Abstract
Introduction
Despite radical surgery and chemotherapy, most patients with ovarian cancer develop recurrence and die due to progressive disease. To stratify patients for optimal therapy, prognostic and predictive factors are needed. We examined the role of pre- and postoperative CA-125 in this context.
Methods
A total of 231 patients with primary ovarian cancer who presented for surgery at our institution between 1996 and 2004 were included in this study (25% FIGO stage I/II and 75% FIGO stage III/IV). The prognostic and predictive values of CA-125 serum concentrations before and after surgery as well as their correlation with clinicopathological variables were analyzed.
Results
Median preoperative CA-125 was 61.6 kU/l (9–1,867 kU/l) in stage I/II patients and 533.15 kU/l (10–22,617 kU/l) in stage III/IV patients. Before surgery, 67% of stage I/II patients and 96% of stage III/IV patients had elevated CA-125 (>35 kU/l). There was a significant decrease in CA-125 after surgery in both patient cohorts (61.6–43.4 kU/l, P = 0.001 and 533.15–92.3 kU/l, P < 0.001, respectively). Furthermore, in stage III/IV patients with complete or so-called optimal (<1 cm residual disease) debulking, preoperative CA-125 levels were significantly lower than in patients with residual disease >1 cm (P = 0.01, P = 0.009, respectively). Neither CA-125 concentration before surgery nor its decrease was prognostically relevant for recurrence and survival at any stage. However, in stage III/IV patients, a high postoperative CA-125 was associated with shorter progression-free survival (P = 0.024).
Conclusions
Although CA-125 serum levels differ significantly before and after surgery in early and advanced-stage ovarian cancer and preoperative CA-125 values correlate with surgical outcome in advanced-stage disease, we could not determine a preoperative cutoff value for prediction of the surgical result. A prognostic relevance was only observed for postoperative CA-125 in stage III/IV patients.
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References
Barlow TS, Przybylski M, Schilder JM, Moore DH, Look KY (2006) The utility of presurgical CA125 to predict optimal tumor cytoreduction of epithelial ovarian cancer. Int J Gynecol Cancer 16(2):496–500
Bast RC Jr, Feeney M, Lazarus H, Nadler LM, Colvin RB, Knapp RC (1981) Reactivity of a monoclonal antibody with human ovarian carcinoma. J Clin Invest 68(5):1331–1337
Bast RC Jr, Klug TL, St. John E, Jenison E, Niloff JM, Lazarus H, Berkowitz RS, Leavitt T, Griffiths CT, Parker L, Zurawski VR Jr, Knapp RC (1983) A radioimmunoassay using a monoclonal antibody to monitor the course of epithelial ovarian cancer. N Engl J Med 309(15):883–887
Bast RC Jr, Badgwell D, Lu Z, Marquez R, Rosen D, Liu J, Baggerly KA, Atkinson EN, Skates S, Zhang Z, Lokshin A, Menon U, Jacobs I, Lu K (2005) New tumor markers: CA125 and beyond. Int J Gynecol Cancer 15(3):274–281
Bristow RE, Duska LR, Lambrou NC, Fishman EK, O’Neill MJ, Trimble EL, Montz FJ (2000) A model for predicting surgical outcome in patients with advanced ovarian carcinoma using computed tomography. Cancer 89(7):1532–1540
Cannistra SA, Bast RC Jr, Berek JS, Bookman MA, Crum CP, DePriest PD, Garber JE, Koh WJ, Markman M, McGuire WP 3rd, Rose PG, Rowinsky EK, Rustin GJ, Skates SJ, Vasey PA, King L (2003) Progress in the management of gynecologic cancer: consensus summary statement. J Clin Oncol 21(10):129s–132s
Chi DS, Venkatraman ES, Masson V, Hoskins WJ (2000) The ability of preoperative serum CA-125 to predict optimal primary tumor cytoreduction in stage III epithelial ovarian carcinoma. Gynecol Oncol 77(2):227–231
Colombo PE, Mourregot A, Fabbro M, Gutowski M, Saint-Aubert B, Quenet F, Gourgou S, Rouanet P (2009) Aggressive surgical strategies in advanced ovarian cancer: a monocentric study of 203 stage IIIC and IV patients. Eur J Surg Oncol 35(2):135–143
Cooper BC, Sood AK, Davis CS, Ritchie JM, Sorosky JI, Anderson B, Buller RE (2002) Preoperative CA 125 levels: an independent prognostic factor for epithelial ovarian cancer. Obstet Gynecol 100(1):59–64
du Bois A, Reuss A, Pujade-Lauraine E, Harter P, Ray-Coquard I, Pfisterer J (2009) Role of surgical outcome as prognostic factor in advanced epithelial ovarian cancer: a combined exploratory analysis of 3 prospectively randomized phase 3 multicenter trials: by the Arbeitsgemeinschaft Gynaekologische Onkologie Studiengruppe Ovarialkarzinom (AGO-OVAR) and the Groupe d’Investigateurs Nationaux Pour les Etudes des Cancers de l’Ovaire (GINECO). Cancer 115(6):1234–1244
Geisler JP, Miller GA, Lee TH, Harwood RM, Wiemann MC, Geisler HE (1996) Relationship of preoperative serum CA-125 to survival in epithelial ovarian carcinoma. J Reprod Med 41(3):140–142
