TUMOR KINETICS, RESPONSE TO CHEMOTHERAPY AND SURVIVAL IN PRIMARY OVARIAN-CANCER

The analysis of thymidine labelling index (TLI) in relation to clinico -pathological variables and survival was carried out in 111 ovarian ca ncer patients. The significance of TLI in predicting response to aggre ssive first line chemotherapy regimens was examined. The overall media n TLI value of 1.8% was used as a cut-off to discriminate slowly from highly proliferating cancers. 94 patients entered into two consecutive randomised trials, and were treated with six courses of cisplatin-bas ed chemotherapy with or without doxorubicin. A significantly higher ob jective response of 60% was reported in the subset of patients with TL I > 1.8% as compared to 35% in patients with TLI less than or equal to 1.8% (P = 0.03). In addition, patients achieving complete response ha d tumours with median TLI of 3.8% as compared to 2.4% for partial resp onders, 1.5% for patients with stable disease and 1.7% for those with progressive disease. A significant increase in tumour kinetics was obs erved in advanced cancers (P = 0.001), more undifferentiated tumours ( P = 0.02) and postsurgical residual disease greater than 2 cm (P = 0.0 4). In univariate analysis, TLI failed to influence significantly clin ical outcome: 26 versus 32 months median survival time for patients wi th high and low tumour TLI, respectively. In the Cox's regression mode l, the only independent prognostic variables were performance status a nd amount of residual disease after primary surgery (P = 0.000).