influenced by being uninsured or on Medicaid and is also associatedwith higher cancer-associated comorbidities and subsequent surgicalmorbidity and in-hospital mortality. These data suggest that limitedaccess to medical care may negatively impact the diagnosis of ovariancancer, resulting in poorer outcomes.

doi:10.1016/j.ygyno.2013.04.339

281Abstract Withdrawn at Author’s Request

doi:10.1016/j.ygyno.2013.04.340

282The efficacy of serum multivariate markers to diagnose ovariancancer in patients with ovarian tumorS. Lee1, M. Kyung2, D. Kim3, J. Kim3, Y. Kim3, Y. Kim3, J. Nam3.1University of Ulsan College of Medicine, Asan Medical Center, Seoul,Republic of Korea, 2Hallym University Sacred Heart Hospital Chuncheon,Chuncheon, Republic of Korea, 3University of Ulsan, Asan MedicalCenter, Seoul, Republic of Korea.

Objective: The development of method to distinguish women withovarian cancer from those with benign conditions is importantbecause most women with a clinical presentation consistent withovarian cancer have benign conditions. The objective of this studywas to analyze the concentration of serum multivariate markers andfind the effective combination to diagnose ovarian cancer.Methods: We collected serum samples prospectively, under appropri-ate institutional review board approval, from patients treated withovarian tumors. A total of 398 samples, includingmalignant and benignovarian tumor and normal controls, were analyzed for their ovariancancer-specific proteins, CA-125, CA-19-9, epidermal growth factorreceptor,myoglobulin, tenascin C, ApoAI, ApoCIII, and c-reactive protein(CRP) by Luminexs methods, which is a multiplexed immunoassay.Results: More than half of the biomarkers tested were found to differsignificantly between benign and malignant cases. The individualmarkers CA-125, tenascin C, and CRP provided the greatest level ofdiscrimination between benign and malignant cases, and ApoAI wassignificantly decreased in malignant cases compared with benign cases.The combination of these 4 biomarkers provided a higher level ofdiscriminatory power than either marker considered alone. Multivariatestatistical analysis identified that these multimarker panels coulddiscriminate ovarian cancers from benign cases with 83.33% sensitivity(SN), 80.00%, specificity(SP), 93.33% positive predictive value, and 87.64%accuracy. This was slightly improved SN/SP levels to the CA-125 alone.Conclusions:Wedescribe a blood-based assay using 4markers that candistinguish women with ovarian cancer from those with benignconditions. Preliminary evaluation of the multimarker panels suggestsit has the potential to improve the accuracy of diagnosing ovariancancers. While promising, the performance needs to be assessed in ablinded clinical validation study.

doi:10.1016/j.ygyno.2013.04.341

283Serous tubal intraepithelial carcinoma frequency inendometriosis-associated epithelial ovarian cancerJ. Nakayama, A. VanRegenmorter, K. Atkins, L. Duska. University ofVirginia Health System, Charlottesville, VA.

Objective: With the discovery of serous tubal intraepithelialcarcinoma (STIC), the fallopian tube has been identified as the siteof origin for many serous ovarian cancers. We hypothesized thatendometriosis-associated ovarian cancer would have the equivalentor lower frequency of STICs as epithelial ovarian cancer alonebecause its site of origin is outside the fallopian tube.Methods: Under institutional review board approval, all patientswith ovarian cancer and endometriosis treated between January 1,1999 and August 31, 2011 were identified. Of 33 identified patients,21 were evaluable. Samples of the patients’ fallopian tubes wereobtained from the pathologic archive and examined histologically forSTICs by a blinded pathologist. All questionable samples wereexamined by a second pathologist and stained for p53 to confirmthe diagnosis of a STIC. Twenty-two age-matched samples frompatients with ovarian cancer alone evaluated in the same mannerserved as our control group. Statistical analysis was performed usinga one way ANOVA and Fisher’s exact test.Results: Two STICs were identified: 1 in a papillary serous ovariancancer patient and 1 in an endometrioid ovarian cancer patient withendometriosis. The histologic distribution of the 2 groups was wellmatched between the patient with andwithout endometriosis (clear: 4vs. 8, endometrioid: 11 vs. 7, serous 6 vs. 5, carcinosarcoma: 1 vs. 1;P= 0.52). Stage (P= 1.0), grade (P= 0.41), and body mass index(29.2 vs. 27.0, P=0.30)were alsowell-matched between patientswithand without endometriosis.Conclusions: There was no difference in the number of STICs be-tween ovarian cancer patients with and with endometriosis.Although limited by sample size, this study shows that the STICfrequency between epithelial ovarian cancer alone and those cancersassociated with endometriosis are not extremely different. It is worthnoting that the 1 ovarian cancer patient with endometriosis with aSTIC had an endometrioid histology that is typically not associatedwith STICs. Further study is needed.

doi:10.1016/j.ygyno.2013.04.342

284Altered recurrence patterns after extended treatment withbevacizumab for ovarian, fallopian tube, and primaryperitoneal cancerM. Dao, L. Alwan, B. Goff, J. Liao. University of Washington MedicalCenter, Seattle, WA.

Objective: To evaluate patterns of recurrence in patients undergoingextended treatment with bevacizumab for ovarian, fallopian tube,and primary peritoneal cancer.Methods: A retrospective chart review of patients with primaryovarian, peritoneal, or fallopian tube cancer treated with bevacizumabfrom2001 to 2011was performed. Qualified patientswere identified bychemotherapy records. Electronic medical records, laboratory results,and imaging reports were reviewed. Clinical characteristics, CA-125 atpreoperative time and at time of recurrence, radiologic studies, physicalexamination findings, patient report of symptoms, site of recurrence,size of largest lesions, andwhich clinical aspectwas the first evidence ofrecurrence were abstracted.Results: Of 108 patients identified, 89 patients met the criteria for thestudy. The most common recurrent symptoms with bevacizumabtreatment were abdominal pain/bloating and ascites. Most commonrecurrent sites were abdominal lymph node, upper abdomen and liver,and lung. Patients who received more than 12 cycles of bevacizumabpresented with fewer symptoms at time of recurrence (P= 0.02)compared to those receiving 12 cycles or less. Radiologic imaging wasmore capable of detecting recurrence than CA-125 among patients whowere treated with bevacizumab at first recurrence (P= 0.006). For

Abstracts / Gynecologic Oncology 130 (2013) e1–e169e118