CA-125 cut-off value as a predictor for complete interval debulking surgery after neoadjuvant chemotherapy in patients with advanced ovarian cancer

다국어 초록 (Multilingual Abstract)

Objective: In the present study, we evaluated changes in CA-125 cut-off values predictive of complete interval debulking surgery (IDS) after neoadjuvant chemotherapy (NAC) using receiver operating characteristic (ROC) analysis.
Methods: This retrospective single-institution study included patients with International Federation of Gynecology and Obstetrics (FIGO) stage III epithelial ovarian cancer and a pre-NAC serum CA-125 level of greater than 40 U/mL who were treated with neoadjuvant platinum-based chemotherapy followed by IDS between 1994 and 2009. Logistic regression analysis was used to evaluate univariate and independent multivariate associations with the effect of clinical, pathological, and CA-125 parameters on complete IDS, and ROC analysis was used to determine potential cut-off values of CA-125 for prediction of the possibility of complete IDS.
Results: Seventy-five patients were identified. Complete IDS was achieved in 46 (61.3%) patients and non-complete IDS was observed 29 (38.7%). Median pre-NAC CA-125 level was 639 U/mL (range, 57 to 6,539 U/mL) in the complete IDS group and 1,427 U/mL (range, 45 to 10,989 U/mL) in the non-complete IDS group. Median pre-IDS CA-125 level was 15 U/mL (range, 2 to 60 U/mL) in the complete IDS group and 53 U/mL (range, 5 to 980 U/mL) in the non-complete IDS group (p<0.001). Multivariate analyses performed with complete IDS as the endpoint revealed only pre-IDS CA-125 as an independent predictor. The odds ratio of non-complete IDS was 10.861 when the pre-IDS CA-125 level was greater than 20 U/mL.
Conclusion: The present data suggest that in the setting of IDS after platinum-based NAC for advanced ovarian cancer, a pre-IDS CA-125 level less than 20 U/mL is an independent predictor of complete IDS.

참고문헌 (Reference)

1 Aletti GD, "Relationship among surgical complexity., short-term morbidity., and overall survival in primary surgery for advanced ovarian cancer" 197 (197): 1-7, 2007

2 Chan YM., "Quality of life in women treated with neoadjuvant chemotherapy for advanced ovarian cancer : a prospective longitudinal study" 88 : 9-16, 2003

3 Ibeanu OA, "Predicting the outcome of cytoreductive surgery for advanced ovarian cancer: a review" 20 (20): 1-11, 2010

4 Vasey PA., "Phase III randomized trial of docetaxelcarboplatin versus paclitaxel-carboplatin as first-line chemotherapy for ovarian carcinoma" 96 : 1682-1691, 2004

5 Coakley FV., "Peritoneal metastases : detection with spiral CT in patients with ovarian cancer" 223 : 495-499, 2002

6 Le T., "Importance of CA125 normalization during neoadjuvant chemotherapy followed by planned delayed surgical debulking in patients with epithelial ovarian cancer" 30 : 665-670, 2008

7 Metser U., "Identification and quantification of peritoneal metastases in patients with ovarian cancer with multidetector computed tomography : correlation with surgery and surgical outcome" 21 : 1391-1398, 2011

8 Eltabbakh GH., "Factors associated with cytoreducibility among women with ovarian carcinoma" 95 : 377-383, 2004

9 Kimio Ushijima, "Current status of gynecologic cancer in Japan" 대한부인종양학회 20 (20): 67-71, 2009

10 Giannopoulos T., "Clinical outcomes of neoadjuvant chemotherapy and primary debulking surgery in advanced ovarian carcinoma" 27 : 25-28, 2006

11 Rodriguez N., "Changes in serum CA-125 can predict optimal cytoreduction to no gross residual disease in patients with advanced stage ovarian cancer treated with neoadjuvant chemotherapy" 125 : 362-366, 2012

12 Matsuda T., "Cancer incidence and incidence rates in Japan in 2006 : based on data from 15 population-based cancer registries in the monitoring of cancer incidence in Japan(MCIJ)project" 42 : 139-147, 2012

13 Vorgias G., "Can the preoperative Ca-125 level predict optimal cytoreduction in patients with advanced ovarian carcinoma? A single institution cohort study" 112 : 11-15, 2009

14 Memarzadeh S., "CA125 levels are a weak predictor of optimal cytoreductive surgery in patients with advanced epithelial ovarian cancer" 13 : 120-124, 2003

15 du Bois A., "A randomized clinical trial of cisplatin/paclitaxel versus carboplatin/paclitaxel as first-line treatment of ovarian cancer" 95 : 1320-1329, 2003