title: Use of CA-125 to define progression of ovarian cancer in patients with persistently elevated levels.
abstract: OBJECTIVE
  To determine an accurate definition for progression of ovarian cancer in patients with a persistently elevated serum CA-125.
  
  
  METHODS
  A retrospective analysis was performed on 300 patients with epithelial ovarian carcinoma with at least one measurement of CA-125. The date of progression according to clinical or radiologic criteria was ascertained in the 88 patients with persistently elevated CA-125 levels (> 23 U/mL). This was compared with the date of progression according to CA-125, defined as the date on which the CA-125 level first increased to >or= twice its nadir level, confirmed by a second sample also >or= twice the nadir.
  
  
  RESULTS
  Eighty of the 88 patients had evidence of progression by both standard and CA-125 criteria, giving a sensitivity of 94%. In six of these patients, no sample was taken to confirm CA-125 doubling. In 13 patients, CA-125 doubling occurred after the date of clinical progression. Only one patient had a false-positive prediction of progression according to CA-125; the patient died as a result of a myocardial infarct before evidence of clinical progression.
  
  
  CONCLUSIONS
  In patients whose CA-125 level decreases to normal after chemotherapy, a doubling from the upper limit of normal has been shown to predict progression. In those with persistently elevated levels, doubling of CA-125 from its nadir level has now been shown to accurately define progression. If confirmed, these CA-125 criteria should be used as additional end points in clinical trials.
authors.affiliation: Department of Medical Oncology, Mount Vernon Hospital, Northwood, Middlesex, United Kingdom. rustin@mtvern.co.uk
authors.forename: G J
authors.initials: GJ
authors.lastname: Rustin
authors.forename: M
authors.initials: M
authors.lastname: Marples
authors.forename: A E
authors.initials: AE
authors.lastname: Nelstrop
authors.forename: M
authors.initials: M
authors.lastname: Mahmoudi
authors.forename: T
authors.initials: T
authors.lastname: Meyer
mesh_terms: D018394:CA-125 Antigen / Q000097:blood*; D002277:Carcinoma / Q000097:blood / Q000276:immunology* / Q000473:pathology; D018450:Disease Progression; D005260:Female; D006801:Humans; D010051:Ovarian Neoplasms / Q000097:blood / Q000276:immunology* / Q000473:pathology; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D016019:Survival Analysis; D013997:Time Factors; D015854:Up-Regulation
chemical_list: D018394:CA-125 Antigen