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

Kang, Sokbom; Kim, Tae-Joong; Seo, Seung‐Woo; Kim, Byoung-Gie; Bae, Duk-Soo; Park, Sang-Yoon

doi:10.3802/jgo.2011.22.4.269

Cited by 5 publications

(5 citation statements)

References 12 publications

(21 reference statements)

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“…Using the same criteria, Kang et al [27] found a progression HR of 2.45 (95% CI, 1.55-3.88) in CA-125 > 10 U/ml Korean population. Gard et al [14] declared a progression HR was higher in patients with CA-125 > 15 U/ml; Kang et al [10] found a survival hazard ratio increasing for 12-18 U/ml and 18-35U/ml in Korean patients; and Altena et al [11] claimed an independent progression HR increasing to 1.51 (95% CI, 1.04-2.31 while CA-125 > 5 U/ml in a Netherlands population.…”

Section: Discussionmentioning

confidence: 99%

CA-125 Level as a Prognostic Indicator in Type I and Type II Epithelial Ovarian Cancer

Chen

Zhang

Cheng

et al. 2013

Int J Gynecol Cancer

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Objective The majority of patients with epithelial ovarian cancer achieved a complete clinical remission with normal CA-125 will still relapse and die from their disease. The present study was to determine whether CA-125 levels before, during and after primary treatment provided prognostic information for both Type I and Type II ovarian cancer. Methods In this retrospective study, we identified 410 epithelial ovarian cancer patients who had achieved a CCR between 1984 and 2011. A Cox proportional hazards model and log-rank test were used to assess associations between the nadir CA-125, histotype, and prognosis. Results The baseline serum CA-125 concentration was higher in patients with type II ovarian cancer than in those with type I (p < 0.001). The nadir CA-125 was an independent predictor of PFS (p < 0.001) and OS (p = 0.035) duration. The PFS and OS durations were 21.7 and 79.4 months in patients with CA-125 ≤ 10 U/ml and 13.6 and 64.6 months in those with 11-35 U/ml (p = 0.01 and 0.002, respectively). Histotype was an independent predictor of PFS (p = 0.041): the PFS and OS durations of type I patients were longer than those in type II (p < 0.001 and < 0.001, respectively). Conclusions The nadir CA-125 and the histotype are predictive of PFS and OS duration in ovarian cancers experienced a CCR. PFS and OS durations were shorter in patients with CA-125 levels of 11-35 U/ml and type II disease than in those with ≤ 10 U/ml and type I.

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Section: Discussionmentioning

confidence: 99%

CA-125 Level as a Prognostic Indicator in Type I and Type II Epithelial Ovarian Cancer

Chen

Zhang

Cheng

et al. 2013

Int J Gynecol Cancer

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“…The primary therapy of EOC patients commonly ends after standard treatment, most including cytoreduction surgery and adjuvant chemotherapy. Several studies have suggested that the CA-125 level may be used to stratify high-risk recurrent patients [13]. As heterogeneous groups, different EOC pathological types present distinct clinical characteristics that indicate patient prognosis, including the CA-125 level.…”

Section: Discussionmentioning

confidence: 99%

“…Thus, patients ranged from those with complete clinical response (CCR), as well as persisting and/or progressing disease, at the end of first line treatment to those with a recurrent disease after a PFS that varied from weeks to years. Most of these studies focused on advanced-stage EOC but not on its pathologic type [13-16]. Pathological heterogeneity of EOC was reported to influence the efficiency of the CA-125 level as an indicator in a single-institution study [12].…”

