10月13-16日，第14届国际妇科肿瘤学会双年会（IGCS 2012）在加拿大温哥华举行。IGCS 2012一如既往地为参会者奉上妇科肿瘤学领域最新研究进展，提供发布、讨论和争辩最新科学信息的良机。金宝搏网站登录技巧 对本届年会进行了专题报道（http://zt.cmt.com.cn/zt/igcs2012/index.html）。

研究摘要：

Potential Effect of the Risk of Ovarian Cancer Algorithm
(ROCA) on the Mortality Outcome of the Prostate, Lung,
Colorectal, and Ovarian (PLCO) Trial.
P Pinsky1, C Zhu1, C Berg1, A Black2, E Partridge3, S Skates4
1Division of Cancer Prevention, NCI; 2Division of Cancer Epidemiology
and Prevention, NCI, Bethesda, Maryland; 3University
of Alabama, Birmingham; 4Massachusetts General
Hospital, Boston, MA.
Background: Recently, the ovarian component of The
Prostate, Lung, Colorectal, and Ovarian (PLCO) Trial
reported no mortality benefit of annual screening with CA-
125 and transvaginal ultrasound versus usual care. Currently
ongoing is the UK Collaborative Trial of Ovarian Cancer
Screening, a 3-armed trial where one arm uses the risk of
ovarian cancer algorithm (ROCA). In contrast to PLCO,
which defined a positive CA-125 test based on the current
CA-125 level only, ROCA considers serial CA-125 levels in
assigning ovarian cancer risk probabilities of low, intermediate,
or high. The unfavorable stage distribution in PLCO of
CA-125Ydetected cancers (85% stages IIIYIV) gives rise to the
speculation that the CA-125 cutoff (35 IU/mL) is too high and

catches cancers too late.AserialCA-125 algorithmmay be able
to catch cancers sooner but without engendering too high a
false-positive rate, by considering CA-125 levels over time. A
high false-positive rate is problematic owing to the frequent
subsequent use of oophorectomy.
Methods: We investigate whether the use of ROCA in PLCO
could have potentially favorably affected the trial’s outcome.
Specifically, we used observed PLCO CA-125 values to
calculate a ROCA score at each screen and analyzed how
many women would have had their tumor detected earlier (or
later) using ROCA than they did under the standard PLCO
protocol (CA-125 Q35 U/mL and/or positive transvaginal
ultrasound). Under a best-case scenario, any women dying of
ovarian cancer whowould have had her cancer detected earlier
with ROCA is considered ‘‘saved’’ under ROCA.
Results: Updated PLCO data show 132 ovarian cancer deaths
in the screened versus 119 in the control arm (relative risk,
1.11). Of the 132 deaths, 81 were ‘‘in play’’ to be detectable by
ROCA, as defined by diagnosis within 3 years of a CA-125
screen. For ROCA cutoffs that classified 14% of all PLCO
screens as intermediate and 3% as high risk, 25 of the 81
women would have had their cancer detected earlier with
ROCA screening. This gives, under a best-case assumption,
107 screened arm ovarian cancer deaths and a relative risk of
0.90 (95% confidence interval, 0.69Y1.17).
Conclusion: Having used ROCA in PLCO likely would not
have resulted in a significant mortality reduction for the
screened arm, although it may have prevented some ovarian
cancer deaths in that arm.