Pre-operative serum CA125, peritoneal cancer index and intra-operative mapping score as predictors of surgical results in primary epithelial ovarian cancer.

OBJECTIVE: Prediction of post-operative residual disease after ovarian cancer cytoreductive surgery remains a topic of interest to gynecologic oncologists. The aim of this study was to explore the correlation between serum CA125, peritoneal cancer index, and intra-operative mapping of ovarian cancer and their predictive value for post-operative outcome. METHODS: A total of 70 patients with primary epithelial ovarian cancer, who underwent primary cytoreductive surgery at Charité, Berlin between January 2013 and February 2014 were included. In all patients, pre-operative CA125 values, intra-operative peritoneal cancer index, and intra-operative mapping of ovarian cancer were determined. RESULTS: Using a receiver operating characteristic analysis, cut-off values for CA125, peritoneal cancer index, and intra-operative mapping of ovarian cancer score could be defined. Patients with pre-operative serum CA125 >600 U/mL had a three times higher risk for residual tumor after primary cytoreductive surgery (p=0.037). A peritoneal cancer index score >20 indicated a nine times increased risk for residual tumor (p=0.003). More than six affected abdominopelvic fields on the intra-operative mapping of ovarian cancer was associated with a 25 times higher risk of residual tumor after primary cytoreductive surgery (p≤0.05). The combination of all three values predicted residual tumor in up to 90% of patients. CONCLUSION: We found that pre-operative CA125 >600 U/mL, peritoneal cancer index >20, and intra-operative mapping of ovarian cancer score >6 could be used as predictors of complete tumor resection. The combination of all these three values predicted the incomplete resection of disease in up to 90% of patients even in experienced centers.

Preoperative CA-125 Value as a Predictive Factor for Postoperative Outcome in First Relapse of Platinum-sensitive Serous Ovarian Cancer.

AIM: The purpose of the study was to evaluate whether preoperative cancer antigen 125 (CA-125) levels predict outcome of secondary cytoreductive surgery (SCS) in patients with serous recurrent ovarian cancer and whether this could be used as a prognostic factor for progression-free (PFS) and overall (OS) survival. PATIENTS AND METHODS: A cohort of 111 patients with first recurrence of platinum-sensitive serous ovarian cancer, who had undergone SCS at the Department of Gynecology and Oncological Surgery, Charité, Campus Virchow Clinic was analyzed in correlation with the preoperative CA-125 value. RESULTS: The median preoperative CA-125 level was 164 U/ml. Complete tumor resection was achieved in 58.6% of the patients. PFS and OS for patients with preoperative CA-125 of less than 164.5 U/ml was significantly better than those with preoperative CA-125 ≥164.5 U/ml (p=0.025 and p<0.001, respectively). CONCLUSION: Preoperative CA-125 is not a statistically significant predictive factor for complete tumor resection after SCS. Preoperative CA-125 <164.5 U/ml can predict significantly better PFS and OS for patients with first recurrence of platinum-sensitive ovarian cancer.

Preoperative CA-125 Values as a Predictive Factor for the Postoperative Outcome in Primary Serous Ovarian Cancer.

BACKGROUND/AIM: The purpose of the study was to examine the preoperative CA-125 values as a predictive factor for postoperative outcome in primary serous ovarian cancer (POC) for complete tumor resection (CTR) and evaluate the preoperative CA-125 levels with other vital clinical dynamics such as ascites, lymph node involvement, diffuse peritoneal carcinomatosis, grading and staging. PATIENTS AND METHODS: A cohort of 277 POC-patients aged 18-75 years, who had undergone primary cytoreductive surgery at the Department of Gynecology & Oncological Surgery, Charité, Campus Virchow Klinikum (CVK) between 2000 und 2009 was analyzed in correlation with the preoperative CA-125 values. RESULTS: The median preoperative CA-125 value in high-grade serous POC patients was 636 U/ml (204- 2312 U/ml) compared to 284 U/ml (148.5-1,378 U/ml) in low-grade serous POC patients (p=0.016). For the survival analyses both the cut-off values 252 and 475 U/ml, with highest sum from sensitivity (79.1% and 65.9%, respectively) and specificity (41.9% and 55.1%, respectively), were used to compare the relationship between preoperative CA-125 levels and (CTR), progression-free (PFS) and overall survival (OS). There was no significant difference between PFS and OS in three different groups of patients (preoperative CA-125 levels <252 U/ml, CA 125 levels between 252-475 U/ml and >475 U/ml). CONCLUSION: Preoperative CA-125 is a poor, but statistically significant predictive factor for CTR after PCS. Preoperative CA-125 can predict neither the progression-free nor overall survival for POC patients.