Department of Gynecology and Gynecologic Oncology, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246, Hamburg, Germany.
J Cancer Res Clin Oncol. 2011 Jul;137(7):1131-7. doi: 10.1007/s00432-011-0977-1. Epub 2011 Feb 23.
Despite radical surgery and chemotherapy, most patients with ovarian cancer develop recurrence and die due to progressive disease. To stratify patients for optimal therapy, prognostic and predictive factors are needed. We examined the role of pre- and postoperative CA-125 in this context.
A total of 231 patients with primary ovarian cancer who presented for surgery at our institution between 1996 and 2004 were included in this study (25% FIGO stage I/II and 75% FIGO stage III/IV). The prognostic and predictive values of CA-125 serum concentrations before and after surgery as well as their correlation with clinicopathological variables were analyzed.
Median preoperative CA-125 was 61.6 kU/l (9-1,867 kU/l) in stage I/II patients and 533.15 kU/l (10-22,617 kU/l) in stage III/IV patients. Before surgery, 67% of stage I/II patients and 96% of stage III/IV patients had elevated CA-125 (>35 kU/l). There was a significant decrease in CA-125 after surgery in both patient cohorts (61.6-43.4 kU/l, P = 0.001 and 533.15-92.3 kU/l, P < 0.001, respectively). Furthermore, in stage III/IV patients with complete or so-called optimal (<1 cm residual disease) debulking, preoperative CA-125 levels were significantly lower than in patients with residual disease >1 cm (P = 0.01, P = 0.009, respectively). Neither CA-125 concentration before surgery nor its decrease was prognostically relevant for recurrence and survival at any stage. However, in stage III/IV patients, a high postoperative CA-125 was associated with shorter progression-free survival (P = 0.024).
Although CA-125 serum levels differ significantly before and after surgery in early and advanced-stage ovarian cancer and preoperative CA-125 values correlate with surgical outcome in advanced-stage disease, we could not determine a preoperative cutoff value for prediction of the surgical result. A prognostic relevance was only observed for postoperative CA-125 in stage III/IV patients.
尽管进行了激进的手术和化疗，大多数卵巢癌患者仍因疾病进展而复发和死亡。为了对最佳治疗进行分层，需要预后和预测因素。我们在这种情况下研究了术前和术后 CA-125 的作用。
本研究纳入了 1996 年至 2004 年期间在我院就诊的 231 例原发性卵巢癌患者（25%FIGO 分期 I/II 期和 75%FIGO 分期 III/IV 期）。分析了术前和术后 CA-125 血清浓度的预后和预测价值及其与临床病理变量的相关性。
I/II 期患者术前中位 CA-125 为 61.6 kU/l（9-1867 kU/l），III/IV 期患者为 533.15 kU/l（10-22617 kU/l）。术前，67%的 I/II 期患者和 96%的 III/IV 期患者 CA-125 升高（>35 kU/l）。两组患者术后 CA-125 均显著下降（61.6-43.4 kU/l，P=0.001 和 533.15-92.3 kU/l，P<0.001）。此外，在完全或所谓的最佳（残留病灶<1cm）减瘤的 III/IV 期患者中，术前 CA-125 水平明显低于残留病灶>1cm 的患者（P=0.01，P=0.009）。无论分期如何，术前 CA-125 浓度及其下降均与复发和生存无关。然而，在 III/IV 期患者中，高术后 CA-125 与无进展生存期较短相关（P=0.024）。
尽管早期和晚期卵巢癌患者术前和术后的 CA-125 血清水平差异显著，且晚期疾病患者的术前 CA-125 值与手术结果相关，但我们无法确定预测手术结果的术前截止值。仅在 III/IV 期患者中观察到术后 CA-125 的预后相关性。
