Ferrero J M, Largillier R, Ramaioli A, Heudier P, Teissier E, Namer M
Département d'oncologie médicale, Centre Antoine-Lacassagne, Nice, France.
Bull Cancer. 1997 Jul;84(7):722-8.
The value of early CA 125 assays and analysis of its diminution kinetics during chemotherapy have been the subject of numerous studies. In contrast, routine utilization of CA 125 assays in clinical practice remains controversial or at best difficult to apply because the definitions and prognostic values associated with CA 125 assays vary greatly from one study to the next. This study was designed to determine whether serial CA 125 assays during induction chemotherapy for ovarian carcinoma, using simple evaluation criteria directly applicable in routine clinical practice such as early normalization (level < 35 UI/ml) are predictive of response to treatment or improved survival. This retrospective longitudinal analysis concerned a historical population of 140 patients with ovarian carcinoma stages III and IV treated at the Antoine-Lacassagne Cancer Center between 1978 and 1993. All the patients were treated by chemotherapy based on platinum salts every 21 days. Serum CA 125 assays were performed both before and after surgery and during each chemotherapy cycle. Eighty-four patients had a pre-operative CA 125 assay. No difference is observed in survival as a function of their preoperative CA 125 concentration (p = 0.4). Sixty-seven patients had a CA 125 assay the 6th week after initiation of chemotherapy, 62 the 9th week and 47 the 18th week. Normalization of CA 125 the 6th week (p = 0.0001), the 9th week (p = 0.0008) and the 18th week (p = 0.03) after the initiation of the chemotherapy cycle are correlated with survival. The median survival in our study is 42 months if the CA 125 is below 35 UI/ml the 6th week versus 13 months if the level of CA 125 remains more than 35 UI/ml. In all, 66 of the 105 FIGO stage III patients underwent second-look surgery. Normalization of CA 125 levels is correlated with the absence of any gross residual tumor at the second-look procedure, the 6th week of chemotherapy (p = 0.0019), the 9th week of chemotherapy (p = 0.0003) and the 18th week of chemotherapy (p = 0.0015). This correlation is not confirmed when the presence of histologic residual tumor in biopsy specimens obtained during second-look surgery is taken into consideration. Overall, 88% of patients whose CA 125 levels failed to normalize during evaluation at the second cycle of chemotherapy have residual tumor at second-look surgery. Outside of clinical trials, repeated early CA 125 assays to determine the chemosensitivity and the prognosis of patients with ovarian carcinoma are of little interest compared to a single CA 125 assay at the 6th week after initiation of chemotherapy. This approach seems to be a good compromise between the information sought and its practical use. However the interest of early modification of chemotherapy regimen after 2 cycles, if the level of CA 125 remains more than 35 UI/ml, will have to be showed.
早期CA 125检测及其在化疗期间下降动力学分析的价值已成为众多研究的主题。相比之下，CA 125检测在临床实践中的常规应用仍存在争议，或者说在实际应用中困难重重，因为不同研究中与CA 125检测相关的定义和预后价值差异很大。本研究旨在确定在卵巢癌诱导化疗期间，采用直接适用于常规临床实践的简单评估标准（如早期恢复正常水平（水平<35 UI/ml））进行系列CA 125检测，是否能预测治疗反应或改善生存率。这项回顾性纵向分析涉及1978年至1993年间在安托万 - 拉卡萨涅癌症中心接受治疗的140例III期和IV期卵巢癌患者的历史队列。所有患者均每21天接受一次基于铂盐的化疗。在手术前后以及每个化疗周期期间均进行血清CA 125检测。84例患者进行了术前CA 125检测。未观察到其术前CA 125浓度对生存率有影响（p = 0.4）。67例患者在化疗开始后第6周进行了CA 125检测，62例在第9周进行检测，47例在第18周进行检测。化疗周期开始后第6周（p = 0.0001）、第9周（p = 0.0008）和第18周（p = 0.03）CA 125恢复正常与生存率相关。在我们的研究中，如果第6周CA 125低于35 UI/ml，中位生存期为42个月；如果CA 125水平保持高于35 UI/ml，则中位生存期为13个月。在105例FIGO III期患者中，共有66例接受了二次探查手术。CA 125水平恢复正常与二次探查手术时无任何肉眼可见残留肿瘤相关，分别在化疗第6周（p = 0.0019）、第9周（p = 0.0003）和第18周（p = 0.0015）。当考虑二次探查手术获取的活检标本中存在组织学残留肿瘤时，这种相关性未得到证实。总体而言，在化疗第二个周期评估期间CA 125水平未恢复正常的患者中，88%在二次探查手术时有残留肿瘤。在临床试验之外，与化疗开始后第6周进行一次CA 125检测相比，重复早期CA 125检测以确定卵巢癌患者的化疗敏感性和预后意义不大。这种方法似乎是在所需信息及其实际应用之间取得了良好的平衡。然而，如果CA 125水平在2个周期后仍高于35 UI/ml，早期调整化疗方案的意义仍有待证明。
