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. 2017 Jan;28(1):e7.
doi: 10.3802/jgo.2017.28.e7. Epub 2016 Sep 12.

Perioperative changes in serum CA125 levels: a prognostic factor for disease-specific survival in patients with ovarian cancer

Nienke Zwakman  1 , Rafli van de Laar  1   2 , Toon Van Gorp  1   3 , Petra L M Zusterzeel  2 , Marc P M L Snijders  4 , Isabel Ferreira  5 , Leon F A G Massuger  2 , Roy F P M Kruitwagen  1   6
Affiliations

Perioperative changes in serum CA125 levels: a prognostic factor for disease-specific survival in patients with ovarian cancer

Nienke Zwakman et al. J Gynecol Oncol. 2017 Jan.

Abstract

Objective: In patients with advanced stage epithelial ovarian cancer (EOC) the volume of residual tumor after debulking is known as prognostic factor for survival. We wanted to examine the relationship between postoperative decline in serum CA125 and residual disease after cytoreductive surgery and evaluate perioperative changes in serum CA125 levels as predictor for disease-specific survival.

Methods: A retrospective study was conducted of patients with FIGO stage IIb-IV EOC treated with cytoreductive surgery, followed by chemotherapy between 1996 and 2010 in three hospitals in the Southeastern region of the Netherlands. Data were analyzed with the use of multilevel linear regression and Cox-proportional hazard regression models.

Results: A postoperative decline in serum CA125 level of ≥80% was associated with complete primary cytoreduction (p=0.035). Univariate analyses showed favorable associations with survival for both the degree of decline in serum CA125 and residual tumor after primary cytoreduction. In multivariate analyses the decline in serum CA125 but not the outcome of surgery remained significantly associated with better survival (HR(50%-79%)=0.52 [95% CI: 0.28-0.96] and HR(≥80%)=0.26 [95% CI: 0.13-0.54] vs. the serum CA125 decline of <50% [p<0.001]).

Conclusion: The current study, although hampered by possible biases, suggests that the perioperative decline in serum CA125 is an early biomarker that predicts disease-specific survival in patients who underwent primary cytoreductive surgery for advanced stage EOC. If confirmed prospectively, the perioperative change in serum CA125 could be a better marker for residual tumor volume after primary cytoreductive surgery (and therewith disease-specific survival) than the surgeons' estimation of residual tumor volume.

Keywords: CA-125 Antigen; Neoplasm, Residual; Ovarian Neoplasms; Prognosis; Survival.

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Conflict of interest statement

No potential conflict of interest relevant to this article was reported.

Figures

Fig. 1
Fig. 1
Flowchart describing the study sample selection.
Fig. 2
Fig. 2
Decline in CA125 by categories of surgery outcome. (A) Absolute levels; (B) Relative levels (categorized and cross-tabulated).
Fig. 3
Fig. 3
Kaplan-Meier survival curves by categories of % perioperative decline in CA125.
See this image and copyright information in PMC

Comment in

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