title: Prognostic and predictive relevance of CA-125 at primary surgery of ovarian cancer.
abstract: BACKGROUND
  Despite radical surgery and chemotherapy, most patients with ovarian cancer develop recurrence and die due to progressive disease. To stratify patients for optimal therapy, prognostic and predictive factors are needed. We examined the role of pre- and postoperative CA-125 in this context.
  
  
  METHODS
  A total of 231 patients with primary ovarian cancer who presented for surgery at our institution between 1996 and 2004 were included in this study (25% FIGO stage I/II and 75% FIGO stage III/IV). The prognostic and predictive values of CA-125 serum concentrations before and after surgery as well as their correlation with clinicopathological variables were analyzed.
  
  
  RESULTS
  Median preoperative CA-125 was 61.6 kU/l (9-1,867 kU/l) in stage I/II patients and 533.15 kU/l (10-22,617 kU/l) in stage III/IV patients. Before surgery, 67% of stage I/II patients and 96% of stage III/IV patients had elevated CA-125 (>35 kU/l). There was a significant decrease in CA-125 after surgery in both patient cohorts (61.6-43.4 kU/l, P = 0.001 and 533.15-92.3 kU/l, P < 0.001, respectively). Furthermore, in stage III/IV patients with complete or so-called optimal (<1 cm residual disease) debulking, preoperative CA-125 levels were significantly lower than in patients with residual disease >1 cm (P = 0.01, P = 0.009, respectively). Neither CA-125 concentration before surgery nor its decrease was prognostically relevant for recurrence and survival at any stage. However, in stage III/IV patients, a high postoperative CA-125 was associated with shorter progression-free survival (P = 0.024).
  
  
  CONCLUSIONS
  Although CA-125 serum levels differ significantly before and after surgery in early and advanced-stage ovarian cancer and preoperative CA-125 values correlate with surgical outcome in advanced-stage disease, we could not determine a preoperative cutoff value for prediction of the surgical result. A prognostic relevance was only observed for postoperative CA-125 in stage III/IV patients.
authors.affiliation: Department of Gynecology and Gynecologic Oncology, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246, Hamburg, Germany.
authors.forename: Dina
authors.initials: D
authors.lastname: Mury
authors.forename: Linn
authors.initials: L
authors.lastname: Woelber
authors.forename: Sabine
authors.initials: S
authors.lastname: Jung
authors.forename: Christine
authors.initials: C
authors.lastname: Eulenburg
authors.forename: Matthias
authors.initials: M
authors.lastname: Choschzick
authors.forename: Isabell
authors.initials: I
authors.lastname: Witzel
authors.forename: Joerg
authors.initials: J
authors.lastname: Schwarz
authors.forename: Fritz
authors.initials: F
authors.lastname: Jaenicke
authors.forename: Sven
authors.initials: S
authors.lastname: Mahner
mesh_terms: D018262:Adenocarcinoma, Clear Cell / Q000097:blood / Q000175:diagnosis* / Q000601:surgery; D002288:Adenocarcinoma, Mucinous / Q000097:blood / Q000175:diagnosis* / Q000601:surgery; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D018394:CA-125 Antigen / Q000097:blood*; D018284:Cystadenocarcinoma, Serous / Q000097:blood / Q000175:diagnosis* / Q000601:surgery; D016889:Endometrial Neoplasms / Q000097:blood / Q000175:diagnosis* / Q000601:surgery; D005260:Female; D006801:Humans; D008565:Membrane Proteins / Q000097:blood*; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000097:blood / Q000175:diagnosis* / Q000601:surgery; D009367:Neoplasm Staging; D010051:Ovarian Neoplasms / Q000097:blood / Q000175:diagnosis* / Q000601:surgery; D011379:Prognosis; D012372:ROC Curve; D012680:Sensitivity and Specificity
chemical_list: D018394:CA-125 Antigen; C451759:MUC16 protein, human; D008565:Membrane Proteins