The prognostic and predictive value of CA-125 regression during neoadjuvant chemotherapy for advanced ovarian or primary peritoneal carcinoma.
OBJECTIVE
To assess the significance of CA-125 regression as a prognostic indicator and predictor of optimal cytoreduction at interval debulking surgery (IDS) in women with ovarian or primary peritoneal carcinoma receiving neoadjuvant chemotherapy (NAC).


METHODS
63 women treated between 2004 and 2007 with neoadjuvant platinum-based chemotherapy followed by IDS were studied retrospectively. Pre-operative CA-125 values were used to calculate a regression coefficient (CA-125r) using exponential regression analysis. Outcome endpoints were overall survival (OS), time to CA-125 progression (TTC) by Rustin criteria and time to second-line treatment (TTS).


RESULTS
Women with a CA-125 half-life greater than 18 days had a significantly worse OS compared to those with a half-life less than 12 days on univariate testing (HR 3.34, 95% CI 1.25-8.94, p = 0.017). On multivariable analysis, CA-125r was an independent predictor of OS [HR 1.18 (per 0.01 increase in CA-125r), 95% CI 1.01-1.40, p = 0.043]. CA-125r was independently predictive of TTC and TTS (HR 1.17, p ≈ 0.03 for each). CA-125r was also predictive of achieving optimal cytoreduction at IDS (AUC 0.756, p < 0.001).


CONCLUSIONS
CA-125 regression rate during pre-operative NAC is of independent prognostic value. CA-125 regression rate strongly predicts for optimal cytoreduction.
Vasudev
Naveen S
NS
St. James's Institute of Oncology, St. James's University Hospital, Leeds, LS9 7TF, UK. n.vasudev@leeds.ac.uk
Trigonis
Ioannis
I
Cairns
David A
DA
Hall
Geoff D
GD
Jackson
David P
DP
Broadhead
Timothy
T
Buxton
John
J
Hutson
Richard
R
Nugent
David
D
Perren
Timothy J
TJ
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000970:Antineoplastic Agents / Q000627:therapeutic use*; D018394:CA-125 Antigen / Q000097:blood*; D002277:Carcinoma / Q000097:blood* / Q000175:diagnosis / Q000188:drug therapy; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D008875:Middle Aged; D015999:Multivariate Analysis; D020360:Neoadjuvant Therapy; D010051:Ovarian Neoplasms / Q000097:blood* / Q000175:diagnosis / Q000188:drug therapy; D010534:Peritoneal Neoplasms / Q000097:blood* / Q000175:diagnosis / Q000188:drug therapy; D011237:Predictive Value of Tests; D011379:Prognosis; D012074:Remission Induction; D012189:Retrospective Studies
D000970:Antineoplastic Agents; D018394:CA-125 Antigen
J Clin Oncol. 2002 Mar 1;20(5):1248-59
11870167
Ann Oncol. 2005 Jan;16(1):47-50
15598937
J Natl Cancer Inst. 2004 Mar 17;96(6):487-8
15026475
Gynecol Oncol. 2008 May;109(2):194-8
18329083
Ann Surg Oncol. 2009 Aug;16(8):2315-20
19517192
Gynecol Oncol. 2009 Jan;112(1):6-10
19100916
J Clin Oncol. 2003 May 15;21(10 Suppl):187s-193s
12743133
Gynecol Oncol. 2007 Jun;105(3):712-5
17400284
Br J Cancer. 1984 Dec;50(6):765-9
6208925
J Obstet Gynaecol Can. 2008 Aug;30(8):665-670
18786288
Gynecol Oncol. 2009 Jan;112(1):11-5
19119502
J Clin Oncol. 2007 Feb 1;25(4):384-9
17264334
N Engl J Med. 2006 Jan 5;354(1):34-43
16394300
Gynecol Oncol. 2009 Jan;112(1):257-64
19017548
J Clin Oncol. 1996 May;14(5):1545-51
8622070
Gynecol Oncol. 2005 Jan;96(1):143-9
15589593
Br J Cancer. 2001 Sep 28;85(7):944-52
11592763