Prognostic relevance of high pretreatment CA125 levels in primary serous ovarian cancer

Abstract

The objective of the present study was to analyze the prognostic relevance of pretreatment serum CA125 ≥500 U/ml and its role as a non-invasive factor for estimating optimal cytoreduction (≤1 cm) in primary serous ovarian cancer. Clinicopathological parameters and CA125 levels prior to primary cytoreductive surgery were retrospectively evaluated in all 261 consecutive patients with primary epithelial ovarian cancer from a single centre. Inclusion criteria were existing preoperative CA125 level, serous ovarian cancer and performed full primary treatment (surgery/platinum-based chemotherapy). A total of 136 patients met the criteria. Among them, 74 patients had CA125 ≥500 U/ml. The other 62 patients that met the aforementioned criteria and had CA125 <500 U/ml were defined as controls. The present study tested cut-off CA125 values to detect subgroups affecting prognosis. The goal was to evaluate patients with optimal cytoreduction (R≤1 cm). Univariate analyses were performed with PASW to identify clinicopathological parameters associated with the pretreatment CA125 level. For survival analyses, a cut-off-value of CA125 ≥500 U/ml was used to identify the association between preoperative CA125 levels, resection status and prognosis. To test significant differences between examined groups, Student's t-test and the Mann-Whitney test were used. P<0.05 was considered to indicate a statistically significant difference. Significantly worse prognosis in terms of overall survival (P=0.023) and progression-free survival (P=0.011) was detected in the CA125 ≥500 U/ml group of optimally cytoreduced patients compared with in the CA125 <500 U/ml group. The complete cytoreduction rate was higher in CA125 <500 U/ml (33.9%) vs. CA125 ≥500 U/ml (21.6%). A CA125 level >1,404 U/ml had a higher rate of suboptimal cytoreduction (32.4%) compared with lower CA125 levels. A pretreatment CA125 level ≥500 U/ml had significantly worse prognostic impact after optimal cytoreduction compared with CA125 <500 U/ml. The higher the CA125 level the higher the suboptimal cytoreduction rate. Patients with CA125 ≥500 U/ml may be candidates for an initial laparoscopic approach to specify resectability and to determine how to proceed. Overall, CA125 levels appear to be helpful in predicting suboptimal cytoreductive surgery for patients with primary ovarian cancer, but should be interpreted together with clinical and radiologic findings. This may improve defining the optimal treatment strategy in these patients.

A Practical Nomogram to Predict Early Death in Advanced Epithelial Ovarian Cancer

“…However, the effect of CA125 on the prognosis of advanced EOC remains controversial. Studies have shown that PFS and OS are significantly better in advanced FIGO stage EOC when CA125 is <500 U/mL than when CA125 is >500 U/mL ( 28 ). However, there are studies that argue against it.…”

Feature Selection is Critical for 2-Year Prognosis in Advanced Stage High Grade Serous Ovarian Cancer by Using Machine Learning

“…Blood biomarkers such as preoperative Hb and Ca125 were not included as they appear more reliable to predict surgical outcomes or simply predict malignancy in women with adnexal masses. 16 , 17 Equally, surveillance modalities are not used to comprehensively evaluate the prognosis of the HGSOC patients provided that the primary objective of follow-up is to detect disease that if treated early can extend survival. It is not to prolong time living with the knowledge that cancer has relapsed without extending survival.…”

Nadir CA-125 has prognostic value for recurrence, but not for survival in patients with ovarian cancer

“…In clinical practice, measuring the serum level of CA-125 was found to be useful at different points of OC management. Increased pretreatment CA-125 levels are an independent predictor of PFS and OS 5 , 6 . A postoperative decline in serum CA125 levels (> 75% or ≥ 80%) was found to be an independent prognostic factor for progression-free survival 7 , 8 .…”