Perioperative changes in serum CA125 levels: a prognostic factor for disease-specific survival in patients with ovarian cancer

Zwakman, Nienke, van de Laar, Rafli, Van Gorp, Toon, Zusterzeel, Petra L. M, Snijders, Marc P. M. L., Ferreira, Isabel, Massuger, Leon F. A. G. and Kruitwagen, Roy F. P. M. (2017) Perioperative changes in serum CA125 levels: a prognostic factor for disease-specific survival in patients with ovarian cancer. Journal of Gynecologic Oncology, 28 1: e7. doi:10.3802/jgo.2017.28.e7


Author Zwakman, Nienke
van de Laar, Rafli
Van Gorp, Toon
Zusterzeel, Petra L. M
Snijders, Marc P. M. L.
Ferreira, Isabel
Massuger, Leon F. A. G.
Kruitwagen, Roy F. P. M.
Title Perioperative changes in serum CA125 levels: a prognostic factor for disease-specific survival in patients with ovarian cancer
Journal name Journal of Gynecologic Oncology   Check publisher's open access policy
ISSN 2005-0380
2005-0399
Publication date 2017-01-01
Year available 2016
Sub-type Article (original research)
DOI 10.3802/jgo.2017.28.e7
Open Access Status DOI
Volume 28
Issue 1
Start page e7
Total pages 12
Place of publication Seoul, Korea
Publisher Korean Society of Gynecologic Oncology
Language eng
Subject 2730 Oncology
2729 Obstetrics and Gynaecology
Abstract Objective: In patients with advanced stage epithelial ovarian cancer (EOC) the volume of residual tumor after debulking is known as prognostic factor for survival. We wanted to examine the relationship between postoperative decline in serum CA125 and residual disease after cytoreductive surgery and evaluate perioperative changes in serum CA125 levels as predictor for disease-specific survival. Methods: A retrospective study was conducted of patients with FIGO stage IIb-IV EOC treated with cytoreductive surgery, followed by chemotherapy between 1996 and 2010 in three hospitals in the Southeastern region of the Netherlands. Data were analyzed with the use of multilevel linear regression and Cox-proportional hazard regression models. Results: A postoperative decline in serum CA125 level of ≥80% was associated with complete primary cytoreduction (p=0.035). Univariate analyses showed favorable associations with survival for both the degree of decline in serum CA125 and residual tumor after primary cytoreduction. In multivariate analyses the decline in serum CA125 but not the outcome of surgery remained significantly associated with better survival (HR50%–79%=0.52 [95% CI: 0.28–0.96] and HR≥80%=0.26 [95% CI: 0.13–0.54] vs. the serum CA125 decline of <50% [p<0.001]). Conclusion: The current study, although hampered by possible biases, suggests that the perioperative decline in serum CA125 is an early biomarker that predicts disease-specific survival in patients who underwent primary cytoreductive surgery for advanced stage EOC. If confirmed prospectively, the perioperative change in serum CA125 could be a better marker for residual tumor volume after primary cytoreductive surgery (and therewith disease-specific survival) than the surgeons’ estimation of residual tumor volume.
Formatted abstract
Objective
In patients with advanced stage epithelial ovarian cancer (EOC) the volume of residual tumor after debulking is known as prognostic factor for survival. We wanted to examine the relationship between postoperative decline in serum CA125 and residual disease after cytoreductive surgery and evaluate perioperative changes in serum CA125 levels as predictor for disease-specific survival.

Methods
A retrospective study was conducted of patients with FIGO stage IIb-IV EOC treated with cytoreductive surgery, followed by chemotherapy between 1996 and 2010 in three hospitals in the Southeastern region of the Netherlands. Data were analyzed with the use of multilevel linear regression and Cox-proportional hazard regression models.

Results
A postoperative decline in serum CA125 level of ≥80% was associated with complete primary cytoreduction (p=0.035). Univariate analyses showed favorable associations with survival for both the degree of decline in serum CA125 and residual tumor after primary cytoreduction. In multivariate analyses the decline in serum CA125 but not the outcome of surgery remained significantly associated with better survival (HR50%–79%=0.52 [95% CI: 0.28–0.96] and HR≥80%=0.26 [95% CI: 0.13–0.54] vs. the serum CA125 decline of <50% [p<0.001]).

Conclusion
The current study, although hampered by possible biases, suggests that the perioperative decline in serum CA125 is an early biomarker that predicts disease-specific survival in patients who underwent primary cytoreductive surgery for advanced stage EOC. If confirmed prospectively, the perioperative decline in serum CA125 could be a better marker for residual tumor volume after primary cytoreductive surgery (and therewith disease-specific survival) than the surgeons’ estimation of residual tumor volume.
Keyword Ovarian neoplasms
CA-125 Antigen
Neoplasms
Residual
Survival
Prognosis
Q-Index Code C1
Q-Index Status Provisional Code
Institutional Status Non-UQ
Additional Notes Article no. e7

Document type: Journal Article
Sub-type: Article (original research)
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Created: Thu, 15 Sep 2016, 07:09:12 EST by Isabel Ferreira on behalf of School of Public Health