Int J Gynecol Cancer. 2026 Aug 7:104948. doi: 10.1016/j.ijgc.2026.104948. Online ahead of print.
ABSTRACT
OBJECTIVE: We aimed to evaluate the association between KELIM and achievement of complete cytoreduction (R0; no macroscopic residual disease) in patients with high-grade serous ovarian carcinoma and to determine whether its performance and candidate thresholds vary according to homologous recombination status.
METHODS: This single-center retrospective study included patients with high-grade serous ovarian carcinoma treated with neoadjuvant chemotherapy between January 2010 and December 2025. KELIM was calculated for each patient and categorized as favorable (≥1) or unfavorable (<1). Associations with residual disease (R0, no macroscopic residual disease; R1, residual tumor <1 cm; or R2, residual tumor ≥1 cm) were assessed. Receiver operating characteristic curves identified candidate KELIM cutoffs. We evaluated the association of KELIM and homologous recombination status with progression-free survival; survival outcomes were analyzed using Kaplan-Meier estimates and Cox proportional hazards models. Sub-group analyses were performed according to homologous recombination status.
RESULTS: Overall, 145 patients were included. Median age was 64 years (interquartile range 57 to 73), and median KELIM was 0.93 (interquartile range 0.91 to 1.02). Patients with favorable KELIM (n = 58) had significantly higher R0 rates than those with unfavorable KELIM (n = 87) (77.6% versus 47.1%, p =.0002). Receiver operating characteristic analysis demonstrated moderate predictive performance for R0 (area under the curve 0.668; candidate cutoff 0.995). Candidate KELIM thresholds were lower in homologous recombination-deficient tumors (0.74) and breast cancer gene mutated tumors (0.745) than in homologous recombination-proficient tumors (0.94). Favorable KELIM was not significantly associated with progression-free survival (hazard ratio 0.78, 95% confidence interval 0.54 to 1.13, p =. 20). Median progression-free survival was numerically longer among patients with favorable KELIM compared with unfavorable KELIM (16.6 vs 13.7 months), although this difference was not statistically significant.
CONCLUSIONS: KELIM was associated with complete cytoreduction in patients with high-grade serous ovarian carcinoma, with differences observed according to homologous recombination status. These findings highlight the need for further investigation of candidate KELIM thresholds across distinct molecular sub-types to determine whether subtype-specific approaches may improve its clinical applicability.
PMID:42642281 | DOI:10.1016/j.ijgc.2026.104948
