Can Serum CA-125 Levels Predict the Optimal Primary Cytoreduction in Patients with Advanced Ovarian Carcinoma?

Saygılı, Uğur; Güçlü, Serkan; Uslu, Turhan; Erten, Oktay; Demir, Namık; Önvural, Ata

doi:10.1006/gyno.2002.6719

Cited by 57 publications

(30 citation statements)

References 28 publications

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“…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.…”

Section: Discussionmentioning

confidence: 99%

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

Dowdy

Mullany

Brandt

et al. 2004

Cancer

167

100

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BACKGROUNDComputed tomography (CT) scans of the abdomen and pelvis may predict which patients with ovarian carcinoma can undergo optimal cytoreduction at primary surgery. Previous studies have demonstrated that patients with ovarian carcinoma had optimal cytoreduction rates ranging from 50–60%. The authors sought to determine whether these findings applied to a surgical practice with a higher rate of optimal debulking. A predictive model using CT scanning and CA 125 values would allow the authors to determine which patients would be more appropriately treated with neoadjuvant chemotherapy.METHODSPreoperative CT scans for patients with Stage III/IV ovarian carcinoma (according to the staging system of the International Federation of Gynecology and Obstetrics) who were treated between 1996 and 2001 were evaluated retrospectively by 2 radiologists for 17 criteria evaluating the extent of disease. Clinical data were extracted from medical records. Residual tumors measuring ≥ 1 cm were considered suboptimal. Logistic regression was used to evaluate which criteria correlated with optimal cytoreduction.RESULTSEighty‐seven patients were identified retrospectively who met entry criteria and had preoperative CT scans of sufficient diagnostic quality. Sixty‐two patients (71%) received optimal cytoreductive surgery and 45 (52%) required aggressive surgical procedures. In a multivariate model, only diffuse peritoneal thickening (DPT) independently predicted suboptimal surgical resection (P = 0.016). However, a model using both DPT and ascites on most CT scans had a positive predictive value of 68% and a sensitivity of 52% for predicting suboptimal cytoreduction.CONCLUSIONSThe presence of DPT and large‐volume ascites was associated with a very low rate of optimal cytoreduction (32%) in a surgical practice. These patients may be more appropriately treated with neoadjuvant chemotherapy followed by surgical cytoreduction. Cancer 2004. © 2004 American Cancer Society.

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Section: Discussionmentioning

confidence: 99%

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

Dowdy

Mullany

Brandt

et al. 2004

Cancer

167

100

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“…2 However, CA 125 is not a reliable predictor for diagnosis due to low sensitivity and there is currently no screening strategy that is proven to be effective. 3 Therefore, for early diagnosis, novel approaches such as identifying cancer-specific cells as biomarkers in the blood or serum/urine by genomics or proteomics technologies are needed. 4 Recently, there have been extensive studies and progress in the molecular pathogenesis analysis and gene profiling of ovarian cancers using serial analysis of gene expression and DNA microarray technologies.…”

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confidence: 99%

Interleukin‐13 receptor α2 chain

Kioi

Kawakami

Shimamura

et al. 2006

Cancer

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BACKGROUND Epithelial ovarian cancer demonstrates high mortality due to diagnosis at an advanced stage. In the search for a biomarker for early diagnosis and a target for therapy, the issue of whether interleukin‐13 receptor (IL‐13R), shown to be expressed on a variety of human cancers, is expressed in ovarian tumor samples was explored. In addition, whether this receptor serves as a biomarker and can be targeted by IL‐13 cytotoxin was examined. METHODS IL‐13R expression in 15 normal and 68 ovarian tumor tissue samples was determined by immunohistochemistry. Correlation between clinicopathologic features and IL‐13R expression was analyzed. The efficacy of IL‐13R‐directed cytotoxin was determined in mice with subcutaneous, orthotopic, and peritoneal metastatic ovarian cancer. RESULTS Immunohistochemical analyses revealed that 83% of ovarian cancer specimens express IL‐13Rα2, a high‐affinity IL‐13R subunit chain, whereas normal ovary samples expressed none or very low levels. The majority of clear cell ovarian carcinomas with the worst prognosis showed strong staining for IL‐13Rα2. IL‐13 cytotoxin was highly cytotoxic to the IGROV‐1 ovarian cancer cell line in vitro, and it mediated significant antitumor activity against a xenografted tumor model. The antitumor effects were confirmed by treating orthotopically implanted or peritoneal metastatic ovarian tumors, which showed significant extension of survival in immunodeficient mice. IL‐13 cytotoxin also prevented cachexia in treated mice. The soluble form of IL‐13Rα2 was detected in the serum of mice with peritoneal metastasis, and the level decreased to baseline in the treated group. CONCLUSIONS IL‐13Rα2 is a promising target for ovarian cancer therapy, and the soluble form of IL‐13R may be a possible surrogate marker for disease monitoring. Cancer. Published 2006 by the American Cancer Society.

