Riedinger J M, Eche N, Basuyau J P, Dalifard I, Hacene K, Pichon M F
Laboratoire de Biologie Médicale, Centre Georges François Leclerc, 1 rue du Pr Marion, 21034 Dijon cedex, France.
Gynecol Oncol. 2008 May;109(2):194-8. doi: 10.1016/j.ygyno.2008.01.035. Epub 2008 Mar 7.
CA 125 assays enable treatment-response monitoring in ovarian cancer.
A multicentric study of CA 125 kinetics under paclitaxel/platinum-based chemotherapy was performed in 130 stage IIc-IV patients. CA 125 half-life and nadir concentration were compared to patient outcome. Some patients (n=38, 29.2%) presented a CA 125 bi-exponential decrease and its clinical implication was studied. Survival analyses for disease-free survival (DFS) and overall survival (OS) used univariate (Kaplan-Meier) and multivariate (Cox model).
During a median follow-up time of 29 months (range 5-106 months), 111 patients (85%) relapsed and 94 (72%) died from ovarian cancer. Patients were split into 4 groups according to their pattern of CA 125 decrease: non-assessable half-life because of a low pre-chemotherapy CA 125 level (n=38), half-life < or = 14 days and mono-exponential CA 125 decay (n=18), half-life < or = 14 days and bi-exponential CA 125 decay (n=21), and half-life > 14 days (n=53). In Cox models, nadir concentration, residual tumour volume and number of chemotherapy courses were found to be independent prognostic factors for DFS and OS. The group classification was found to be an independent prognostic factor only for DFS. However, when nadir was not introduced in the models, the CA 125 kinetics groups were the most important prognostic factor for OS.
Characteristics of CA 125 kinetics during first line paclitaxel/platinum chemotherapy have a strong and independent prognostic value. A CA 125 bi-exponential decrease is an indicator of bad prognosis.
CA 125检测可用于监测卵巢癌的治疗反应。
对130例IIc-IV期患者进行了一项关于紫杉醇/铂类化疗下CA 125动力学的多中心研究。将CA 125半衰期和最低点浓度与患者预后进行比较。部分患者（n = 38，29.2%）呈现CA 125双指数下降，并对其临床意义进行了研究。无病生存期（DFS）和总生存期（OS）的生存分析采用单因素（Kaplan-Meier）和多因素（Cox模型）分析。
在中位随访时间29个月（范围5 - 106个月）内，111例患者（85%）复发，94例（72%）死于卵巢癌。根据CA 125下降模式将患者分为4组：化疗前CA 125水平低导致半衰期不可评估（n = 38），半衰期≤14天且CA 125呈单指数衰减（n = 18），半衰期≤14天且CA 125呈双指数衰减（n = 21），以及半衰期>14天（n = 53）。在Cox模型中，最低点浓度、残余肿瘤体积和化疗疗程数被发现是DFS和OS的独立预后因素。分组仅被发现是DFS的独立预后因素。然而，当最低点浓度未纳入模型时，CA 125动力学分组是OS最重要的预后因素。
一线紫杉醇/铂类化疗期间CA 125动力学特征具有强大且独立的预后价值。CA 125双指数下降是预后不良的指标。
