Nadir CA‐125 level is an independent prognostic factor in advanced epithelial ovarian cancer

Kang, Sokbom; Seo, Seung‐Woo; Park, Sang-Yoon

doi:10.1002/jso.21258

Cited by 22 publications

(21 citation statements)

References 12 publications

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“…Patients whose nadir CA-125 value was below 10 U/ml had longer median OS than those patients whose nadir was 11 U/ml, although neither HRs nor p-values were presented in the original paper. Following this, other groups have subsequently validated the concept that the CA-125 nadir after primary treatment of EOC may serve as a prognostic factor for PFS and OS, even though the patient population and the clinical setting differ notably amongst studies [34][35][36][37] (Table 2). Van Altena et al have recently reported the largest study (n=331) evaluating the CA-125 nadir after primary treatment and its potential association with both PFS and OS [38].…”

Section: Resultsmentioning

confidence: 99%

“…This association seems particularly signifi cant in those patients who have optimal debulking [44]. In addition, the lowest CA-125 value (CA-125 nadir) achieved after the primary treatment of EOC has consistently been associated with survival (PFS) outcome [33][34][35][36][37][38]. Again, if this observation could be validated by using prospective data sets from large phase III clinical trials, it may be worth further investigating if the CA-125 nadir levels could serve to stratify patients into different subgroups when designing future clinical trials in the adjuvant setting, especially from the perspective of maintenance or consolidation therapy strategies [45] (Fig.…”

Section: Resultsmentioning

confidence: 99%

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Prognostic and predictive value of CA-125 in the primary treatment of epithelial ovarian cancer: potentials and pitfalls

et al. 2012

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The serum cancer antigen 125 (CA-125) remains a reliable biomarker in the therapeutic management of epithelial ovarian cancer (EOC). Monitoring the efficacy of cytotoxic chemotherapy (CT) and the early detection of relapse during the follow up of patients in remission represent the two most common clinical situations where the CA-125 has been successfully applied. There are however other scenarios along the course of the disease where the CA-125 can potentially aid in the decision-making process. Preoperative levels of CA-125 can help in selecting a subset of patients where an optimal cytoreduction may not be easily achieved. Perioperative variations in the CA- 125 levels after primary surgery and, more importantly, the nadir value of the CA-125 after primary chemotherapy, are associated with patient outcome. This review focuses on the clinical relevance of dynamic changes in CA-125 levels during the primary treatment of EOC and its potential influence both in the patient management and in the design of clinical trials in the adjuvant setting.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Prognostic and predictive value of CA-125 in the primary treatment of epithelial ovarian cancer: potentials and pitfalls

et al. 2012

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“…The most famous biomarker in EOC is CA-125, which has been used in both diagnosis of the disease and monitoring of treatment [4-6]. Recent evidence indicates that the nadir CA-125 level after completion of primary treatment was associated with prognosis [7-11]. Though the use of prognostic information is not well studied, some have proposed its possible role in the stratification of patients in clinical trials and planning further treatment [9,10].…”

Section: Introductionmentioning

confidence: 99%

“…Many researchers have usually used the cut-off value of 10 and/or 20 U/mL [7,9-11]. Some suggested 12 U/mL as a cut-off value based on the median CA-125 level of their study cohort [8].…”

Section: Introductionmentioning

confidence: 99%

Prediction of a high-risk group based on postoperative nadir CA-125 levels in patients with advanced epithelial ovarian cancer

et al. 2011

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ObjectiveWe aimed to determine the ideal cut-off of nadir serum CA-125 level for prediction of progression free survival.MethodsAmong 267 patients who achieved complete remission after chemotherapy, the correlation between nadir CA-125 and progression free survival were compared among the subgroups classified according to the distribution of CA-125. The diagnostic odds ratio and area under the receiver operator characteristics curve were compared at various cut-off points.ResultsThe nadir CA-125 levels did not have prognostic value under 12 U/mL (to 75 percentile). In contrast, they were significantly correlated with progression free survival only when the CA-125 level was greater than 12, which was 75 percentile (p=0.034). In predicting progression free survival <6 and 12 months, the cut-off value of 18 (90 percentile) showed superior diagnostic performance over 10 or 12 U/mL. Compared with patients who showed nadir levels between 0 and 12 U/mL (0 to 75 percentile), those with nadir >18 U/mL showed a hazard ratio of 2.85 (95% confidence interval, 1.70 to 4.76; p<0.001); patients with nadir levels between 18 and 12 U/mL showed a the hazard ratio of 1.68 (95% confidence interval, 1.11 to 2.56; p=0.015) compared with those whose nadir levels were under 12 U/mL.ConclusionThe predictive power of the traditional cut-off of 10 U/mL to classify a risk group or to identify high risk patients was unsatisfactory. The optimal diagnostic performance was observed at the cut-off of 18 U/mL and this can be proposed to dichotomize cut-off values to predict outcomes among individual patients.

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“…Recently, a number of studies have indicated that a nadir CA-125 level above 10 U/ml is an independent prognostic factor associated with progression-free survival (PFS) in patients who achieved complete remission (CR) after first-line treatment [5,6,7,8,9,10]. In addition, a study suggested that not only the nadir level, but also the level after six cycles of standard chemotherapy was an independent prognostic factor [11].…”

Section: Introductionmentioning

confidence: 99%

Role of Extended Chemotherapy in Advanced Ovarian Cancer Patients with High Posttreatment Serum CA-125 Levels

Kang

Kim

Seo

et al. 2011

Gynecol Obstet Invest

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Background: We aimed to determine whether the inclusion of additional cycles of carboplatin-paclitaxel is beneficial to patients with high posttreatment serum CA-125 levels. Methods: Among patients who achieved remission after six cycles of carboplatin-paclitaxel chemotherapy, those with CA-125 of 10–35 U/ml at the time of remission were divided into two groups (group A: six cycles of standard chemotherapy vs. group B: two or more additional cycles) and were analyzed. Results: Among the 436 patients with advanced epithelial ovarian cancer, 154 patients (46.8%) had CA-125 of 10–35 U/ml at the time of remission. Fifty-six patients (36.4%) received two or more cycles after the first six cycles of chemotherapy (group B). The addition of two or more cycles of chemotherapy did not improve the progression-free survival (p = 0.660). There was no statistical difference in the rates of CA-125 falling to <10 U/ml between the two groups (p = 0.256). Moreover, the degree of CA-125 decrease after six cycles of chemotherapy was similar regardless of the additional cycles (p = 0.656). Conclusion: The addition of two or more cycles of standard chemotherapy based on posttreatment CA-125 levels was not beneficial.

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Nadir CA‐125 level is an independent prognostic factor in advanced epithelial ovarian cancer

Abstract: The prognostic role of the nadir CA-125 is independent of residual tumor size in the patients with advanced EOC. However, it is still unclear whether maximal surgical effort can affect the nadir CA-125 levels.

Cited by 22 publications

References 12 publications

Prognostic and predictive value of CA-125 in the primary treatment of epithelial ovarian cancer: potentials and pitfalls

Prognostic and predictive value of CA-125 in the primary treatment of epithelial ovarian cancer: potentials and pitfalls

Prediction of a high-risk group based on postoperative nadir CA-125 levels in patients with advanced epithelial ovarian cancer

Role of Extended Chemotherapy in Advanced Ovarian Cancer Patients with High Posttreatment Serum CA-125 Levels

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