Does preoperative CA-125 cutoff value and percent reduction in CA-125 levels correlate with surgical and survival outcome after neoadjuvant chemotherapy in patients with advanced-stage ovarian cancer? – Our experience from a tertiary cancer institute

Abstract

Aim: The aim of the study is to evaluate percent fall in CA-125 levels after neoadjuvant chemotherapy (NAC) and preoperative CA-125 value to predict surgical and survival outcomes in women with advanced-stage epithelial ovarian cancer (EOC). Methods: A retrospective review of 406 women receiving NAC for advanced-stage EOC from January 2012 to July 2015 was conducted. Data were collected for demography, radiographic profile, CA-125 levels before and after NAC, chemotherapy, and surgicopathological information. Percent fall in CA-125 was categorized into two groups: <95% (R < 95) and >95% (R > 95) fall from prechemotherapy to preoperative levels. Similarly, women were also categorized using preoperative CA-125 levels of <100 and >100 U/ml. A subset of women from January 2012 to December 2013 was followed to June 2015 for evidence of any recurrence to determine survival outcomes. Results: About 56% women had R > 95 and 44% had R < 95. As compared to R < 95, R > 95 group was more likely to have complete cytoreduction (P = 0.00). Furthermore, women with R > 95 had significant better progression-free survival (PFS) as compared to women with R < 95 (P = 0.009) but no difference in overall survival (OS) (P = 0.28). Women with preoperative CA-125 <100 had significant higher number of complete cytoreduction (55% vs. 40%; P = 0.00) and were associated with both PFS (P = 0.007) and OS benefit (P = 0.02). Conclusion: Our data showed that >95% fall in CA-125 and an absolute preoperative CA-125 value of <100 U/ml is associated with better surgical and survival outcome in women with advanced EOC. These data are important in patient counseling and treatment planning.

Preoperative Cancer Antigen 125 Level as Predictor for Complete Cytoreduction in Ovarian Cancer: A Prospective Cohort Study and Systematic Review

“…The QUIPS quality assessment outcomes of the included studies are reported in Supporting Information Supplementary Table S3 . Generally, the risk of bias was low for most studies [ 8 , 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 ]. The risk of bias was moderate for only three studies [ 25 , 26 , 27 ].…”

“…Two studies were prospective cohort studies [ 15 , 25 ]; the other twelve studies were retrospective cohort studies [ 8 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 26 , 27 ]. Four out of 14 studies reported the results of patients who underwent primary CRS [ 15 , 16 , 17 , 25 ], and nine studies reported the results of patients who underwent interval CRS [ 8 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 26 ]. One study reported patients undergoing either primary or interval CRS [ 27 ].…”

“…Matsuhashi et al reported a significant relation between lower preoperative CA-125 levels and complete/optimal CRS ( p = 0.003) [ 19 ]. Gupta et al demonstrated higher rates of complete CRS in patients with preoperative levels of CA-125 <100 kU/L ( p = 0.00) [ 18 ], whereas Zeng et al reported the cut off level of CA-125 level ≤200 kU/L ( p = 0.012) [ 8 ]. In two studies, preoperative CA-125 was not a significant predictor of surgical outcome in multivariable analysis [ 20 , 23 ].…”

Preoperative serum CA-125 level as a predictor for the extent of cytoreduction in patients with advanced stage epithelial ovarian cancer

“…A study published by Gupta et al . 26 showed that a 95% reduction of CA-125 levels and an absolute preoperative CA-125 level of 100 IU/ml or less predicted complete gross resection after NACT.…”

Choosing the right timing for interval debulking surgery and perioperative chemotherapy may improve the prognosis of advanced epithelial ovarian cancer: a retrospective study

“…Furthermore, our results showed that the interval between preoperative and postoperative chemotherapy was significantly correlated with both PFS and OS; we established the threshold of 35.5 days by ROC curve analysis, such that patients with an interval between preoperative and postoperative chemotherapy of < 35.5 days had better PFS and OS, yielding an improvement in PFS and OS of 5.6 months and 25.4 month, respectively. In addition, regarding the decline in CA125 levels after NACT, a published study reported that a CA125 decrease of > 95% after NACT and CA125 level < 100 U/ml before IDS were related to better surgical outcomes and prognosis [ 23 ]. Similarly, we concluded that a normal CA125 level before IDS was associated with better OS and PFS, but in our study, a > 90% decrease in CA125 levels after NACT did not correlate significantly with optimal cytoreduction or prognosis.…”