Is postoperative CA125 level in patients with epithelial ovarian cancer reliable to guess the optimality of surgery?

Introduction: Cytoreductive surgery is a pivotal component of primary treatment in patients with ovarian epithelial caner (OEC) and several studies have shown better outcomes of optimal debulking. The aim of this prospective study was to determine if optimum versus suboptimal cytoreductive surgery predicts CA125 levels two weeks after surgery. Material and methods: Sixty patients with epithelial ovarian cancer scheduled for cytoreductive surgery in Imam Khomeini Hospital, Tehran, Iran were enrolled in this study. Two groups of patients were to undergo optimal or suboptimal cytoreductive surgery. Optimal cytoreduction was defined as the largest volume of residual disease < 1 cm in maximal dimension. CA125 levels were measured in all patients preoperatively and at two, seven and 14 days after surgery. CA125 levels were converted to a log scale. Results: The distribution of staging, grading and types of tumors in each group were statistically equal but insignificant (chi square). The difference in mean of CA125 before and two weeks after surgery was statistically significant (paired t-test; p = 0.0001) but the grade, stage and type of tumors did not have any impact on CA125 regression. However, regression of CA125 two weeks after the operation did not differ statistically between the optimal and suboptimal cytoreduction groups (repeated measure ANOVA). Conclusion: Although, postoperative CA125 decreased significantly in two weeks after tumor cytoreduction in patients with epithelial ovarian cancer, its regression did not differ according to optimal or suboptimal groups.

Ovarian cancer; CA125; Cytoreductive surgery; Optimal; Iran

[1] Bast R.C. Jr, Xu F.J., Yu Y.H., Barnhill S., Zhang Z., Mills G.B.: “CA125: the past and the future”. Int. J. Biol. Markers, 1998, 13, 179.

[2] Gadducci A., Cosio S., Zanca G., Genazzani A.R.: “Evolving role of serum biomarkers in the management of ovarian cancer”.Women’s Health, 2006, 2, 141.

[3] Beck E.P., Moldenhauer A., Merkle E.: “CA 125 production and release by ovarian cancer cells in vitro”. Int. J. Biol. Markers, 1998, 13, 200.

[4] Marth C., Zeimet A.G., Böck G., Daxenbichler G.: “Modulation of tumour marker CA-125 expression in cultured ovarian carcinoma cells”. Eur. J. Cancer, 1992, 28, 2002.

[5] Marth C., Fuith L.C., Böck G., Daxenbichler G., Dapunt O.: “Modulation of ovarian carcinoma tumor marker CA-125 by gamma-interferon”. Cancer Res., 1989, 49, 6538.

[6] Michel G., Delaco P., Castaigne D. et al.: “Extensive cytoreductive surgery in advanced ovarian carcinoma”. Eur. J. Gynaecol. Oncol., 1997, 18, 9.

[7] Kabawat S.E., Bast R.C. Jr, Bhan A.K., Welch W.R., Knapp R.C., Colvin R.B.: “Tissue distribution of a coelomic-epitheliumrelated antigen recognized by the monoclonal antibody OC125”. Int. J. Gynecol. Pathol., 1983, 2, 275.

[8] Jacobs I., Bast R.C. Jr.: “The CA125 tumor-associated antigen: a review of the literature”. Hum. Reprod., 1989, 4, 1.

[9] Gemer O., Segal S., Kopmar A.: “Preoperative CA-125 level as a predictor of non optimal cytoreduction of advanced epithelial ovarian cancer”. Acta Obstet. Gynecol. Scand.,2001, 80, 583.

[10] Hoskins W.J., McGuire W.P., Brady M.F., Homesley H.D., Creasman W.T., Berman M. et al.: “The effect of diameter of largestresidual disease on survival after primary cytoreductive surgery in patients with suboptimal residual epithelial ovarian carcinoma”. Am. J. Obstet. Gynecol., 1994, 170 974.

[11] Mayer A.R., Chambers S.K., Graves E., Holm C., Tseng P.C., Nelson B.E., Schwartz P.E.: “Ovarian cancer staging: does it require a gynecologic oncologist?”. Gynecol. Oncol., 1992, 47, 223.

[12] Eisenkop S.M., Spirtos N.M., Montag T.W., Nalick R.H., Wang H. J.: “The impact of subspecialty training on the management of advanced ovarian cancer”. Gynecol. Oncol., 1992, 47, 203.

[13] Winter W., Maxwell G., Tian C., Carlson J., Ozols R., Rose P. et al.: “Prognostic factors for Stage III epithelial ovarian cancer: A Gynecologic Oncology Group Study”. J. Clin. Oncol., 2007, 25 3621

[14] van Dalen A., Favier J., Baumgartner L., Hasholzner U., de Bruijn H., Dobbler D.: “Prognostic significance of CA 125 and TPS levels after chemotherapy in ovarian cancer patients”. Anticancer Res., 1999, 19, 2523.

