Secondary cytoreductive surgery Book Section

  


Authors: Bristow, R. E.; Chi, D. S.
Editors: Bristow, R. E.; Karlan, B. Y.; Chi, D. S.
Article/Chapter Title: Secondary cytoreductive surgery
Abstract: Serum Biomarkers The serum CA-125 level is the most commonly used measure for ovarian cancer surveillance, although other biomarkers such as plasma YKL-40, MUC-1, PAI-1, and HE4 have been evaluated alongside of CA-125 in an effort to increase diagnostic precision (9-11). In many cases where an individual’s CA-125 was elevated at diagnosis and returned to normal following therapy, the biomarker correspondingly elevates at the time of recurrence. The clinical significance of a rising CA-125 in this setting has been confirmed to reflect disease recurrence, with several authors reporting a sensitivity and specificity of 77% and 94%, respectively (12,13). When a rising CA-125 level is accompanied by the appearance of new disease-related symptoms or radiographic changes, the diagnosis of recurrent ovarian cancer is relatively straightforward. Not infrequently, however, an elevation of the serum CA-125 may be the only clinical manifestation suggestive of recurrent ovarian cancer. The precise definition of what constitutes a “significant” change in CA-125 level among asymptomatic patients has been debated as well as the classification of patients with an apparent serologic recurrence in the absence of measurable disease. Rustin et al. retrospectively evaluated 131 patients entered on the North Thames Ovary Trial of five versus eight cycles platinum chemotherapy for stages IC to IV ovarian cancer and proposed a model where two consecutive CA-125 values double the upper cutoff value of 30 U/mL (i.e., two serial samples 60 U/mL) provided the most diagnostic precision in predicting recurrent disease (14). Using this “Rustin” criterion, the diagnostic model yielded a sensitivity of 84%, a specificity of 98%, and a predictive value positive of 99%. In addition, a marker change of two consecutive CA-125 values 60 U/mL preceded conventional objective measures of recurrence by a median of 63 days (“lead time”). © 2010 Informa Healthcare, except as otherwise indicated.
Book Title: Surgery for Ovarian Cancer: Principles and Practice. 2nd ed
ISBN: 9781841847061
Publisher: Informa Healthcare  
Publication Place: New York, NY
Date Published: 2010-01-01
Start Page: 218
End Page: 234
Language: English
PROVIDER: scopus
DOI/URL:

https://www.scopus.com/inward/record.uri?eid=2-s2.0-85056061221&doi=10.3109%2f9781841847825&partnerID=40&md5=bb1e036d06bf885edf3e062ce86db377
Notes: Book Chapter: 11 -- Export Date: 3 December 2018 -- Source: Scopus