The utility of physical examination in ovarian cancer recurrence detection: a retrospective analysis informing virtual surveillance care

ABSTRACT

Objectives: To investigate the utility of symptom review, serum CA125, and physical exam in the detection of ovarian cancer recurrence to determine the role of virtual surveillance care in the post- COVID-19 era. Methods: Patients diagnosed with ovarian cancer between 2013 and 2020 were identified and included if they completed standard of care treatment with surgical resection and platinum doublet chemotherapy, had no evidence of disease after completion of treatment, and had recurrence of disease detected by symptoms, CA125, physical exam, or imaging. Patients were excluded if they did not have pretreatment elevated serum CA125 (>35 U/ml) or a complete medical record. All recurrences were confirmed with imaging or biopsy. Modalities of recurrence detection were defined as the following symptoms, physical exam, elevated CA125, or other. “Other” was denoted if imaging studies were obtained for reasons other than suspected recurrence and recurrence was incidentally identified. Descriptive statistics were used to summarize the cohort. Kaplan Meier analyses were used to estimate overall survival. Results: 109 patients met criteria at our institution. At initial diagnosis, the median age was 61 years (range 33-84) and most patients had advanced-stage disease, with 73 (67%) patients with Stage III disease and 26 (23.9%) with Stage IV disease. The median time to recurrence was 12 months (range 3-65) and median overall survival was 56 months (95% CI 46-79). In 46 (42.2%) patients, recurrence was suspected based on multiple modalities. At time of recurrence, elevated CA125 was present in 97 (89.0%) patients, symptoms in 41 (37.6%) patients, and abnormal physical exam findings in 27 (24.8%) patients. Of patients with abnormal physical exam, 26 (96.3%) also had elevated CA125 or symptoms present. Recurrence was suspected based on abnormal physical exam findings alone in 1 (0.9%) patient. Detection modalities other than abnormal physical exam (e.g., CA125, symptoms) were present in 102 (93.6%) patients. Recurrence was incidentally found with imaging obtained for reasons other than suspicion of recurrence in 6 (5.5%) patients.(Table Presented) Conclusions: Most ovarian cancer recurrences can be detected by rising CA125 or symptoms. Physical exam may have limited value in the detection of recurrence. Review of CA125 and symptoms can be conducted virtually. The inclusion of virtual visits for ovarian cancer surveillance should be considered for patients with pretreatment elevated CA125.