Faculty Bibliography

OBJECTIVE:Nomograms have been developed for numerous malignancies to predict a specific individual's probability of long-term survival based on known prognostic factors. To date, only one prediction model has been reported for patients with epithelial ovarian carcinoma (EOC). The objective of this study was to develop a more accurate survival nomogram for patients with bulky stage IIIC EOC. PATIENTS AND METHODS/METHODS:Nomogram predictor variables included age, tumor grade, histologic type, preoperative platelet count, ascites, and residual disease after primary cytoreduction. Disease-specific survival was estimated by the Kaplan-Meier method. Cox proportional hazards regression was used for multivariate analysis, which was the basis for the nomogram. The concordance index was used as an accuracy measure with bootstrapping to correct for optimistic bias. RESULTS:A total of 424 evaluable patients with bulky stage IIIC EOC underwent primary surgery at our institution during the study period of 1/89 to 12/03. All patients received postoperative platinum-based systemic chemotherapy. EOC-specific survival at 5 years was 51%. Using the six predictor variables, a nomogram was constructed and internally validated using bootstrapping. It was shown to have excellent calibration with a bootstrap corrected concordance index of 0.67, which was more accurate in predicting survival at this stage than the previously published model (concordance index=0.53). CONCLUSION/CONCLUSIONS:Utilizing six readily accessible predictor variables, our nomogram more accurately predicted 5-year disease-specific survival for bulky stage IIIC EOC than the previously published model. This tool may be useful for patient counseling, determination of clinical trial eligibility, and postoperative management.

Epidermal growth factor receptor (EGFR) inhibitors are a new biologically targeted therapy, which may offer new hope in the treatment of patients with advanced or recurrent ovarian cancers. In this review, we summarize and discuss the results of research to date on EGFR inhibitors with particular emphasis on ovarian cancer. We reviewed data identified by searches of MEDLINE, PubMed, and abstracts from the proceedings of the American Society of Clinical Oncology meetings from 1998 to 2006, with the search terms "Ovarian Cancer,""EGFR,""gefitinib, ZD1839, Iressa,""erlotinib, OSI-774, Tarceva,""CI-1033,"" GW 572016, lapatinib,""PKI-166,""EKB 569,""anti-EGFR antibodies,""trastuzumab, Herceptin,""cetuximab, Erbitux, IMC-C225,""matuzumab, EMD 72000,""panitumamab, ABX-EGF,""pertuzumab," and "vandetanib, rINN, Zactima, ZD6474." Phase II trials of both small molecule inhibitors of EGFR- and antibody-based inhibitors are currently ongoing in ovarian cancer and emerging data suggest that their activity in unselected women with advanced or recurrent ovarian cancer is modest, when utilized as a single agent. It is possible that these agents will be highly effective in smaller subsets of patients whose tumors are dependent on EGFR signaling, perhaps through activating mutations in EGFR or its downstream pathway. Targeted therapy with EGFR inhibitors is an untapped potential resource in the treatment of advanced or recurrent ovarian cancer. Ongoing trials will elucidate the most effective strategies to use these agents individually or in combination with traditional chemotherapeutic agents.

BACKGROUND:Endometriosis is rarely a cause of recurrent hemorrhagic ascites. This report draws attention to this uncommon condition, which could present a diagnostic dilemma. CASE/METHODS:A young African-American woman who had experienced recurrent hemorrhagic ascites for more than 2 years underwent laparotomy and was found to have extensive pelvic endometriosis. After a hysterectomy and bilateral salpingo-oophorectomy, her ascites resolved. CONCLUSION/CONCLUSIONS:Endometriosis should be considered in the differential diagnosis of recurrent hemorrhagic ascites in premenopausal women. The diagnosis always requires operative assessment and histologic confirmation.