title: Risk of epithelial ovarian cancer recurrence in patients with rising serum CA-125 levels within the normal range.
abstract: OBJECTIVE
  To evaluate the risk of epithelial ovarian cancer (EOC) recurrence in patients with rising serum cancer antigen 125 (CA-125) levels that remain below the upper limit of normal (< 35 U/mL).
  
  
  METHODS
  All patients treated for EOC between September 1997 and March 2003 were identified and screened retrospectively for the following: (1) elevated serum CA-125 at time of diagnosis, (2) complete clinical and radiographic response (CR) to initial treatment with normalization of serum CA-125, (3) at least three serial serum CA-125 determinations that remained within the normal range, and (4) clinical and/or radiographic determination of disease status at the time of last follow-up or recurrence. For statistical analyses, univariate regression models were used to compare absolute and relative changes in CA-125 levels among patients with recurrent disease and those without EOC recurrence.
  
  
  RESULTS
  A total of 39 patients satisfied study inclusion criteria; 22 patients manifested EOC recurrence at a median interval from complete response of 11 months. The median follow-up time from complete response to last contact was 32 months for the 17 patients in the no recurrence group. A relative increase in CA-125 of 100% (odds ratio [OR] = 23.7; 95% CI, 2.9 to 192.5; P = .003) was significantly predictive of recurrence. From baseline CA-125 nadir levels, an absolute increase in CA-125 of 5 U/mL (OR = 8.4; 95% CI, 2.2 to 32.6; P = .002) and 10 U/mL (OR = 71.2; 95% CI, 4.8 to > 999.9; P = .002) were also significantly associated with the likelihood of concurrent disease recurrence.
  
  
  CONCLUSIONS
  Among patients with EOC in complete clinical remission, a progressive low-level increase in serum CA-125 levels is strongly predictive of disease recurrence.
authors.affiliation: Kelly Gynecology Oncology Service, Johns Hopkins Medical Institutions, Baltimore, MD, USA. asantil1@jhmi.edu
authors.forename: Antonio
authors.initials: A
authors.lastname: Santillan
authors.forename: Ruchi
authors.initials: R
authors.lastname: Garg
authors.forename: Marianna L
authors.initials: ML
authors.lastname: Zahurak
authors.forename: Ginger J
authors.initials: GJ
authors.lastname: Gardner
authors.forename: Robert L
authors.initials: RL
authors.lastname: Giuntoli
authors.forename: Deborah K
authors.initials: DK
authors.lastname: Armstrong
authors.forename: Robert E
authors.initials: RE
authors.lastname: Bristow
mesh_terms: D000328:Adult; D000368:Aged; D014408:Biomarkers, Tumor / Q000097:blood; D018394:CA-125 Antigen / Q000097:blood*; D005260:Female; D006801:Humans; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local; D016017:Odds Ratio; D010051:Ovarian Neoplasms / Q000473:pathology*; D012016:Reference Values; D012189:Retrospective Studies; D012307:Risk Factors
chemical_list: D014408:Biomarkers, Tumor; D018394:CA-125 Antigen