In a prospective study of52 patients with ovarian malignancy followed up for 3-1 8 months the clinical significance of pre-operative serum CA 125 as ii tumour marker was assessed. In 41 patients with epithelial ovarian cancer. the level of CA 125 correlated wcll with tuniour load as indicated by F I G 0 stage. All epithelial histological types, including mucinous. released CA 125 although serouh and undifferentiated tuinours produced quantitatively more antigen. 'l'hcre was, however, no correlation between CA 125 concentration and histopathological grade. n o r did CA 125 level appear to be of any prognostic value in epithelial ovarian cancer. Elevated CA 125 levels were also found in patjcnts with sex cordistronial tumours, K r u k e n b e r g tumours. an ovarian sarcoma and a serous carcinoma of low malignant potential.

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To assess the clinical potential of serial serum CA125 measurements in the follow-up of patients with epithelial ovarian cancer, 74 consecutive unselected patients with histologically confirmed ovarian carcinoma were studied prospectively. There was an 83% concordance between clinical assessment and CA125 assessment of response. The positive predictive values of a rising CA125 for disease progression and a falling CA125 for disease regression were 0.93 and 0.94, respectively. The absolute CA125 values during observations of complete response (mean 96 U/ml; 95% confidence interval; 33 to 128 U/ml), partial response (mean 134 U/ml; 95% confidence interval; 98 to 159 U/ml) and stable or progressive disease (mean 391 U/ml; 95% confidence interval; 282 to 545 U/ml) were significantly different. A randomized study is required to determine whether CA125 monitoring has any benefit in terms of outcome, and particularly survival, in epithelial ovarian cancer.

Although the results from chemotherapy for advanced ovarian carcinoma have improved over the past 15 years with the introduction of platinum compounds, there are still a large number of patients who will relapse from complete response (clinical or pathological) to first line therapy, and there is little published data on prognostic factors for survival after relapse. A total of 270 patients from two randomized trials in ovarian carcinoma conducted in Scotland were reviewed and the data from 117 patients who were disease free after first line treatment were analyzed to determine prognostic factors associated with disease‐free survival and survival after relapse respectively. The most important prognostic factors adversely influencing time to relapse were the presence of ascites at presentation and an advanced tumor stage. For time from relapse to death, the most important adverse features were: early relapse, no chemotherapy at relapse, histology other than serous and stage at diagnosis (either stage IC/II or stage III/IV with residual disease 2 cm). From our results, 26% of patients who achieve complete response are alive and disease‐free after 5 years, while 56% relapsed within 2 years. Of the patients whose disease‐free period following initial complete response extends beyond 600 days, 50% can expect a further period of at least 600 days following relapse and subsequent therapy. Patients with ascites and advanced stage may be suitable for consideration of a more aggressive approach (high dose chemotherapy) once complete response is confirmed, the aim being to improve the disease‐free period.

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