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.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
References
Tangjitgamol S, Manusirivithaya S, Laopaiboon M et al (2009) Interval debulking surgery for advanced epithelial ovarian cancer: a Cochrane systematic review. Gynecol Oncol 112:257–264
Kang S, Nam BH (2009) Does neoadjuvant chemotherapy increase optimal cytoreduction rate in advanced ovarian cancer? Meta-analysis of 21 studies. Ann Surg Oncol 16:2315–2320
Vergote I, Trope CG, Amant F (2008) EORTC-GCG/NCIC-CTG randomized trial comparing primary debulking surgery with neoadjuvant chemotherapy in stage IIIC–IV ovarian, fallopian tube and peritoneal cancer. Plenary presentation at the 12th Biennial Meeting International Gynecologic Cancer Society IGCS, Bangkok, Thailand
Rustin GJ, Nelstrop AE, McClean P et al (1996) Defining response of ovarian carcinoma to initial chemotherapy according to serum CA 125. J Clin Oncol 14:1545–1551
Riedinger JM, Eche N, Basuyau JP et al (2008) Prognostic value of serum CA 125 bi-exponential decrease during first line paclitaxel/platinum chemotherapy: a French multicentric study. Gynecol Oncol 109:194–198
Crawford SM, Peace J (2005) Does the nadir CA125 concentration predict a long-term outcome after chemotherapy for carcinoma of the ovary? Ann Oncol 16:47–50
Bristow RE, Tomacruz RS, Armstrong DK et al (2002) Survival effect of maximal cytoreductive surgery for advanced ovarian carcinoma during the platinum era: a meta-analysis. J Clin Oncol 20:1248–1259
Vorgias G, Iavazzo C, Savvopoulos P et al (2009) Can the preoperative CA-125 level predict optimal cytoreduction in patients with advanced ovarian carcinoma? A single institution cohort study. Gynecol Oncol 112:11–15
Chi DS, Zivanovic O, Palayekar MJ et al (2009) A contemporary analysis of the ability of preoperative serum CA-125 to predict primary cytoreductive outcome in patients with advanced ovarian, tubal and peritoneal carcinoma. Gynecol Oncol 112:6–10
Cox D (1972) Regression models and life-tables. J R Stat Soc Ser B Stat Methodol 34:187–220
Rustin GJ (2003) Use of CA-125 to assess response to new agents in ovarian cancer trials. J Clin Oncol 21:187s–193s
Armstrong DK, Bundy B, Wenzel L et al (2006) Intraperitoneal cisplatin and paclitaxel in ovarian cancer. N Engl J Med 354:34–43
Le T, Hopkins L, Faught W et al (2007) The lack of significance of CA125 response in epithelial ovarian cancer patients treated with neoadjuvant chemotherapy and delayed primary surgical debulking. Gynecol Oncol 105:712–715
Le T, Faught W, Hopkins L et al (2008) Importance of CA125 normalization during neoadjuvant chemotherapy followed by planned delayed surgical debulking in patients with epithelial ovarian cancer. J Obstet Gynaecol Can 30:665–670
Tate S, Hirai Y, Takeshima N et al (2005) CA125 regression during neoadjuvant chemotherapy as an independent prognostic factor for survival in patients with advanced ovarian serous adenocarcinoma. Gynecol Oncol 96:143–149
Canney PA, Moore M, Wilkinson PM et al (1984) Ovarian cancer antigen CA125: a prospective clinical assessment of its role as a tumour marker. Br J Cancer 50:765–769
Rustin GJ, Quinn M, Thigpen T et al (2004) Re: New guidelines to evaluate the response to treatment in solid tumors (ovarian cancer). J Natl Cancer Inst 96:487–488
Axtell AE, Lee MH, Bristow RE et al (2007) Multi-institutional reciprocal validation study of computed tomography predictors of suboptimal primary cytoreduction in patients with advanced ovarian cancer. J Clin Oncol 25:384–389
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.
Author information
Authors and Affiliations
Corresponding author
Additional information
N. S. Vasudev and I. Trigonis have joint first authorship.
Rights and permissions
About this article
Cite this article
Vasudev, N.S., Trigonis, I., Cairns, D.A. et al. The prognostic and predictive value of CA-125 regression during neoadjuvant chemotherapy for advanced ovarian or primary peritoneal carcinoma. Arch Gynecol Obstet 284, 221–227 (2011). https://doi.org/10.1007/s00404-010-1655-2
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00404-010-1655-2