title: Prognostic significance of rising serum CA-125 levels within the normal range in patients with epithelial ovarian, primary peritoneal, and tubal cancers, who, after initial treatment, had a complete clinical response.
abstract: OBJECTIVE
  This study aimed to assess the ability of 3 criteria of rising CA-125 levels within the reference range to predict recurrence in patients with ovarian, primary peritoneal, and tubal carcinomas after complete clinical response to initial treatment.
  
  
  METHODS
  Included were patients diagnosed during 1998 to 2008 who fulfilled the following criteria: CA-125 levels of 35 U/mL or greater at diagnosis and recurrence, full primary treatment with a complete clinical and radiographic response, follow-up according to schedule, and at least 2 CA-125 results within the reference range during follow-up. Three criteria of rising CA-125 values within the reference range were used for the prediction of recurrence: (1) an absolute increase of 5 U/mL or higher from the nadir value at completion of chemotherapy, (2) early signal of progressive disease criterion, and (3) a rise to an absolute level of 20 U/mL or greater.
  
  
  RESULTS
  Of 82 patients who satisfied study inclusion criteria, 58 (70.7%) had disease recurrence. Early signal of progressive disease and a rise to an absolute level of 20 U/mL or greater were highly statistically significant predictors of disease recurrence (odds ratio, 12.62 [95% confidence interval, 2.71-58.7], P = 0.0012; and odds ratio, 6.7 [95% confidence interval, 2.18-20.54], P = 0.001, respectively) and preceded recurrence by a median of 3 and 3.3 months, respectively.
  
  
  CONCLUSIONS
  Our data indicate that the early signal of progressive disease criterion and a single rise to an absolute level of 20 U/mL or greater within reference limits are highly predictive of clinical recurrence, although the latter is simpler to use. However, whether this is of practical clinical value remains to be proven.
authors.affiliation: Division of Gynecologic Oncology, Edith Wolfson Medical Center, Holon, Israel. levyt@wolfson.health.gov.il
authors.forename: Tally
authors.initials: T
authors.lastname: Levy
authors.forename: Roi
authors.initials: R
authors.lastname: Weiser
authors.forename: Mona
authors.initials: M
authors.lastname: Boaz
authors.forename: Erez Ben
authors.initials: EB
authors.lastname: Shem
authors.forename: Abraham
authors.initials: A
authors.lastname: Golan
authors.forename: Joseph
authors.initials: J
authors.lastname: Menczer
mesh_terms: D018262:Adenocarcinoma, Clear Cell / Q000401:mortality / Q000473:pathology / Q000601:surgery; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D014408:Biomarkers, Tumor / Q000097:blood*; D018394:CA-125 Antigen / Q000097:blood*; D016190:Carboplatin / Q000008:administration & dosage; D018284:Cystadenocarcinoma, Serous / Q000097:blood / Q000188:drug therapy / Q000401:mortality; D016889:Endometrial Neoplasms / Q000097:blood / Q000188:drug therapy / Q000401:mortality; D005185:Fallopian Tube Neoplasms / Q000097:blood* / Q000188:drug therapy / Q000401:mortality; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007124:Immunoenzyme Techniques; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000097:blood* / Q000188:drug therapy / Q000401:mortality; D009367:Neoplasm Staging; D018365:Neoplasm, Residual / Q000097:blood / Q000188:drug therapy / Q000401:mortality; D010051:Ovarian Neoplasms / Q000097:blood* / Q000188:drug therapy / Q000401:mortality; D017239:Paclitaxel / Q000008:administration & dosage; D010534:Peritoneal Neoplasms / Q000097:blood* / Q000188:drug therapy / Q000401:mortality; D011379:Prognosis; D015996:Survival Rate
chemical_list: D014408:Biomarkers, Tumor; D018394:CA-125 Antigen; D016190:Carboplatin; D017239:Paclitaxel