title: Preoperative CA 125 levels: an independent prognostic factor for epithelial ovarian cancer.
abstract: OBJECTIVE
  To estimate the association of preoperative CA 125 levels with outcome in primary ovarian cancer patients.
  
  
  METHODS
  One hundred forty-two patients with epithelial ovarian cancer, who had a serum CA 125 level drawn before surgery, were retrospectively evaluated. The relationship of preoperative CA 125 levels and various preoperative and postoperative variables was evaluated. CA 125 levels were determined using a solid-phase immunoassay.
  
  
  RESULTS
  The median CA 125 value for all patients was 582 U/mL (range 7-52,930 U/mL). Preoperative CA 125 values did not correlate with increasing age (P =.40), but were found to be significantly associated with serous histology compared with other histology (median CA 125 of 870 versus 334 U/mL, P =.02), high-stage (III/IV) compared with low-stage (median CA 125 of 893 versus 174 U/mL, P <.001), high tumor grade (3) compared with grade 1 or 2 (median CA 125 of 928 versus 323 U/mL, P <.001), and the presence of ascites compared with absence of ascites (median CA 125 of 893 versus 220 U/mL, P <.001). Suboptimal cytoreduction (more than 1 cm residual) was associated with significantly higher CA 125 levels (1067 U/mL) compared with individuals with optimal cytoreduction (399 U/mL, P <.001). Preoperative CA 125 values less than 500 U/mL had a positive predictive value for optimal cytoreduction of 82%, but a poor negative predictive value of 48%. After adjusting for covariates, there was a significant association between CA 125 levels and disease-specific survival. As preoperative CA 125 levels increased, the risk of death increased except at the highest values of CA 125.
  
  
  CONCLUSIONS
  Preoperative CA 125 is an independent risk factor for death due to disease in ovarian cancer, but not a reliable predictor of optimal cytoreduction.
authors.affiliation: Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, the University of Iowa Hospitals and Clinics, Iowa City 52242, USA.
authors.forename: Brian C
authors.initials: BC
authors.lastname: Cooper
authors.forename: Anil K
authors.initials: AK
authors.lastname: Sood
authors.forename: Charles S
authors.initials: CS
authors.lastname: Davis
authors.forename: Justine M
authors.initials: JM
authors.lastname: Ritchie
authors.forename: Joel I
authors.initials: JI
authors.lastname: Sorosky
authors.forename: Barrie
authors.initials: B
authors.lastname: Anderson
authors.forename: Richard E
authors.initials: RE
authors.lastname: Buller
mesh_terms: D000328:Adult; D000368:Aged; D000704:Analysis of Variance; D014408:Biomarkers, Tumor / Q000032:analysis*; D018394:CA-125 Antigen / Q000032:analysis*; D002277:Carcinoma / Q000401:mortality / Q000473:pathology* / Q000601:surgery*; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D008875:Middle Aged; D010051:Ovarian Neoplasms / Q000401:mortality / Q000473:pathology* / Q000601:surgery*; D011237:Predictive Value of Tests; D011300:Preoperative Care; D011336:Probability; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D018709:Statistics, Nonparametric; D015996:Survival Rate; D016896:Treatment Outcome
chemical_list: D014408:Biomarkers, Tumor; D018394:CA-125 Antigen