Section: Introductionmentioning

confidence: 99%

Nadir CA-125 level as prognosis indicator of high-grade serous ovarian cancer

Wang

et al. 2013

J Ovarian Res

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PurposeThe capacity of nadir CA-125 levels to predict the prognosis of epithelial ovarian cancer remains controversial. This study aimed to explore whether the nadir CA-125 serum levels could predict the durations of overall survival (OS) and progression free survival (PFS) in patients with high-grade serous ovarian cancer (HG-SOC) from the USA and PRC.Materials and methodsA total of 616 HG-SOC patients from the MD Anderson Cancer Center (MDACC, USA) between 1990 and 2011 were retrospectively analyzed. The results of 262 cases from the Jiangsu Institute of Cancer Research (JICR, PRC) between 1992 and 2011 were used to validate the MDACC data. The CA-125 immunohistochemistry assay was performed on 280 tissue specimens. The Cox proportional hazards model and the log-rank test were used to assess the associations between the clinicopathological characteristics and duration of survival.ResultsThe nadir CA-125 level was an independent predictor of OS and PFS (p < 0.01 for both) in the MDACC patients. Lower nadir CA-125 levels (≤10 U/mL) were associated with longer OS and PFS (median: 61.2 and 16.8 months with 95% CI: 52.0–72.4 and 14.0–19.6 months, respectively) than their counterparts with shorter OS and PFS (median: 49.2 and 10.5 months with 95% CI: 41.7–56.7 and 6.9–14.1 months, respectively). The nadir CA-125 levels in JICR patients were similarly independent when predicting the OS and PFS (p < 0.01 for both). Nadir CA-125 levels less than or equal to 10 U/mL were associated with longer OS and PFS (median: 59.9 and 15.5 months with 95% CI: 49.7–70.1 and 10.6–20.4 months, respectively), as compared with those more than 10 U/mL (median: 42.0 and 9.0 months with 95% CI: 34.4–49.7 and 6.6–11.2 months, respectively). Baseline serum CA-125 levels, but not the CA-125 expression in tissues, were associated with the OS and PFS of HG-SOC patients in the MDACC and JICR groups. However, these values were not independent. Nadir CA-125 levels were not associated with the tumor burden based on second-look surgery (p = 0.09). Patients who achieved a pathologic complete response had longer OS and PFS (median: 73.7 and 20.7 months with 95% CI: 63.7–83.7 and 9.5–31.9 months, respectively) than those with residual tumors (median: 34.6 and 10.6 months with 95% CI: 6.9–62.3 and 4.9–16.3 months, respectively).ConclusionsThe nadir CA-125 level was an independent predictor of OS and PFS in HG-SOC patients. Further prospective studies are required to clinically optimize the chances for a complete clinical response of HG-SOC cases with higher CA-125 levels (>10 U/mL) at the end of primary treatment.

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“…The DNA content is an important prognostic factor for epithelial ovarian cancer. Other important factors like residual disease, age, histology type and grade were not evaluated as well as other imunohistochemical factors including ARID1A, CA-125 and its new cut-off of 18 U/mL (32,40) . The study of these other factors would contribute to a better understanding of this cancer.…”

Section: Resultsmentioning

confidence: 99%

DNA content evaluation for epithelial ovarian cancer identification

Tomé

et al. 2018

Curr. Gynecol. Oncol.

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To assess the cellular DNA status of epithelial ovarian cancer cells for clinical stage identification and its effect on survival. Methods: Sixty-two patients treated by primary surgery and six courses of platinum-based chemotherapy were enrolled. The surgical stage was analyzed in correlation with DNA ploidy, S-phase fraction and DNA index. DNA analysis was performed via image cytometry. Results: From the 62 cases, 38 were International Federation of Gynecology and Obstetrics (Fédération Internationale de Gynécologie et d'Obstétrique, FIGO) stage I and II, 24-stage III and IV. In the DNA histograms obtained, the DNA index ranged from 0.85 to 3.02. Sixteen were classified as diploid and 46 as aneuploid (18 multiploid). S-phase fraction ranged from 9.8 to 51%. The aneuploid cells with DNA content above 5C ranged from 0.0 to 77.2%. Patients diagnosed with FIGO III and IV (vs. I and II) were 3.3 times more likely to die. Only in FIGO stage I and II the survival differed significantly for the different groups of ploidy. The risk of death for the multiploid (vs. diploid) group is 6.4 times and for aneuploid (vs. diploid) 2.3 times. Overall survival was better in the group with low DNA index. The low percentage compared with a high percentage of 5C cells ploidy groups showed association with mortality. The death hazard for the S-phase >33 median group is 4.9 times the hazard in relation to the S-phase <33. Conclusions: DNA ploidy, DNA index, S-phase, and 5C cells are important prognosticators for epithelial ovarian cancer mainly in early stages.

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

Cited by 5 publications

References 12 publications

CA-125 Level as a Prognostic Indicator in Type I and Type II Epithelial Ovarian Cancer

CA-125 Level as a Prognostic Indicator in Type I and Type II Epithelial Ovarian Cancer

Nadir CA-125 level as prognosis indicator of high-grade serous ovarian cancer

DNA content evaluation for epithelial ovarian cancer identification

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