CA125 levels are a weak predictor of optimal cytoreductive surgery in patients with advanced epithelial ovarian cancer

Abstract

The utility of preoperative CA125 to predict optimal primary tumor cytoreduction in patients with advanced (stages IIIC and IV) epithelial ovarian cancer is controversial. In this paper, we retrospectively review patients with stage IIIC and IV epithelial ovarian cancer who underwent primary cytoreductive surgery from 1989 to 2001. Ninety-nine patients were identified and included in the analysis. All patients had preoperative CA125 levels measured. Operative and pathology reports were reviewed. Optimal cytoreduction was defined as largest volume of residual disease < 1 cm in maximal dimension. Mean values were compared with t-test on a log scale when needed. The optimal cut-point for discriminating between those with vs. without optimal cytoreduction was determined using the receiver operator curve (ROC) method. Optimal cytoreduction was achieved in 73% of patients. Among patients with optimal cytoreductive status the mean CA125 level was 569, while among patients with suboptimal cytoreduction the mean CA125 level was 1520 (P < 0.007). A CA125 level of 912 was identified as the optimal cut-point to distinguish the two groups. Using this CA125 level, the sensitivity of this test in predicting optimal cytoreduction was 58% and the specificity was 54%. The positive predictive value of CA125 for optimal cytoreduction was 78% and the negative predictive value was 31%. We conclude that CA125 level is a weak positive and negative predictor of optimal cytoreductive surgery in patients with advanced epithelial ovarian cancer. The CA125 level should not be used as a primary predictor of the outcome of cytoreductive surgery and should be viewed in the context of all other preoperative features.

The utility of presurgical CA125 to predict optimal tumor cytoreduction of epithelial ovarian cancer

“…Although our data did not show CA125 to be an ideal predictor of OD, our ability to achieve overall OD rate of 46% for patients with stage III and IV diseases was comparable to that achieved by others (17–20) . Our ability to achieve OD rate of 37% for those with CA125 level >500 compares favorably to the 22% reported by Chi et al (17) .…”

“…The utility of preoperative computed tomography scans (15,16) and serum CA125 (17–20) to predict OD for patients with EOC has been examined. The performance of preoperative CA125 exhibited a sensitivity for predicting OD in patients with stage III–IV EOC ranging from 55% to 78% and a specificity from 54% to 73% (17,18) . Chi et al (17) reported that the probability of OD was only one in five for those with CA125 greater than 500.…”

Neoadjuvant chemotherapy in gynaecological cancers – Implications for staging

“…Optimal cytoreduction was achieved in 73% of patients with a CA-125 < 500 U/ml compared to only 22% with a CA-125 > 500 U/ml with a sensitivity of 78%, a specificity of 73%, a positive predictive value of 78% and a negative predictive value of 73% [28]. On the contrary, others did not find any correlation between preoperative CA-125 levels and surgical outcome [29]. A wide variation in the percentage of patients undergoing optimal debulking in different studies may be a possible explanation.…”

Chirurgie initiale ou d'intervalle dans les cancers de l'ovaire de stade avancé ? État de la question en 2004 et critères de sélection des patientes

“…Le taux de CA 125 a fait l'objet de plusieurs études de la littérature, qui en ont évalué la pertinence en tant que critère de résécabilité dans les tumeurs ovariennes, avec des résultats divergents [33][34][35][36][37].…”

“…La déter-mination du seuil à 500 UI/ml avait une sensibilité de 78 % et une spécificité de 73 % pour sélectionner les patientes résécables ou non [33] [36]. Cette étude concluait que la détermination du seuil du CA 125 n'est pas un critère suffisamment fiable pour discriminer les patientes.…”