[Prognostic value of serum CA(125) level change during chemotherapy post-surgery in patients with advanced epithelial ovarian carcinoma].

OBJECTIVE: To investigate the prognostic value of the changes in serum CA(125) level during chemotherapy post-surgery in patients with advanced epithelial ovarian carcinoma.

METHODS: A retrospective analysis was conducted on 142 patients with stage III - IV epithelial ovarian carcinoma who had primary treatment in the Cancer Center of the Sun Yat-sen University during January 1998 to December 2003. The changes in CA(125) levels during chemotherapy post-surgery in patients were analyzed. The survival outcomes of patients with various levels of CA(125) were studied using Kaplan-Meier method. Multivariate Cox regression model was used to assess the correlations between survival and the change in CA(125) level during chemotherapy and other prognostic factors.

RESULTS: The 3-year overall survival (OS) was 64%, 71%, and 64% respectively in patients with different pretreatment CA(125) levels (< or = 500, > 500 - 1500 and > 1500 kU/L; P > 0.05). The CA(125) level was normalized (0 - 35 kU/L) in 77 (54.2%) patients after three cycles of postoperative chemotherapy. It revealed significant differences in 3-year OS (84% vs. 42%) and 5-year OS (56% vs. 15%) between the patients with normalized and elevated CA(125) levels (n = 48) after three cycles of chemotherapy (P < 0.01). Multivariate analysis showed that residual tumor size > 1 cm (P < 0.01) and elevated CA(125) after three-cycle postoperative chemotherapies (P < 0.01) were two independent factors related to survival. In the subgroup of optimal cytoreduction (residual tumor size < or = 1 cm), the 3-year and 5-year OS rate were 88% and 64% for patients with normalized CA(125) level after three cycles of chemotherapy respectively, while only 52% and 18% for patients with elevated CA(125) level (P < 0.01). Similarly, even in the suboptimal cytoreduction group, the 3-year and 5-year OS were also significantly increased for patients with normalized CA(125) level after three cycles of chemotherapy post-surgery, as compared with patients with elevated CA(125) level (74% vs. 33% in 3-year OS, 32% vs. 13% in 5-year OS; P < 0.01).

CONCLUSIONS: CA(125) level after three cycles of chemotherapy post-surgery is an independent predictor of survival for advanced ovarian carcinoma. Whatever the patients undergo, optimal or suboptimal cytoreduction, if the CA(125) becomes normalized after three cycles of chemotherapy, they would have more favorable prognosis than those with elevated CA(125) after three cycles of chemotherapy.