Brockbank E C, Ind T E J, Barton D P J, Shepherd J H, Gore M E, A'Hern R, Bridges J E
Department of Gynaecological Oncology, The Royal Marsden Hospital, London, UK.
Int J Gynecol Cancer. 2004 Jan-Feb;14(1):42-50. doi: 10.1111/j.1048-891x.2004.14065.x.
Women with epithelial ovarian cancer (EOC) are conventionally treated with primary cytoreductive surgery. For those with a low probability of optimal primary surgical debulking, an alternative management option is primary chemotherapy with delayed primary surgery. Selection criteria are required to identify women who may benefit from this approach.
Patient age, presence of ascites, preoperative serum CA-125 level, surgical procedures performed, postoperative residual disease, FIGO stage, and histology data were collected on 97 women with preoperative clinical evidence of advanced EOC. Univariate and multivariate analysis was performed to identify which preoperative factors predict disease that will be suboptimally debulked. Receiver-operator curves were constructed for CA-125 level as a predictor for residual disease.
The best predictor of disease suboptimally cytoreduced was serum CA-125 level (OR = 22.76, 95% CI = 7.13-72.69). Other predictive factors included age over 60 years (OR = 3.16, 95% CI = 1.04-9.56) and clinical evidence of ascites (OR = 3.30, 95% CI = 1.03-10.62). The optimal cut-off for serum CA-125 as a predictor of suboptimal debulking was 586 IU (sensitivity 80.0%, specificity 88.5%, PPV 85.7%).
Serum CA-125 level is a reliable component of the preoperative assessment of women with EOC.
上皮性卵巢癌（EOC）女性患者传统上接受初次肿瘤细胞减灭术治疗。对于那些初次手术达到最佳减瘤效果可能性较低的患者，另一种治疗选择是先行化疗再择期行初次手术。需要制定选择标准来识别可能从这种治疗方法中获益的女性患者。
收集了97例术前有晚期EOC临床证据的女性患者的年龄、腹水情况、术前血清CA-125水平、所施行的手术操作、术后残留病灶、国际妇产科联盟（FIGO）分期及组织学数据。进行单因素和多因素分析以确定哪些术前因素可预测手术减瘤效果欠佳的疾病。构建了以CA-125水平作为残留病灶预测指标的受试者工作特征曲线。
疾病细胞减灭效果欠佳的最佳预测指标是血清CA-125水平（比值比[OR]=22.76，95%置信区间[CI]=7.13 - 72.69）。其他预测因素包括年龄超过60岁（OR = 3.16，95% CI = 1.04 - 9.56）和有腹水的临床证据（OR = 3.30，95% CI = 1.03 - 10.62）。血清CA-125作为减瘤效果欠佳预测指标的最佳临界值为586 IU（敏感性80.0%，特异性88.5%，阳性预测值85.7%）。
血清CA-125水平是EOC女性患者术前评估的可靠指标。