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“…Although the accuracy of preoperative serum Ca125 levels ranges between 50 and 78%, and conflicting data about the predictive ability of Ca125 levels have been reported (Chi et al, 2000(Chi et al, , 2009Cooper et al, 2002;Saygili et al, 2002;Memarzadeh et al, 2003), computed tomography(CT) scan assessed parameters might conceivably offer better predictive performances, as they define not only the extension of disease, but also more important, the involvement of specific intraabdominal sites generally recognised to heavily preclude the feasibility of optimal debulking, such as portal triad disease, agglutinated bowel/mesentery, bulky diaphragmatic disease, or suprarenal aortic lymph nodes (Eisenkop and Spirtos, 2001). In particular, Bristow et al (2000) developed a CT scan-based model achieving an overall accuracy of 93% in predicting successful cytoreduction.…”

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confidence: 99%

Role of CT scan-based and clinical evaluation in the preoperative prediction of optimal cytoreduction in advanced ovarian cancer: a prospective trial

et al. 2009

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BACKGROUND: In advanced ovarian cancer, maximal efforts have to be attemptedto achieve optimal cytoreduction, as this represents the keystone in the therapeutic management. This large, prospective study aims at investigating the role of computed tomography (CT) scan in predicting the feasibility of optimal cytoreduction in ovarian cancer. METHODS: A total of 195 consecutive patients with clinical/radiographic suspicion of advanced ovarian/peritoneal cancer were enrolled at the Gynecologic Oncology Unit, Catholic University of Rome and Campobasso, Italy. Preoperative CT scans were performed with a high-speed scanner (CT Hi Speed Nx/i Pro; 2-slice; GE Medical System). All patients underwent standard laparotomy, and maximal surgical effort was attempted. The following CT parameters were used: peritoneal thickening, peritoneal implants 42 cm, bowel mesentery involvement, omental cake, pelvic sidewall involvement and/or hydroureter, suprarenal aortic lymph nodes 41 cm, infrarenal aortic lymph nodes 42 cm, superficial liver metastases 42 cm and/or intraparenchimal liver metastases any size, large volume ascites (4500 ml). Clinical data included were age, Ca125 serum levels, and ECOG-PS. Radiographic and clinical features exhibiting a specificity 475%, a positive and negative predictive value 450%, an accuracy 460% in predicting surgical outcome were assigned a point value of 2. With this scoring system, a predictive index (PI) was calculated for each patient. RESULTS: The PI scores ranged from 0 to 6, and from 0 to 8, in Model 1 (including only radiographic parameters) and in Model 2 (including radiographic and clinical data). The AUC was 0.78 þ 0.035 in Model 1, and 0.81 þ 0.031 in Model 2. Therefore, the addition of ECOG-PS data led to the improvement of the diagnostic performances (z ¼ 2.41, P-value o0.05). CONCLUSIONS: Computed scan still represents a valid tool to predict ovarian cancer optimal cytoreduction; the predictive ability of a CT scan-based model is improved by integrating ECOG-PS data.

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Can Serum CA-125 Levels Predict the Optimal Primary Cytoreduction in Patients with Advanced Ovarian Carcinoma?

Cited by 57 publications

References 28 publications

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

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

Interleukin‐13 receptor α2 chain

Role of CT scan-based and clinical evaluation in the preoperative prediction of optimal cytoreduction in advanced ovarian cancer: a prospective trial

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