title: Prognostic value of elevated preoperative serum CA125 in ovarian tumors of low malignant potential: a multinational collaborative study (ANZGOG0801).
abstract: OBJECTIVE
  Previous studies on prognostic factors in ovarian tumors of low malignant potential (LMP) were too small for robust conclusions. We examined the prognostic impact of preoperative serum CA125 ≥ 50 U/ml levels in patients diagnosed with ovarian LMP tumors in a large multinational cohort.
  
  
  METHODS
  This retrospective study included 940 patients with ovarian LMP tumors diagnosed between 1985 and 2008 at six gynecologic cancer centers. Patients either had radical treatment (bilateral salpingo-oophorectomy with or without hysterectomy) or conservative, fertility-sparing treatment. Multivariate Cox proportional hazard models were used to determine independent prognostic factors for disease-free (DFS) and overall survival (OS). Based on receiver operating characteristic curve (ROC), a preoperative serum CA125 level ≥ 50 U/ml was considered "elevated".
  
  
  RESULTS
  CA125 was more often elevated in serous than in mucinous tumors and in advanced FIGO stages (2 to 4) compared to stage 1. DFS at 5 years was 89% and 95% in patients with elevated and normal CA125 levels (p<0.05). Similarly, the 5-year OS was 90% among patients with elevated CA125 compared to 95% among patients with normal levels (p<0.05). For both DFS and OS elevated CA125 levels and advanced stages of the disease were independent prognostic factors. Analysis of subgroups revealed that CA125 was only prognostic in serous LMP tumors.
  
  
  CONCLUSIONS
  In the context of serous ovarian LMP tumors, elevated preoperative serum CA125 represents a biomarker independently associated with impaired disease-free and overall survival. CA125 is available in most centers and could inform surgeons about the risk of treatment failure.
authors.affiliation: Queensland Centre for Gynaecological Cancer, Royal Brisbane & Women's Hospital, Brisbane, Australia.
authors.forename: Amy
authors.initials: A
authors.lastname: Tang
authors.forename: Srinivas
authors.initials: S
authors.lastname: Kondalsamy-Chennakesavan
authors.forename: Hextan
authors.initials: H
authors.lastname: Ngan
authors.forename: Petra
authors.initials: P
authors.lastname: Zusterzeel
authors.forename: Michael
authors.initials: M
authors.lastname: Quinn
authors.forename: Jonathan
authors.initials: J
authors.lastname: Carter
authors.forename: Yee
authors.initials: Y
authors.lastname: Leung
authors.forename: Andreas
authors.initials: A
authors.lastname: Obermair
mesh_terms: D018394:CA-125 Antigen / Q000097:blood*; D015331:Cohort Studies; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D008875:Middle Aged; D010051:Ovarian Neoplasms / Q000473:pathology* / Q000601:surgery; D011379:Prognosis; D012189:Retrospective Studies; D016019:Survival Analysis
chemical_list: D018394:CA-125 Antigen