title: The prognostic and predictive value of CA-125 regression during neoadjuvant chemotherapy for advanced ovarian or primary peritoneal carcinoma.
abstract: 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.
authors.affiliation: St. James's Institute of Oncology, St. James's University Hospital, Leeds, LS9 7TF, UK. n.vasudev@leeds.ac.uk
authors.forename: Naveen S
authors.initials: NS
authors.lastname: Vasudev
authors.forename: Ioannis
authors.initials: I
authors.lastname: Trigonis
authors.forename: David A
authors.initials: DA
authors.lastname: Cairns
authors.forename: Geoff D
authors.initials: GD
authors.lastname: Hall
authors.forename: David P
authors.initials: DP
authors.lastname: Jackson
authors.forename: Timothy
authors.initials: T
authors.lastname: Broadhead
authors.forename: John
authors.initials: J
authors.lastname: Buxton
authors.forename: Richard
authors.initials: R
authors.lastname: Hutson
authors.forename: David
authors.initials: D
authors.lastname: Nugent
authors.forename: Timothy J
authors.initials: TJ
authors.lastname: Perren
mesh_terms: 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
chemical_list: D000970:Antineoplastic Agents; D018394:CA-125 Antigen
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