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Evaluation of the Prognostic Value of CA-125 Dynamics in Women With Newly Diagnosed Advanced Ovarian Cancer in a Meta-analysis
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Evaluation of the Prognostic Value of CA-125 Dynamics in Women With Newly Diagnosed Advanced Ovarian Cancer in a Meta-analysis
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Evaluation of the Prognostic Value of CA-125 Dynamics in Women With Newly Diagnosed Advanced Ovarian Cancer in a Meta-analysis
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Dissertation
Evaluation of the Prognostic Value of CA-125 Dynamics in Women With Newly Diagnosed Advanced Ovarian Cancer in a Meta-analysis
2024
Overview
Ovarian cancer ranks 18th in terms of incidence and 14th in terms of mortality. Due to a lack of specific symptoms and late diagnosis at an advanced stage, the survival prognosis for these patients is poor. After initial management, the majority of patients will progress. Treatment options will then depend on the speed of progression, and simple, non-intrusive follow-up is essential.Despite the use of the CA-125 blood marker, since the 1980s, the best means of analyzing its decline and prognostic role are poorly quantified.Using individual patient data from the individual patient data meta-analysis initiated by the GCIG, this thesis aims to evaluate the different summaries of CA-125 dynamics over the first few months after the start of treatment to predict patient progression and survival.These summaries include observed and estimated measurements obtained by a linear mixed model (LMM) with splines. Their performance was assessed by cross- validation and adapted scores such as the area under the ROC curve (AUC) and the Brier Score.In our first study, we showed that 3-month monitoring with CA-125 provides individual predictions on overall survival up to 48 months for patients receiving first-line chemotherapy. The second study concludes that a simple CA-125 measurement at 3 months gave a fairly good predictive capacity for detecting platinum-resistant patients, but with a risk of misclassification that would nonetheless lead to a wrong therapeutic orientation,which prompts caution. This thesiscontributes to establishing a framework for the use of CA-125 to guide clinicians in their decision-making for the follow-up of ovarian cancer patients. It also highlights the importance of updating the meta-analysis to include the latest developments in treatment and clinical practice.
Publisher
ProQuest Dissertations & Theses
Subject
