant chemotherapy.
      • Patients with a KELIM<1 had a lower progression free- and overall survival compared to patients with KELIM ≥1.
      • Patients with KELIM<1 had higher risk of disease progression and death compared to patients with KELIM ≥1.
      • BRCA positive mutation status was independently associated with a higher KELIM score.
      • Patients with KELIM<1 were more likely to have platinum-resistant disease and worse progression free- and overall survival.

      Abstract

      Objective

      The objective of this study is to externally validate the KELIM (rate of elimination of CA-125 elimation) score in patients with high grade serous ovarian cancer(HGSC)undergoing NACT and determine its relation to outcome of cytoreduction, platinum sensitivity, progression free(PFS) and overall survival(OS).

      Methods

      This is a retrospective cohort study of patients with Stage III-IV HGSC diagnosed between January 1, 2010 and December 31, 2019 and treated with NACT. KELIM score was calculated using at least 3 CA-125 values within the first 100 days of chemotherapy. Demographic parameters were collected and Kaplan Meier survival analyses were performed for PFS and OS. This study was approved by local ethics board.

      Results

      217 patients met inclusion criteria. Median follow-up was 28.93 months(range 2.86–135.06). There was no significant difference in stage, functional status, cytoreductive outcome or BRCA status(germline or somatic) between patients with a KELIM ≥ 1 and <1. Patients with a KELIM<1 had a lower median PFS (13.58 vs 19.69, p < 0.001), median platinum free interval(PFI) (7.66 vs 13.64, p < 0.001) and 5-year OS (57% vs 72%, p = 0.0140) compared to patients with KELIM≥1 . After adjusting for stage, treatment delays, bevacizumab or poly adenosine diphosphate-ribose polymerase(parp)-inhibitor use, and BRCA status, patients with KELIM<1 had a high risk of disease progression(HR = 1.57 (95% CI 1.08–2.28) and death(HR = 1.99 (95% CI 1.01–3.95) compared to KELIM≥1. BRCA status was independently associated to an increase on KELIM score (OR = 1.917, 95% CI 1.046–3.512, p = 0.035).

      Conclusion

      Patients with advanced HGSC undergoing NACT with a KELIM <1 were more likely to have platinum-resistant disease, worse PFS and worse OS when compared to patients with KELIM≥1. The KELIM score can be a helpful tool to predict chemo-response and aid in treatment decision making.

      Keywords

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