155Elevated serum adiponectin levels correlate with survival inepithelial ovarian cancersE. Diaz, I. Chen, N. Liburd, B. Karlan, C. Walsh, I. Cass, A. LiCedars–Sinai Medical Center, Los Angeles, CA

Objective: The adipocyte-secreted hormone adiponectin influencesthe regulation of inflammation and angiogenesis, and serumconcentrations are determined not only by adiposity but also bygenetic factors and nutrition. Translational studies indicate adipo-nectin may exert antiproliferative effects in cancer biology, but datain pancreatic cancer suggest elevated levels promote carcinogenesis.We sought to examine the correlation between serum adiponectinand clinical outcome in a cohort of women with epithelial ovariancancers.

After institutional review board approval we queried theinstitutional tumor registry for consecutive patients with ovariancancer with available banked fasting prediagnostic serum. Allpatients underwent cytoreductive surgery with histologicallyconfirmed epithelial ovarian or primary peritoneal cancer, followedby platinum-based chemotherapy. We assayed frozen serum foradiponectin using ELISA (R&D, Inc.) and abstracted clinicopatho-logic data from medical records. Adiponectin levels were con-sidered elevated if greater than 10.0 μg/mL. Statistical testsincluded rank correlation, Kaplan–Meier, and Cox regressionanalyses.Results: We examined serum and clinical data from 95 patients.Adiponectin concentrations ranged from 2.7 to 28.4 μg/mL(mean=11.2); body mass index (BMI) ranged from 16.9 to 39.9 kg/m2 (mean=24.7). We did not determine a significant correlationbetween BMI and adiponectin (r=–0.21). Women with elevatedadiponectin levels demonstrated statistically shorter disease-specific survival (44 months) compared with those with normallevels (67 months) (P=0.03). When examining the cohort in threestrata (low, moderate, and high levels of adiponectin), weidentified a significant trend of decreasing survival with increasingadiponectin concentration (median survival=125, 58, and44 months, respectively) (P=0.02). On multivariate analysis, aftercontrolling for BMI, age, stage, and grade, we determined thatadiponectin and cytoreductive status retained significance asindependent prognostic factors for overall survival (P=0.02 and0.004, respectively).Conclusions: These data suggest adiponectin concentration, inde-pendent of adiposity, is negatively associated with clinical outcome inthis cohort. Translational studies and prospective trials are indicatedto determine the role of adiponectin as a potential therapeutic targetin women with ovarian cancer.

doi:10.1016/j.ygyno.2010.12.162

156Evaluation of the risk of ovarian malignancy algorithm in womenwith a pelvic mass presenting to general gynecologistsR. Moore1, C. Miller2, P. DiSilvestro1, L. Landrum3, W. Gajewski4,P. Renneisen5, S. Skates61Women & Infants Hospital/Brown University, Providence, RI, 2StatisticalConsultant, Quakertown, PA, 3University of Oklahoma, Oklahoma City,OK, 4New Hanover Regional Medical Center, Wilmington, NC, 5FujirebioDiagnostics, Malvern, PA, 6Massachusetts General Hospital/HarvardUniversity, Boston, MA

Objective: Women with epithelial ovarian cancer (EOC) haveimproved outcomes when surgically managed by gynecologic

oncologists. It is often difficult to distinguish a benign pelvic massfrom a malignancy, and tools to help referring physicians are needed.The objective of this trial was to validate the Risk of OvarianMalignancy Algorithm (ROMA) in a population of women presentingto a gynecologist with a pelvic mass.

This was an institutional review board-approved multicenterblinded prospective trial. All women had a pelvic mass andsurgical intervention. Serum levels of HE4 and CA-125 weredetermined preoperatively. An initial clinical assessment (ICA)was performed by a gynecologist. A ROMA risk was calculated foreach patient. Sensitivity, specificity, and negative (NPV) andpositive (PPV) predictive values were calculated for ROMA, ICA,and ROMA plus ICA.Results: Thirteen sites enrolled 512 women with 468 evaluablepatients, of whom 255 were premenopausal and 213 werepostmenopausal. There were 48 cases of EOC (8 stage I, 4 stage II,32 stage III, two stage IV, and two unstaged), 18 low-malignant-potential (LMP) tumors, 21 cases of nonepithelial ovarian cancer,and 381 benign cases. In evaluation of premenopausal women withbenign tumors (n=235) versus EOC (n=8), ROMA had a sensitivityof 100% (95% CI=63.1–100%) and a specificity of 74.5% (95%CI=68.4–79.9%). In postmenopausal women with benign tumors(n=146) versus EOC (n=40), ROMA had a sensitivity of 92.5% (95%CI=79.6–98.4%) and a specificity of 76.0% (95% CI=68.3–82.7%). Inall women with benign tumors (n=381) versus EOC (n=48),ROMA had a sensitivity of 93.8% (95% CI=82.8–98.7%), a specificityof 75.1% (95% CI=70.4–79.3%), a PPV of 32.1% (95% CI=24.5–40.6%), and a NPV of 99.0% (95% CI=97.0–99.8%). In contrast, the ICAhad a sensitivity of 83.3% (95% CI=69.8–92.5%), a specificity of84.5% (95% CI=80.5–88.0%), a PPV of 40.4% (95% CI=30.7–50.7%),and a NPV of 97.6% (95% CI=95.3–98.9%). In analysis of benignversus EOC and LMP tumors, ROMA had a sensitivity of 87.9% (95%CI=77.5–94.6%) and a specificity of 75.1% (95% CI=70.4–79.3%),whereas the ICA had a sensitivity of 75.8% (95% CI=63.6–85.5%) anda specificity of 84.5% (95% CI=80.5–88.0%). In analysis with thecombination of ICA and ROMA in benign versus EOC and LMP tumors,the two methods together had a sensitivity of 90.9% (95% CI=81.3–96.6%) and a specificity of 66.9% (95% CI=62.0–71.6%). Of the 8 casesof EOC the ICA missed, ROMA detected 5 (3 stage I or II and 2 stage IIIor IV).Conclusions: ROMA has a high sensitivity for evaluating womenwith a pelvic mass for EOC. ROMA should be used in conjunctionwith ICA to aid in the triage of women to gynecologiconcologists.

doi:10.1016/j.ygyno.2010.12.163

157Factors associated with hospice use in ovarian cancerC. Casey, H. Deshmukh, A. Sherman, L. Chen, J. ChanUCSF Helen Diller Family Comprehensive Cancer Center, San Francisco, CA

Objective: The purpose of this study was to determine the factors andtrends in hospice use in patients with ovarian cancer in the Medicarepopulation.

All women aged 65 and older who were diagnosed and died ofovarian cancer between 1991 and 2002 were identified from theMedicare–SEER database. χ2 analyses were used to examine hospiceuse and length of stay in hospice.Results: Among 8740 patients, the overall rate of hospice use was30.5% (n=2667). Of these patients, 29.8% were white and 41.3% wereblack. The proportions of patients aged 65–70, 71–75, 76–80, and>80 years were 30.4, 32.3, 30, and 29.7%, respectively. The median

S68 ABSTRACTS / Gynecologic Oncology 120 (2011) S2–S133