Abstract：
OBJECTIVE: Symptom-triggered testing for ovarian cancer was introduced to the UK whereby symptomatic women undergo an ultrasound scan and serum CA125, and are referred to hospital within 2 weeks if these are abnormal. The potential value of symptom-triggered testing in the detection of early-stage disease or low tumor burden remains unclear in women with high grade serous ovarian cancer. In this descriptive study, we report on the International Federation of Gynecology and Obstetrics (FIGO) stage, disease distribution, and complete cytoreduction rates in women presenting via the fast-track pathway and who were diagnosed with high grade serous ovarian cancer.
METHODS: We analyzed the dataset from Refining Ovarian Cancer Test accuracy Scores (ROCkeTS), a single-arm prospective diagnostic test accuracy study recruiting from 24 hospitals in the UK. The aim of ROCkeTS is to validate risk prediction models in symptomatic women. We undertook an opportunistic analysis for women recruited between June 2015 to July 2022 and who were diagnosed with high grade serous ovarian cancer via the fast-track pathway. Women presenting with symptoms suspicious for ovarian cancer receive a CA125 blood test and an ultrasound scan if the CA125 level is abnormal. If either of these is abnormal, women are referred to secondary care within 2 weeks. Histology details were available on all women who underwent surgery or biopsy within 3 months of recruitment. Women who did not undergo surgery or biopsy at 3 months were followed up for 12 months as per the national guidelines in the UK. In this descriptive study, we report on patient demographics (age and menopausal status), WHO performance status, FIGO stage at diagnosis, disease distribution (low/pelvic confined, moderate/extending to mid-abdomen, high/extending to upper abdomen) and complete cytoreduction rates in women who underwent surgery.
RESULTS: Of 1741 participants recruited via the fast-track pathway, 119 (6.8%) were diagnosed with high grade serous ovarian cancer. The median age was 63 years (range 32-89). Of these, 112 (94.1%) patients had a performance status of 0 and 1, 30 (25.2%) were diagnosed with stages I/II, and the disease distribution was low-to-moderate in 77 (64.7%). Complete and optimal cytoreduction were achieved in 73 (61.3%) and 18 (15.1%). The extent of disease was low in 43 of 119 (36.1%), moderate in 34 of 119 (28.6%), high in 32 of 119 (26.9%), and not available in 10 of 119 (8.4%). Nearly two thirds, that is 78 of 119 (65.5%) women with high grade serous ovarian cancer, underwent primary debulking surgery, 36 of 119 (30.3%) received neoadjuvant chemotherapy followed by interval debulking surgery, and 5 of 119 (4.2%) women did not undergo surgery.
CONCLUSIONS: Our results demonstrate that one in four women identified with high grade serous ovarian cancer through the fast-track pathway following symptom-triggered testing was diagnosed with early-stage disease. Symptom-triggered testing may help identify women with a low disease burden, potentially contributing to high complete cytoreduction rates.
METHODS: We analyzed the dataset from Refining Ovarian Cancer Test accuracy Scores (ROCkeTS), a single-arm prospective diagnostic test accuracy study recruiting from 24 hospitals in the UK. The aim of ROCkeTS is to validate risk prediction models in symptomatic women. We undertook an opportunistic analysis for women recruited between June 2015 to July 2022 and who were diagnosed with high grade serous ovarian cancer via the fast-track pathway. Women presenting with symptoms suspicious for ovarian cancer receive a CA125 blood test and an ultrasound scan if the CA125 level is abnormal. If either of these is abnormal, women are referred to secondary care within 2 weeks. Histology details were available on all women who underwent surgery or biopsy within 3 months of recruitment. Women who did not undergo surgery or biopsy at 3 months were followed up for 12 months as per the national guidelines in the UK. In this descriptive study, we report on patient demographics (age and menopausal status), WHO performance status, FIGO stage at diagnosis, disease distribution (low/pelvic confined, moderate/extending to mid-abdomen, high/extending to upper abdomen) and complete cytoreduction rates in women who underwent surgery.
RESULTS: Of 1741 participants recruited via the fast-track pathway, 119 (6.8%) were diagnosed with high grade serous ovarian cancer. The median age was 63 years (range 32-89). Of these, 112 (94.1%) patients had a performance status of 0 and 1, 30 (25.2%) were diagnosed with stages I/II, and the disease distribution was low-to-moderate in 77 (64.7%). Complete and optimal cytoreduction were achieved in 73 (61.3%) and 18 (15.1%). The extent of disease was low in 43 of 119 (36.1%), moderate in 34 of 119 (28.6%), high in 32 of 119 (26.9%), and not available in 10 of 119 (8.4%). Nearly two thirds, that is 78 of 119 (65.5%) women with high grade serous ovarian cancer, underwent primary debulking surgery, 36 of 119 (30.3%) received neoadjuvant chemotherapy followed by interval debulking surgery, and 5 of 119 (4.2%) women did not undergo surgery.
