Comparison of CA 125 after three courses of chemotherapy and results of second-look surgery.
OBJECTIVE
To compare CA 125 levels after three courses of cisplatin-based chemotherapy and the results of second-look surgery.


METHODS
From January 1990 to December 1996, the medical records of 72 patients diagnosed with epithelial ovarian cancer were reviewed. After initial staging surgery, all patients received cisplatin-based chemotherapy. Prior to each course of chemotherapy, patients underwent physical exams and serum CA 125 was obtained. After 6 courses of chemotherapy, if CA 125 levels were normal (< or = 35 IU/ml) and there was no clinical evidence of disease, the patient was offered second-look surgery. The sensitivity, specificity, and negative predicative value of CA 125 levels after 3 courses of chemotherapy and results of second-look surgery were calculated. Survival curves were constructed using Kaplan-Meier actuarial methods.


RESULTS
Seventy-two patients were enrolled in the study. After completing 3 courses of chemotherapy, 43 out of 72 patients were reported to have normal CA 125 levels and were offered second-look surgery. Forty-six out of 72 patients underwent second-look surgery, 28 patients (60%) were reported to have positive second-look surgery. Of the patients with normal CA 125 levels after 3 courses of chemotherapy, 23 patients (57.5%) had a positive second-look surgery. The sensitivity and specificity of CA 125 values after 3 courses of chemotherapy were 17.9% and 94.7%, respectively and the negative predicative value was 43.9%. Patients with normal CA 125 values after 3 courses of chemotherapy had a significantly improved survival compared to those who failed to normalized their CA 125 levels after three courses of chemotherapy.


CONCLUSIONS
Normalization of CA 125 after 3 courses of chemotherapy is a poor predicator of findings at second-look surgery.
Wong
C
C
Department of Gynecologic Oncology, Roswell Park Cancer Institute, Buffalo, New York 14263,USA.
Dai
Z M
ZM
Lele
S B
SB
Natarajan
N
N
D000970:Antineoplastic Agents / Q000627:therapeutic use*; D014408:Biomarkers, Tumor / Q000032:analysis*; D018394:CA-125 Antigen / Q000032:analysis*; D002945:Cisplatin / Q000627:therapeutic use*; D004334:Drug Administration Schedule; D005260:Female; D006801:Humans; D008875:Middle Aged; D010051:Ovarian Neoplasms / Q000188:drug therapy / Q000276:immunology* / Q000601:surgery; D011237:Predictive Value of Tests; D011379:Prognosis; D012086:Reoperation; D012189:Retrospective Studies
D000970:Antineoplastic Agents; D014408:Biomarkers, Tumor; D018394:CA-125 Antigen; D002945:Cisplatin