Can Optimal Primary Cytoreduction Be Predicted in Advanced Stage Epithelial Ovarian Cancer? Role of Preoperative Serum CA-125 Level

Abstract

The aim of this study was to determine the ability of preoperative serum CA-125 levels to predict optimal cytoreduction in patients with stage III epithelial ovarian cancer. A retrospective review was made of the records of 40 patients with FIGO stage III ovarian carcinoma who underwent primary cytoreductive surgery. A receiver operating characteristic (ROC) curve was used to determine the most useful CA-125 level in predicting optimal versus suboptimal tumour cytoreduction. Twenty-two (55%) patients were optimally cytoreduced (residual disease ≤1 cm). A preoperative serum CA-125 level of 500 U/ml was found to be the value with the most predictive power. Optimal cytoreduction was obtained in 16 of the 21 cases (76%) with a CA-125 <500 U/ml compared to only 6 of the 19 cases (32%) with a CA-125 >500 U/ml. At this threshold, preoperative serum CA-125 level was able to predict optimal versus suboptimal cytoreduction with a sensitivity of 72%, specificity of 73%, positive predictive value of 68%, and negative predictive value of 76%. In the management of patients with advanced epithelial ovarian carcinoma, preoperative serum CA-125 level may help to predict optimal primary cytoreduction and to identify candidates for alternative approaches other than traditional primary cytoreductive surgery, such as neoadjuvant chemotherapy.

Contemporary considerations for neoadjuvant chemotherapy in primary ovarian cancer

“…Recognition that all patients undergoing initial cytoreduction surgery cannot be optimally cytoreduced has led to the use of diagnostic imaging techniques, serum biomarkers, and diagnostic laparoscopic procedures to identify which patients might not be suitable for undergoing conventional therapy [3,[29][30][31][32][33][34][35][36].…”

“…Using serum CA-125 levels as objective means of establishing which patients cannot be optimally surgically cytoreduced has produced confl icting results in the literature [33][34][35][36].…”

The role of neoadjuvant chemotherapy in treating advanced epithelial ovarian cancer

“…However, after the year 2000, with the change in practice to ultra-radical cytoreductive surgery, the CA125 level was no longer shown to be predictive of the ability to optimally cytoreduce patients. This has been supported by several other studies [42][43][44]. However, recently De Jong et al [45] reported a normogram that predicted tumor resectability based on serum CA125 and albumin levels.…”

The Significance of Normal Pretreatment Levels of Ca125 (<35 U/Ml) in Epithelial Ovarian Carcinoma

“…14 In many studies it has also been shown that the preoperative level of CA125 can serve as a predictor of optimal tumor cytoreduction in advanced ovarian cancer. [15][16][17][18][19] In these studies high preoperative CA125 serum levels were associated with decreased likelihood of achieving an optimal cytoreduction, although the threshold cutoff levels differed in them. On the other hand, in other studies preoperative serum CA125 level was not found to be a reliable predictor of optimal cytoreduction.…”