CONCLUSIONS: Our results demonstrate that one in four women identified with high grade serous ovarian cancer through the fast-track pathway following symptom-triggered testing was diagnosed with early-stage disease. Symptom-triggered testing may help identify women with a low disease burden, potentially contributing to high complete cytoreduction rates.
摘要：
目的：卵巢癌的症状触发检测被引入英国，有症状的女性接受超声扫描和血清CA125，如果这些异常，将在2周内转诊至医院。在高级别浆液性卵巢癌女性中，症状触发检测在早期疾病或低肿瘤负荷检测中的潜在价值尚不清楚。在这项描述性研究中，我们报告国际妇产科联合会(FIGO)阶段，疾病分布,以及通过快速通道途径出现并被诊断为高级别浆液性卵巢癌的女性的完全细胞减量率。
方法：我们分析了来自精炼卵巢癌测试准确性评分（ROCkeTS）的数据集，一项来自英国24家医院的单臂前瞻性诊断测试准确性研究.ROCkeTS的目的是验证有症状女性的风险预测模型。我们对2015年6月至2022年7月之间招募的女性进行了机会性分析，这些女性通过快速通道途径被诊断为高级别浆液性卵巢癌。出现可疑卵巢癌症状的妇女接受CA125血液检查和超声扫描，如果CA125水平异常。如果其中任何一个是不正常的，妇女在2周内接受二级保健。在招募后3个月内接受手术或活检的所有女性均可获得组织学详细信息。根据英国国家指南，3个月时未接受手术或活检的女性随访12个月。在这项描述性研究中，我们报告患者的人口统计学（年龄和更年期状态），世卫组织绩效状况，FIGO诊断阶段，疾病分布(低/骨盆局限，中度/延伸至腹部中部，高/延伸到上腹部）和接受手术的女性的完全细胞减灭率。
结果：在通过快速通道招募的1741名参与者中，119例（6.8%）被诊断为高级别浆液性卵巢癌。中位年龄为63岁（范围32-89）。其中,112例（94.1%）患者的表现状态为0和1，30例（25.2%）被诊断为I/II期，77例(64.7%)中低度分布。在73（61.3％）和18（15.1％）中实现了完全和最佳的细胞减少。119人中有43人(36.1%)患病程度低,119人中的34人(28.6%)中等，119个中的32个（26.9%），119人中有10人(8.4%)没有。近三分之二，119名女性中有78名（65.5%）患有高级别浆液性卵巢癌，接受了初次切除手术，119人中有36人（30.3%）接受新辅助化疗，然后进行间隔减积手术，119名女性中有5名(4.2%)未接受手术.
结论：我们的结果表明，通过症状触发测试后的快速通道途径确定为高级别浆液性卵巢癌的女性中有四分之一被诊断为早期疾病。症状触发测试可能有助于识别疾病负担低的女性，可能导致高的完全细胞减少率。
方法：我们分析了来自精炼卵巢癌测试准确性评分（ROCkeTS）的数据集，一项来自英国24家医院的单臂前瞻性诊断测试准确性研究.ROCkeTS的目的是验证有症状女性的风险预测模型。我们对2015年6月至2022年7月之间招募的女性进行了机会性分析，这些女性通过快速通道途径被诊断为高级别浆液性卵巢癌。出现可疑卵巢癌症状的妇女接受CA125血液检查和超声扫描，如果CA125水平异常。如果其中任何一个是不正常的，妇女在2周内接受二级保健。在招募后3个月内接受手术或活检的所有女性均可获得组织学详细信息。根据英国国家指南，3个月时未接受手术或活检的女性随访12个月。在这项描述性研究中，我们报告患者的人口统计学（年龄和更年期状态），世卫组织绩效状况，FIGO诊断阶段，疾病分布(低/骨盆局限，中度/延伸至腹部中部，高/延伸到上腹部）和接受手术的女性的完全细胞减灭率。
结果：在通过快速通道招募的1741名参与者中，119例（6.8%）被诊断为高级别浆液性卵巢癌。中位年龄为63岁（范围32-89）。其中,112例（94.1%）患者的表现状态为0和1，30例（25.2%）被诊断为I/II期，77例(64.7%)中低度分布。在73（61.3％）和18（15.1％）中实现了完全和最佳的细胞减少。119人中有43人(36.1%)患病程度低,119人中的34人(28.6%)中等，119个中的32个（26.9%），119人中有10人(8.4%)没有。近三分之二，119名女性中有78名（65.5%）患有高级别浆液性卵巢癌，接受了初次切除手术，119人中有36人（30.3%）接受新辅助化疗，然后进行间隔减积手术，119名女性中有5名(4.2%)未接受手术.
结论：我们的结果表明，通过症状触发测试后的快速通道途径确定为高级别浆液性卵巢癌的女性中有四分之一被诊断为早期疾病。症状触发测试可能有助于识别疾病负担低的女性，可能导致高的完全细胞减少率。
