Arits A H M M, Stoot J E G M, Botterweck A A M, Roumen F J M E, Voogd A C
Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands.
Int J Gynecol Cancer. 2008 Jul-Aug;18(4):621-8. doi: 10.1111/j.1525-1438.2007.01064.x. Epub 2007 Sep 14.
The objective is to assess the ability of preoperative serum CA125 levels to identify patients at high risk of suboptimal cytoreductive surgery for epithelial ovarian cancer (EOC). One hundred and thirty-two women diagnosed with EOC between 1998 and 2004, who had serum CA125 levels measured preoperatively and received primary cytoreductive surgery, were retrospectively evaluated. The value of CA125 and patient and disease characteristics to predict suboptimal cytoreduction were determined, and a prognostic scoring system, based on statistically significant variables, was created. Optimal cytoreduction was achieved in 42.7% of the women with FIGO stage III/IV EOC. The optimal cutoff point of preoperative CA125 to predict surgical outcome in this group was 330 U/mL (sensitivity 80.0%; specificity 41.5%). The area under the receiver-operating characteristic curve (AUC) for preoperative CA125 predicting suboptimal surgery in FIGO stage III/IV was 0.576 (P = 0.617). Preoperative radiologic amount of ascites and weight loss (ie, >or=10% in the last 6 months before diagnosis) were independent prognostic factors for suboptimal cytoreduction, showing an AUC of 0.76 (P < 0.001) in women with FIGO stage III/IV. A prognostic scoring system showed that the chance of suboptimal surgery was 84.6% in FIGO stage III/IV when both these factors are present preoperatively. The role of CA125 levels predicting suboptimal cytoreduction seems questionable. Instead, women with considerable weight loss and a gross amount of ascites have a higher risk of suboptimal cytoreduction. These patients may be candidates for neoadjuvant chemotherapy.
目的是评估术前血清CA125水平识别上皮性卵巢癌（EOC）患者接受次优细胞减灭术高风险的能力。对1998年至2004年间诊断为EOC且术前测量了血清CA125水平并接受初次细胞减灭术的132名女性进行回顾性评估。确定了CA125值以及患者和疾病特征对预测次优细胞减灭的作用，并基于具有统计学意义的变量创建了一个预后评分系统。国际妇产科联盟（FIGO）III/IV期EOC女性中42.7%实现了最佳细胞减灭。该组中预测手术结果的术前CA125最佳截断点为330 U/mL（敏感性80.0%；特异性41.5%）。FIGO III/IV期术前CA125预测次优手术的受试者工作特征曲线（AUC）下面积为0.576（P = 0.617）。术前影像学检查腹水的量和体重减轻（即诊断前最后6个月内体重减轻≥10%）是次优细胞减灭的独立预后因素，在FIGO III/IV期女性中AUC为0.76（P < 0.001）。一个预后评分系统显示，术前同时存在这两个因素时，FIGO III/IV期次优手术的几率为84.6%。CA125水平预测次优细胞减灭的作用似乎存疑。相反，体重明显减轻且腹水量大的女性发生次优细胞减灭的风险更高。这些患者可能是新辅助化疗的候选者。