[15] Wu M., Shen K., Lang J.: “Treatment and prognostic factors for Stage IV epithelial ovarian cancer”. Zhonghua Fu Chan Ke Za Zhi., 2000, 35, 200.

[16] Board R., Buijns C., Pronk A., Ryder W., Wilkinson P., Welch

R. et al.: “Stage- and CA125-related survival in patients with epithelial ovarian cancer treated at a cancer center”. Int. J. Gynecol. Cancer, 2006, 16, 18.

[17] Griffiths C.T.: “Surgical resection of tumor bulk in the primary treatment of ovarian carcinoma”. Natl. Cancer Inst. Monogr., 1975, 42, 101.

[18] Hoskins W.J.: “Epithelial ovarian carcinoma: principles of primary surgery”. Gynecol. Oncol., 1994, 55, 91.

[19] Ozols R.F., Rubin S.C., Thomas G., Robboy S.: “Epithelial Ovarian Cancer”. In: Hoskins W.J., Perez C.A., Young R.C. (eds.): Principles and Practice of Gynecologic Oncology, 2nd edition, Philadelphia, Lippincott-Raven, 1997, 919.

[20] Bristow R.E., Tomacruz R.S., Armstrong D.K., Trimble E.L., Montz F.J.: “Survival effect of maximal cytoreductive surgery for advanced ovarian carcinoma during the platinum era: a metaanalysis”. J. Clin. Oncol., 2002, 20, 1248.

[21] Byrom J., Widjaja E., Redman C.W.E., Jones P.W., Tebby S.: “Can preoperative computed tomography predict resectability of ovarian carcinoma at primary laparotomy?”. BJOG, 2002, 109, 369.

[22] Bristow R.E., Duska L.R., Lambrou N.C.: “A model for predicting surgical outcome in patients with advanced ovarian carcinoma using computed tomography”. Cancer, 2000, 89, 1532.

[23] Chi D.S., Venkatraman E.S., Masson V., Hoskins W.J.: “The ability of preoperative serum CA-125 to predict optimal primary tumor cytoreduction in Stage III epithelial ovarian carcinoma”. Gynecol. Oncol., 2000, 77, 227.

[24] Memarzadeh, Lee S.B., Berek J.S., Farias-Eisner R.: “CA-125 levels are a weak predictor of optimally cytoredcutive surgery in patients with advance epithelial ovarian cancer”. Int. J. Gynecol. Cancer, 2003, 13, 120.

[25] Michel G., Delaco P., Castaigne D.: “Extensive cytoreductive surgery in advanced ovarian carcinoma”. Eur. J. Gynaecol. Oncol., 1997, 18, 9.

[26] Kabawat S.E., Bast R., Bhan A.K., Welch W.R., Knapp R.C., Colvin R.B.: “Tissue distribution of a coelomic-epithelium related antigen recognized by the monoclonal antibody OC125”. Int. J. Gynecol. Pathol., 1983, 2, 275.

[27] Jacobs I., Bast R.C. Jr.: “The CA125 tumor-associated antigen: a review of the literature”. Hum. Reprod., 1989, 4, 1.

[28] Rustin G., Nelstrop A., McClean P., Brady M., McGuire W., Hoskins W. et al.: “Defining response of ovarian carcinoma to initial chemotherapy according to CA 125”. J. Clin. Oncol., 1996, 14, 1545.

[29] Zanetta G., Rota S., Chiari S.: “The accuracy of staging: an important, prognostic determinator in Stage I ovarian carcinoma.A multivariate analysis”. Ann. Oncol., 1998, 9, 1097.

[30] Münstedt K., Krisch M., Sachsse S., Vahrson H.: “Serum CA 125 levels, survival in advanced ovarian cancer”. Arch. Gynecol. Obstet., 1997, 259, 117.

[31] Mogensen O., Mogensen B., Jacobsen A.: “CA 125 in the diagnosis of pelvic masses”. Eur. J. Cancer Clin. Oncol., 1989, 25, 1187.

[32] Mogensen O., Mogensen B., Jacobsen A.: “Predictive value of CA 125 during early chemotherapy of advanced ovarian cancer”. Gynecol. Oncol., 1990, 37, 44.

[33] Mogensen O.: “Prognostic value of CA 125 in advanced ovarian cancer”. Gynecol. Oncol., 1992, 44, 207.

[34] Oehler M.K., Stterlin M., Caffier H.: “CASA and CA 125 in diagnosis and follow-up of advanced ovarian cancer”. Anticancer Res., 1999, 19, 2513.

[35] Nielsen H.A., Nielsen D., Engelholm S.A.: “Effect of topotecan on serum CA-125 in patients with advanced epithelial ovarian cancer. Gynecol. Oncol., 2000, 77, 383.