title: A preoperative low cancer antigen 125 level (≤25.8 mg/dl) is a useful criterion to determine the optimal timing of interval debulking surgery following neoadjuvant chemotherapy in epithelial ovarian cancer.
abstract: OBJECTIVE
  The purpose of this study is to investigate the clinical characteristics to determine the optimal timing of interval debulking surgery following neoadjuvant chemotherapy in patients with advanced epithelial ovarian cancer.
  
  
  METHODS
  We reviewed the charts of women with advanced epithelial ovarian cancer, fallopian tube cancer or primary peritoneal cancer who underwent interval debulking surgery following neoadjuvant chemotherapy at our cancer center from April 2006 to April 2014.
  
  
  RESULTS
  There were 139 patients, including 91 with ovarian cancer [International Federation of Gynecology and Obstetrics (FIGO) Stage IIIc in 56 and IV in 35], two with fallopian tube cancers (FIGO Stage IV, both) and 46 with primary peritoneal cancer (FIGO Stage IIIc in 27 and IV in 19). After 3-6 cycles (median, 4 cycles) of platinum-based chemotherapy, interval debulking surgery was performed. Sixty-seven patients (48.2%) achieved complete resection of all macroscopic disease, while 72 did not. More patients with cancer antigen 125 levels ≤25.8 mg/dl at pre-interval debulking surgery achieved complete resection than those with higher cancer antigen 125 levels (84.7 vs. 21.3%; P< 0.0001). Patients with no ascites at pre-interval debulking surgery also achieved a higher complete resection rate (63.5 vs. 34.1%; P< 0.0001). Moreover, most patients (86.7%) with cancer antigen 125 levels ≤25.8 mg/dl and no ascites at pre-interval debulking surgery achieved complete resection.
  
  
  CONCLUSIONS
  A low cancer antigen 125 level of ≤25.8 mg/dl and the absence of ascites at pre-interval debulking surgery are major predictive factors for complete resection during interval debulking surgery and present useful criteria to determine the optimal timing of interval debulking surgery.
authors.affiliation: Department of Gynecologic Oncology, Hyogo Cancer Center, Akashi, Hyogo, Japan.
authors.forename: Akemi
authors.initials: A
authors.lastname: Morimoto
authors.affiliation: Department of Gynecologic Oncology, Hyogo Cancer Center, Akashi, Hyogo, Japan nagao@hp.pref.hyogo.jp.
authors.forename: Shoji
authors.initials: S
authors.lastname: Nagao
authors.affiliation: Department of Gynecologic Oncology, Hyogo Cancer Center, Akashi, Hyogo, Japan.
authors.forename: Ai
authors.initials: A
authors.lastname: Kogiku
authors.affiliation: Department of Gynecologic Oncology, Hyogo Cancer Center, Akashi, Hyogo, Japan.
authors.forename: Kasumi
authors.initials: K
authors.lastname: Yamamoto
authors.affiliation: Department of Gynecologic Oncology, Hyogo Cancer Center, Akashi, Hyogo, Japan.
authors.forename: Maiko
authors.initials: M
authors.lastname: Miwa
authors.affiliation: Department of Gynecologic Oncology, Hyogo Cancer Center, Akashi, Hyogo, Japan.
authors.forename: Senn
authors.initials: S
authors.lastname: Wakahashi
authors.affiliation: Department of Gynecologic Oncology, Hyogo Cancer Center, Akashi, Hyogo, Japan.
authors.forename: Kotaro
authors.initials: K
authors.lastname: Ichida
authors.affiliation: Department of Gynecologic Oncology, Hyogo Cancer Center, Akashi, Hyogo, Japan.
authors.forename: Tamotsu
authors.initials: T
authors.lastname: Sudo
authors.affiliation: Department of Gynecologic Oncology, Hyogo Cancer Center, Akashi, Hyogo, Japan.
authors.forename: Satoshi
authors.initials: S
authors.lastname: Yamaguchi
authors.affiliation: Department of Gynecologic Oncology, Hyogo Cancer Center, Akashi, Hyogo, Japan.
authors.forename: Kiyoshi
authors.initials: K
authors.lastname: Fujiwara
mesh_terms: D000328:Adult; D000368:Aged; D000970:Antineoplastic Agents / Q000627:therapeutic use*; D019540:Area Under Curve; D001201:Ascites; D018394:CA-125 Antigen / Q000032:analysis; D000077216:Carcinoma, Ovarian Epithelial; D065426:Cytoreduction Surgical Procedures; D005185:Fallopian Tube Neoplasms / Q000150:complications / Q000188:drug therapy / Q000601:surgery; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D008565:Membrane Proteins / Q000032:analysis; D008875:Middle Aged; D020360:Neoadjuvant Therapy; D009367:Neoplasm Staging; D009375:Neoplasms, Glandular and Epithelial / Q000150:complications / Q000188:drug therapy* / Q000601:surgery; D009378:Neoplasms, Multiple Primary / Q000188:drug therapy / Q000601:surgery; D010051:Ovarian Neoplasms / Q000150:complications / Q000188:drug therapy* / Q000601:surgery; D010534:Peritoneal Neoplasms / Q000188:drug therapy / Q000601:surgery; D012372:ROC Curve; D012074:Remission Induction; D012189:Retrospective Studies; D012307:Risk Factors
chemical_list: D000970:Antineoplastic Agents; D018394:CA-125 Antigen; C451759:MUC16 protein, human; D008565:Membrane Proteins
keywords: CA125; cut-off level; interval debulking surgery; neoadjuvant chemotherapy; ovarian cancer