Guppy AE, Rustin GJ (2002) CA125 response: can it replace the traditional response criteria in ovarian cancer? Oncologist 7(5):437–443
IARC IAfRoC (2006) Descriptive epidemiology group of IARC
Juretzka MM, Barakat RR, Chi DS, Iasonos A, Dupont J, Abu-Rustum NR, Poynor EA, Aghajanian C, Spriggs D, Hensley ML, Sabbatini P (2007) CA125 level as a predictor of progression-free survival and overall survival in ovarian cancer patients with surgically defined disease status prior to the initiation of intraperitoneal consolidation therapy. Gynecol Oncol 104(1):176–180
Kang S, Kim TJ, Nam BH, Seo SS, Kim BG, Bae DS, Park SY (2010) Preoperative serum CA-125 levels and risk of suboptimal cytoreduction in ovarian cancer: a meta-analysis. J Surg Oncol 101(1):13–17
Kumar P, Rehani MM, Kumar L, Sharma R, Bhatla N, Chaudhry R, Thulkar S, Sundaram KR, Kumar N (2005) Tumor marker CA-125 as an evaluator and response indicator in ovarian cancer: its quantitative correlation with tumor volume. Med Sci Monit 11(2):CR84–CR89
Lloyd KO, Yin BW, Kudryashov V (1997) Isolation and characterization of ovarian cancer antigen CA 125 using a new monoclonal antibody (VK-8): identification as a mucin-type molecule. Int J Cancer 71(5):842–850
Mahner S, Baasch C, Schwarz J, Hein S, Wolber L, Janicke F, Milde-Langosch K (2008a) C-Fos expression is a molecular predictor of progression and survival in epithelial ovarian carcinoma. Br J Cancer 99(8):1269–1275
Mahner S, Schirrmacher S, Brenner W, Jenicke L, Habermann CR, Avril N, Dose-Schwarz J (2008b) Comparison between positron emission tomography using 2-[fluorine-18]fluoro-2-deoxy-d-glucose, conventional imaging and computed tomography for staging of breast cancer. Ann Oncol 19(7):1249–1254
Mahner S, Woelber L, Jung S, Eulenburg CZ, Ihnen M, Schwarz J, Sehouli J, Jaenicke F (2009) Prognostic significance of CA-125 in the management of patients with recurrent epithelial ovarian carcinoma selected for secondary cytoreduction. Anticancer Res 29(7):2817–2821
Markman M (2009) PET/CT scans in ovarian cancer: prognostic versus predictive utility? Minerva Med 100(5):415–420
Nagele F, Petru E, Medl M, Kainz C, Graf AH, Sevelda P (1995) Preoperative CA 125: an independent prognostic factor in patients with stage I epithelial ovarian cancer. Obstet Gynecol 86(2):259–264
Nossov V, Amneus M, Su F, Lang J, Janco JM, Reddy ST, Farias-Eisner R (2008) The early detection of ovarian cancer: from traditional methods to proteomics. Can we really do better than serum CA-125? Am J Obstet Gynecol 199(3):215–223
Paramasivam S, Tripcony L, Crandon A, Quinn M, Hammond I, Marsden D, Proietto A, Davy M, Carter J, Nicklin J, Perrin L, Obermair A (2005) Prognostic importance of preoperative CA-125 in international federation of gynecology and obstetrics stage I epithelial ovarian cancer: an Australian multicenter study. J Clin Oncol 23(25):5938–5942
Rossi AC, Di Vagno G, Cormio G, Cazzolla A, Stefanelli S, D’Elia E, Selvaggi L (2004) A retrospective study of preoperative CA 125 levels in 82 patients with ovarian cancer. Arch Gynecol Obstet 269(4):263–265
Shaaban A, Rezvani M (2009) Ovarian cancer: detection and radiologic staging. Clin Obstet Gynecol 52(1):73–93
Shih KK, Chi DS (2010) Maximal cytoreductive effort in epithelial ovarian cancer surgery. J Gynecol Oncol 21(2):75–80
Vorgias G, Iavazzo C, Savvopoulos P, Myriokefalitaki E, Katsoulis M, Kalinoglou N, Akrivos T (2009) Can the preoperative Ca-125 level predict optimal cytoreduction in patients with advanced ovarian carcinoma? A single institution cohort study. Gynecol Oncol 112(1):11–15
Woelber L, Mueller V, Eulenburg C, Schwarz J, Carney W, Jaenicke F, Milde-Langosch K, Mahner S (2010) Serum carbonic anhydrase IX during first-line therapy of ovarian cancer. Gynecol Oncol 117(2):183–188
Zorn KK, Tian C, McGuire WP, Hoskins WJ, Markman M, Muggia FM, Rose PG, Ozols RF, Spriggs D, Armstrong DK (2009) The prognostic value of pretreatment CA 125 in patients with advanced ovarian carcinoma: a gynecologic oncology group study. Cancer 115(5):1028–1035
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This study was funded by internal departmental sources.
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We declare that we have no conflict of interest.
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D. Mury and L. Woelber contributed equally to this work.
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Mury, D., Woelber, L., Jung, S. et al. Prognostic and predictive relevance of CA-125 at primary surgery of ovarian cancer. J Cancer Res Clin Oncol 137, 1131–1137 (2011). https://doi.org/10.1007/s00432-011-0977-1
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DOI: https://doi.org/10.1007/s00432-011-0977-1