PREOPERATIVE SERUM LEVEL OF TUMOR-ASSOCIATED TRYPSIN-INHIBITOR AND RESIDUAL TUMOR SIZE AS PROGNOSTIC INDICATORS IN STAGE-III EPITHELIAL OVARIAN-CANCER

Objective To evaluate the use of the pre-operative tumour-associated t rypsin inhibitor (TATI) level and residual tumour size at primary surg ery as a prognostic indicators for patients with Stage III epithelial ovarian cancer. Design Retrospective cohort study. Setting Department of Obstetrics and Gynaecology University Hospital, Helsinki, Finland. Participants Ninety-eight women with Stage III ovarian cancer. Methods TATI was measured by radioimmunoassay from serum samples obtained wit hin one week before surgery. A cutoff value of 22 mu g/L was used. Mul tivariate analysis included pre-operative TATI level, age, histologic grade an;l histologic type. Mantel-Cox test was used for calculating s tatistical significance of differences in survival between groups. Mai n outcome measures Cumulative five-year survival, pre-operative serum TATI level and residual tumour size. Results Surgery was optimal (resi dual tumour size less than or equal to 2 cm) in 55 patients and subopt imal (residual tumour size > 2 cm) in 43. Pre-operative TATI level les s than or equal to 22 mu g/L predicted better prognosis both in patien ts with optimal and suboptimal surgery compared with patients with pre -operative TATI level > 22 mu L. Patients with optimal surgery and a p re-operative TATI > 22 mu g/L had a twofold relative risk of death com pared with those with a pre-operative TATI less than or equal to 32 mu g/L. The cumulative survival was less than three years for patients w ith suboptimal surgery and pre-operative TATI > 22 mu g/L. Conclusions Pre-operative serum TATI in combination with residual tumour size may be useful in stratifying patients with Stage III ovarian cancer into different categories in randomised treatment trials.