A contemporary analysis of the ability of preoperative serum CA-125 to predict primary cytoreductive outcome in patients with advanced ovarian, tubal and peritoneal carcinoma Journal Article

  

Authors:	Chi, D. S.; Zivanovic, O.; Palayekar, M. J.; Eisenhauer, E. L.; Abu-Rustum, N. R.; Sonoda, Y.; Levine, D. A.; Leitao, M. M.; Brown, C. L.; Barakat, R. R.
Article Title:	A contemporary analysis of the ability of preoperative serum CA-125 to predict primary cytoreductive outcome in patients with advanced ovarian, tubal and peritoneal carcinoma
Abstract:	Objective: We previously reported that preoperative CA-125 may predict primary cytoreductive outcome in patients with stage III ovarian carcinoma (OC). The objective of this study was to perform a contemporary analysis of the ability of CA-125 to predict cytoreductive outcome in advanced OC since our programmatic change in surgical approach that currently incorporates the utilization of extensive upper abdominal procedures, as needed, to achieve maximal cytoreduction. Methods: We reviewed the records of all patients with advanced ovarian, tubal or peritoneal carcinoma who underwent primary cytoreduction at our institution between 1/01 and 4/05. Results: The study cohort included 277 patients. Primary disease sites were: ovary, 232 (84%); tubal, 9 (3%); and peritoneum, 36 (13%). Stages were: IIIA, 6 (2%); IIIB, 12 (4%); IIIC, 215 (78%); and IV, 44 (16%). Tumor grades were: grade 1, 6 (2%); grade 2, 30 (11%); grade 3, 233 (84%), and undifferentiated, 8 (3%). Cytoreductive outcomes were: no gross residual disease (RD), 68 (25%); ≤ 1 cm RD, 153 (55%); and > cm RD, 56 (20%). There was no threshold CA-125 level that accurately predicted cytoreductive outcome. However, with CA-125 values > 500 U/mL, 50% (57/113) of patients required extensive upper abdominal surgery to achieve RD ≤ 1 cm, compared to 27% (25/93) for those with CA-125 < 500 U/mL (P = 0.001). Conclusion: Following our change in surgical paradigm that the incorporated extensive upper abdominal procedures to attain optimal debulking, preoperative CA-125 did not predict the primary cytoreductive outcome of patients with advanced ovarian, tubal, or peritoneal carcinoma. However, with a preoperative CA-125 > 500 U/mL, extensive upper abdominal procedures were necessary in 50% of cases to achieve residual disease ≤ 1 cm. These data may be useful as part of preoperative surgical counseling and planning. © 2008 Elsevier Inc. All rights reserved.
Keywords:	adult; controlled study; treatment outcome; aged; middle aged; retrospective studies; major clinical study; cancer localization; advanced cancer; cancer staging; neoplasm staging; preoperative evaluation; cytoreductive surgery; ovarian neoplasms; peritoneum cancer; cohort studies; peritoneal neoplasms; cohort analysis; surgical approach; medical record review; ovary carcinoma; predictive value of tests; ca 125 antigen; advanced ovarian cancer; ca-125; optimal cytoreduction; abdominal surgery; ca-125 antigen; fallopian tube neoplasms
Journal Title:	Gynecologic Oncology
Volume:	112
Issue:	1
ISSN:	0090-8258
Publisher:	Elsevier Inc.
Date Published:	2009-01-01
Start Page:	6
End Page:	10
Language:	English
DOI:	10.1016/j.ygyno.2008.10.010
PUBMED:	19100916
PROVIDER:	scopus
DOI/URL:	http://www.scopus.com/inward/record.url?eid=2-s2.0-57649097026&partnerID=40&md5=e05369e0b90a8fa23686bf6fa06f71c0
Notes:	--- - "Cited By (since 1996): 7" - "Export Date: 30 November 2010" - "CODEN: GYNOA" - "Source: Scopus"

https://synapse.mskcc.org/synapse/works/has_related_data_chk/307