Prognostic and predictive value of CA-125 in the primary treatment of epithelial ovarian cancer: potentials and pitfalls

Abstract

The serum cancer antigen 125 (CA-125) remains a reliable biomarker in the therapeutic management of epithelial ovarian cancer (EOC). Monitoring the efficacy of cytotoxic chemotherapy (CT) and the early detection of relapse during the follow up of patients in remission represent the two most common clinical situations where the CA-125 has been successfully applied. There are however other scenarios along the course of the disease where the CA-125 can potentially aid in the decision-making process. Preoperative levels of CA-125 can help in selecting a subset of patients where an optimal cytoreduction may not be easily achieved. Perioperative variations in the CA- 125 levels after primary surgery and, more importantly, the nadir value of the CA-125 after primary chemotherapy, are associated with patient outcome. This review focuses on the clinical relevance of dynamic changes in CA-125 levels during the primary treatment of EOC and its potential influence both in the patient management and in the design of clinical trials in the adjuvant setting.

Prognostic Factors in Women With Synchronous Endometrial and Ovarian Cancers

“…Since its first introduction as a glycoprotein epithelial surface tumor marker in epithelial ovarian cancer with particular use for follow-up monitoring of disease activity, 16 serum CA-125 has widely been used as an important biomarker in the management of women with ovarian cancer. 17 Elevated CA-125 levels were also shown to be a strong predictor of poor prognosis in patients with endometrial cancer. 18 These findings support our result that CA-125 is a prognostic factor even in synchronous endometrial and ovarian cancers.…”

Microvesicles as Potential Ovarian Cancer Biomarkers

“…CA 125 is undoubtedly the most carefully studied and extensively used biomarker despite being characterized as having low sensitivity and specificity [85]. Many gynecologic and nongynecologic pathological conditions showed increased serum levels for this marker such as endometriosis and adenomyosis, pelvic, peritoneal, pleural, and musculoskeletal inflammatory diseases, hepatitis, and pancreatitis [81, 86].…”

A longitudinal analysis with CA-125 to predict overall survival in patients with ovarian cancer

“…Many of the related studies focus on specific values of CA-125. For example, studies on absolute CA-125 values have shown that the CA-125 levels after surgery, after 2, 3, or 6 cycles of chemotherapy are important prediction factors for OS [16-20], but the preoperative CA-125 may not correlate with OS [21]. The results presented here also suggested that those patients survived <3 years had an overall higher CA-125 curve compared to those who survived 3 years or more, even in the first month of treatment, which typically represents the CA-125 changes after the first couple of chemotherapy cycles.…”