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Archives of Gynecology and Obstetrics

, Volume 284, Issue 1, pp 221–227 | Cite as

The prognostic and predictive value of CA-125 regression during neoadjuvant chemotherapy for advanced ovarian or primary peritoneal carcinoma

  • Naveen S. Vasudev
  • Ioannis Trigonis
  • David A. Cairns
  • Geoff D. Hall
  • David P. Jackson
  • Timothy Broadhead
  • John Buxton
  • Richard Hutson
  • David Nugent
  • Timothy J. Perren
Gynecologic Oncology

Abstract

Purpose

To assess the significance of CA-125 regression as a prognostic indicator and predictor of optimal cytoreduction at interval debulking surgery (IDS) in women with ovarian or primary peritoneal carcinoma receiving neoadjuvant chemotherapy (NAC).

Methods

63 women treated between 2004 and 2007 with neoadjuvant platinum-based chemotherapy followed by IDS were studied retrospectively. Pre-operative CA-125 values were used to calculate a regression coefficient (CA-125r) using exponential regression analysis. Outcome endpoints were overall survival (OS), time to CA-125 progression (TTC) by Rustin criteria and time to second-line treatment (TTS).

Results

Women with a CA-125 half-life greater than 18 days had a significantly worse OS compared to those with a half-life less than 12 days on univariate testing (HR 3.34, 95% CI 1.25–8.94, p = 0.017). On multivariable analysis, CA-125r was an independent predictor of OS [HR 1.18 (per 0.01 increase in CA-125r), 95% CI 1.01–1.40, p = 0.043]. CA-125r was independently predictive of TTC and TTS (HR 1.17, p ≈ 0.03 for each). CA-125r was also predictive of achieving optimal cytoreduction at IDS (AUC 0.756, p < 0.001).

Conclusions

CA-125 regression rate during pre-operative NAC is of independent prognostic value. CA-125 regression rate strongly predicts for optimal cytoreduction.

Keywords

CA-125 regression Ovarian cancer Neoadjuvant chemotherapy Interval debulking surgery 

Notes

Acknowledgments

The authors gratefully acknowledge the support of Cancer Research UK and the UK Medical Research Council (G0802416). We would also like to thank the following, who in addition to the authors, contributed to the management of patients within the study: Mr Geoff Lane and Mr Sam Saidi, Department of Gynecological Oncology, St. James’s University Hospital, Leeds, UK; Dr Dawn Alison, St. James’s Institute of Oncology, St. James’s University Hospital, Leeds, UK.

Conflict of interest

We declare that we have no conflict of interest.

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Copyright information

© Springer-Verlag 2010

Authors and Affiliations

  • Naveen S. Vasudev
    • 1
  • Ioannis Trigonis
    • 1
  • David A. Cairns
    • 2
  • Geoff D. Hall
    • 1
  • David P. Jackson
    • 1
  • Timothy Broadhead
    • 3
  • John Buxton
    • 3
  • Richard Hutson
    • 3
  • David Nugent
    • 3
  • Timothy J. Perren
    • 1
  1. 1.St. James’s Institute of OncologySt. James’s University HospitalLeedsUK
  2. 2.Section of Oncology and Clinical Research, Leeds Institute of Molecular MedicineSt. James’s University HospitalLeedsUK
  3. 3.Department of Gynecological OncologySt. James’s University HospitalLeedsUK

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