Does serum CA-125 level prior to second-look laparotomy for invasive ovarian adenocarcinoma predict size of residual disease?

The records of 125 patients with nonmucinous invasive ovarian adenocarcinoma who underwent cytoreductive surgery, cisplatin-based combination chemotherapy, and second-look laparotomy were analyzed to correlate pre-second-look serum CA-125 levels with the size of residual ovarian cancer. The majority of patients with negative second-look laparotomy had normal serum CA-125 levels (46/50 or 92%). Of the 75 patients with positive second-look, 56 (75%) had normal CA-125 levels preoperatively. Twenty-three of twenty-four (96%) patients with residual disease less than or equal to 1 cm had normal CA-125 levels as did 20 of 28 (71%) patients with disease 1.1-2.0 cm. Although elevated serum CA-125 levels were invariably associated with visible/gross disease and increasing size of residual disease tended to be associated with increasing elevations of CA-125, normal CA-125 levels often occurred in the presence of large-volume (greater than 2 cm) disease (13/23, 57% of patients). The considerable overlap of serum CA-125 levels for all sizes of residual disease precluded precise prediction of residual disease size based on serum CA-125 level alone.