title: COX-2 and preoperative CA-125 level are strongly correlated with survival and clinical responsiveness to chemotherapy in ovarian cancer.
abstract: BACKGROUND
  CA-125 is elevated in the serum of the majority of ovarian carcinoma patients. Cyclooxygenase-2 is an enzyme whose synthesis is upgraded by several cytokines, growth factors, and tumor promoters.
  
  
  METHODS
  We analyzed cyclooxygenase-2, preoperative CA-125 levels, and CA-125 levels during chemotherapy in 41 FIGO stage III, grade 3, ovarian serous carcinoma patients in relation to survival with a logistic regression. The correlation of cyclooxygenase-2 expression and CA-125 preoperative level with clinical responsiveness to chemotherapy was studied according to Fisher's exact test. We compared 23 patients living with no evident disease five years after primary treatment to 18 patients who had died of progression of disease no later than two years after primary treatment.
  
  
  RESULTS
  Cyclooxygenase-2 overexpression (p = 0.014 and p = 0.036) and preoperative CA-125 level (p = 0.012 and p = 0.029) were found to be independent predictors of survival in univariate and multivariate analyses. Cyclooxygenase-2 and CA-125 level were correlated to responsiveness to chemotherapy (p = 0.003 and p = 0.036, respectively; Fisher's exact test). The patients with a CA-125 level <35 U/ml after two cycles of chemotherapy showed a longer survival (p = 0.008). The median preoperative CA-125 was 195 in high survival patients and 650 in low survival patients (p= 0.004, Wilcoxon Mann-Whitney test).
  
  
  CONCLUSIONS
  Cyclooxygenase-2 overexpression and CA-125 levels may help the management of ovarian cancer patients, permitting the selection of more aggressive and tailored first-line therapy.
authors.affiliation: Department of Human Pathology and Oncology, School of Medicine, University of Florence, Italy. mariarosaria.raspollini@unifi.it
authors.forename: Maria Rosaria
authors.initials: MR
authors.lastname: Raspollini
authors.forename: Gianni
authors.initials: G
authors.lastname: Amunni
authors.forename: Alessandro
authors.initials: A
authors.lastname: Villanucci
authors.forename: Vieri
authors.initials: V
authors.lastname: Boddi
authors.forename: Gian Luigi
authors.initials: GL
authors.lastname: Taddei
mesh_terms: D000328:Adult; D000368:Aged; D018394:CA-125 Antigen / Q000097:blood*; D002277:Carcinoma / Q000188:drug therapy* / Q000473:pathology*; D051546:Cyclooxygenase 2 / Q000097:blood*; D005260:Female; D006801:Humans; D008875:Middle Aged; D015999:Multivariate Analysis; D010051:Ovarian Neoplasms / Q000188:drug therapy* / Q000473:pathology*; D011237:Predictive Value of Tests; D011379:Prognosis; D012189:Retrospective Studies; D016019:Survival Analysis
chemical_list: D018394:CA-125 Antigen; D051546:Cyclooxygenase 2