title: A multicenter study of CA 125 level as a predictor of non-optimal primary cytoreduction of advanced epithelial ovarian cancer.
abstract: OBJECTIVE
  To provide a large database of pre-operative CA 125 levels which may predict inappropriate cytoreductive surgery in patients with advanced epithelial ovarian cancer.
  
  
  METHODS
  A multicenter review of the records of 424 patients with FIGO stage III and IV epithelial ovarian cancer of patients who underwent primary cytoreductive surgery was performed. The validity of pre-operative CA 125 level measurement as a single predictor of the possibility to achieve only suboptimal cytoreduction was evaluated by calculating the sensitivity and the specificity of various cut-off values. The relative importance of different cut-off values in achieving the best predictive validity was assessed by a receiver operating characteristics (ROC) curve.
  
  
  RESULTS
  Optimal cytoreduction (largest diameter of residual tumour < or =1 cm) was achieved in 242 patients. The median CA 125 level in optimally cytoreduced patients was lower than in those patients suboptimally debulked (304 vs 863 U/mL; p<0.001). The area under the ROC curve was 0.65 (95% confidence interval, 0.60-0.71) and the CA 125 threshold derived from the ROC was 400 U/mL. The accuracy of the test at this level was 62%.
  
  
  CONCLUSIONS
  The clinical applicability of the ROC derived CA 125 threshold is limited. The data accrued in the study provides a basis for decision-making regarding the place of primary surgery various CA 125 levels.
authors: Department of Obstetrics and Gynecology Barzilai Medical Center, 78306 Ashkelon, Ben Gurion University of the Negev, Israel. gemer.barzi@health.gov.il
authors: O
authors: O
authors: Gemer
authors: M
authors: M
authors: Lurian
authors: M
authors: M
authors: Gdalevich
authors: V
authors: V
authors: Kapustian
authors: E
authors: E
authors: Piura
authors: D
authors: D
authors: Schneider
authors: O
authors: O
authors: Lavie
authors: T
authors: T
authors: Levy
authors: A
authors: A
authors: Fishman
authors: R
authors: R
authors: Dgani
authors: H
authors: H
authors: Levavi
authors: U
authors: U
authors: Beller
mesh_terms: D014408:Biomarkers, Tumor / Q000032:analysis; D018394:CA-125 Antigen / Q000032:analysis*; D005260:Female; D006801:Humans; D008875:Middle Aged; D010051:Ovarian Neoplasms / Q000473:pathology / Q000601:surgery*; D011237:Predictive Value of Tests; D012372:ROC Curve; D012680:Sensitivity and Specificity; D019564:Unnecessary Procedures
chemical_list: D014408:Biomarkers, Tumor; D018394:CA-125 Antigen