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 computed tomography scans in predicting suboptimal cytoreductive surgery in women with advanced ovarian carcinoma

“…Although their overall optimal cytoreduction level was 45%, 73% of patients with a CA 125 level Ͻ 500 underwent optimal cytoreduction. In contrast, only 22% of 24,25 In contrast, Memarzadeh et al 26 published an investigation of 99 patients with advanced ovarian carcinoma. With a relatively high overall optimal resection rate of 73%, they found that the preoperative CA 125 level was a poor predictor of optimal resection.…”

Comparative study of pre-operative CT scan and per-operative findings in carcinoma ovary

“…A recent metaanalysis concluded that although a CA-125 > 500 U/mL was a strong risk factor for suboptimal debulking, it lacked the accuracy to independently predict surgical outcome. [34][35][36][37][38] In our study, it was found that almost equal number of patients (around 70 and 74.9%%) underwent optimal cytoreduction in both groups i.e., <500IU/ml and >500IU/ml. The value of CA125 did not correlate with optimal cytoreduction with P value -0.721 which is statistically not significant.…”

The Significance of Normal Pretreatment Levels of Ca125 (<35 U/Ml) in Epithelial Ovarian Carcinoma

“…On the other hand, in other studies preoperative serum CA125 level was not found to be a reliable predictor of optimal cytoreduction. [20][21][22][23][24][25] Several studies included data regarding low preoperative CA125 levels (<100 U/mL) in the assessment of the ability to predict optimal cytoreduction and outcome. Vorgias et al 26 found that all of 19 patients with CA125 levels of <100 U/mL were optimally cytoreduced.…”