Memarzadeh S, Lee S B, Berek J S, Farias-Eisner R
Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, UCLA School of Medicine, University of California-Los Angeles, Los Angeles, California, USA.
Int J Gynecol Cancer. 2003 Mar-Apr;13(2):120-4. doi: 10.1046/j.1525-1438.2003.13019.x.
The utility of preoperative CA125 to predict optimal primary tumor cytoreduction in patients with advanced (stages IIIC and IV) epithelial ovarian cancer is controversial. In this paper, we retrospectively review patients with stage IIIC and IV epithelial ovarian cancer who underwent primary cytoreductive surgery from 1989 to 2001. Ninety-nine patients were identified and included in the analysis. All patients had preoperative CA125 levels measured. Operative and pathology reports were reviewed. Optimal cytoreduction was defined as largest volume of residual disease < 1 cm in maximal dimension. Mean values were compared with t-test on a log scale when needed. The optimal cut-point for discriminating between those with vs. without optimal cytoreduction was determined using the receiver operator curve (ROC) method. Optimal cytoreduction was achieved in 73% of patients. Among patients with optimal cytoreductive status the mean CA125 level was 569, while among patients with suboptimal cytoreduction the mean CA125 level was 1520 (P < 0.007). A CA125 level of 912 was identified as the optimal cut-point to distinguish the two groups. Using this CA125 level, the sensitivity of this test in predicting optimal cytoreduction was 58% and the specificity was 54%. The positive predictive value of CA125 for optimal cytoreduction was 78% and the negative predictive value was 31%. We conclude that CA125 level is a weak positive and negative predictor of optimal cytoreductive surgery in patients with advanced epithelial ovarian cancer. The CA125 level should not be used as a primary predictor of the outcome of cytoreductive surgery and should be viewed in the context of all other preoperative features.
术前CA125用于预测晚期（IIIC期和IV期）上皮性卵巢癌患者实现最佳原发性肿瘤细胞减灭术的效用存在争议。在本文中，我们回顾性分析了1989年至2001年间接受原发性细胞减灭术的IIIC期和IV期上皮性卵巢癌患者。共识别出99例患者并纳入分析。所有患者均测量了术前CA125水平。回顾了手术和病理报告。最佳细胞减灭术定义为最大残留病灶直径<1 cm。必要时采用对数尺度的t检验比较均值。使用受试者操作特征曲线（ROC）方法确定区分实现最佳细胞减灭术和未实现最佳细胞减灭术患者的最佳切点。73%的患者实现了最佳细胞减灭术。在实现最佳细胞减灭术状态的患者中，CA125平均水平为569，而在未实现最佳细胞减灭术的患者中，CA125平均水平为1520（P<0.007）。确定CA125水平912为区分两组的最佳切点。使用该CA125水平，该检测预测最佳细胞减灭术的敏感性为58%，特异性为54%。CA125对最佳细胞减灭术的阳性预测值为78%，阴性预测值为31%。我们得出结论，CA125水平对晚期上皮性卵巢癌患者的最佳细胞减灭术是一个弱的阳性和阴性预测指标。CA125水平不应作为细胞减灭术结果的主要预测指标，而应结合所有其他术前特征进行考量。
