Lan Chun-Yan, Huang He, Liu Ji-Hong
Department of Gynecologic Oncology, Cancer Center, Sun Yat-sen University, Guangzhou 510060, China.
Zhonghua Fu Chan Ke Za Zhi. 2008 Oct;43(10):732-6.
To investigate the prognostic value of the changes in serum CA(125) level during chemotherapy post-surgery in patients with advanced epithelial ovarian carcinoma.
A retrospective analysis was conducted on 142 patients with stage III - IV epithelial ovarian carcinoma who had primary treatment in the Cancer Center of the Sun Yat-sen University during January 1998 to December 2003. The changes in CA(125) levels during chemotherapy post-surgery in patients were analyzed. The survival outcomes of patients with various levels of CA(125) were studied using Kaplan-Meier method. Multivariate Cox regression model was used to assess the correlations between survival and the change in CA(125) level during chemotherapy and other prognostic factors.
The 3-year overall survival (OS) was 64%, 71%, and 64% respectively in patients with different pretreatment CA(125) levels (< or = 500, > 500 - 1500 and > 1500 kU/L; P > 0.05). The CA(125) level was normalized (0 - 35 kU/L) in 77 (54.2%) patients after three cycles of postoperative chemotherapy. It revealed significant differences in 3-year OS (84% vs. 42%) and 5-year OS (56% vs. 15%) between the patients with normalized and elevated CA(125) levels (n = 48) after three cycles of chemotherapy (P < 0.01). Multivariate analysis showed that residual tumor size > 1 cm (P < 0.01) and elevated CA(125) after three-cycle postoperative chemotherapies (P < 0.01) were two independent factors related to survival. In the subgroup of optimal cytoreduction (residual tumor size < or = 1 cm), the 3-year and 5-year OS rate were 88% and 64% for patients with normalized CA(125) level after three cycles of chemotherapy respectively, while only 52% and 18% for patients with elevated CA(125) level (P < 0.01). Similarly, even in the suboptimal cytoreduction group, the 3-year and 5-year OS were also significantly increased for patients with normalized CA(125) level after three cycles of chemotherapy post-surgery, as compared with patients with elevated CA(125) level (74% vs. 33% in 3-year OS, 32% vs. 13% in 5-year OS; P < 0.01).
CA(125) level after three cycles of chemotherapy post-surgery is an independent predictor of survival for advanced ovarian carcinoma. Whatever the patients undergo, optimal or suboptimal cytoreduction, if the CA(125) becomes normalized after three cycles of chemotherapy, they would have more favorable prognosis than those with elevated CA(125) after three cycles of chemotherapy.
探讨晚期上皮性卵巢癌患者术后化疗期间血清CA(125)水平变化的预后价值。
对1998年1月至2003年12月在中山大学肿瘤防治中心接受初次治疗的142例Ⅲ-Ⅳ期上皮性卵巢癌患者进行回顾性分析。分析患者术后化疗期间CA(125)水平的变化。采用Kaplan-Meier法研究不同CA(125)水平患者的生存结局。采用多因素Cox回归模型评估化疗期间CA(125)水平变化及其他预后因素与生存的相关性。
不同术前CA(125)水平（≤500、>500-1500和>1500 kU/L）患者的3年总生存率（OS）分别为64%、71%和64%；P>0.05）。77例（54.2%）患者术后化疗3个周期后CA(125)水平恢复正常（0-35 kU/L）。化疗3个周期后CA(125)水平恢复正常和升高的患者（n=48），其3年OS（84%对42%）和5年OS（56%对15%）差异有统计学意义（P<0.01）。多因素分析显示，残留肿瘤大小>1 cm（P<0.01）和术后化疗3个周期后CA(125)水平升高（P<0.01）是与生存相关的两个独立因素。在最佳减瘤（残留肿瘤大小≤1 cm）亚组中，化疗3个周期后CA(125)水平恢复正常的患者3年和5年OS率分别为88%和64%，而CA(125)水平升高的患者仅为52%和18%（P<0.01）。同样，即使在次优减瘤组中，术后化疗3个周期后CA(125)水平恢复正常的患者3年和5年OS也较CA(125)水平升高的患者显著提高（3年OS：74%对33%，5年OS：32%对13%；P<0.01）。
术后化疗3个周期后的CA(125)水平是晚期卵巢癌生存的独立预测因素。无论患者接受的是最佳还是次优减瘤治疗，若化疗3个周期后CA(125)恢复正常，其预后将优于化疗3个周期后CA(125)水平升高的患者。
