Asian Pacific Journal of Cancer Prevention

Asian Pacific Journal of Cancer Prevention (아시아태평양암예방학회)
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Impact of Preoperative Serum Levels of CA 125 on Epithelial Ovarian Cancer Survival

  • Pradjatmo, Heru (Obstetric and Gynecology Department, Faculty of Medicine, Universitas Gadjah Mada and Sardjito Central Hospital)
  • Published : 2016.06.01
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Abstract

Background: CA125 is very helpful in treatment monitoring and detection of epithelial ovarian cancer (EOC) recurrence. However there is controversy as to its accuracy and optimal usage. What is the impact of the CA125 levels before primary surgery treatment to the survival of patients? This study aimed to detect any association of preoperative serum levels with prognosis and survival in EOC patients. Materials and Methods: Our cohort comprised EOC patients in Dr. Sardjito Hospital, Yogyakarta, Indonesia, who complied with follow up. To explore the effect of preoperative CA125 levels and other variables on survival Cox's regression models were applied. Results: A total of 90 cases of EOC who had surgery were available for follow up. The level of CA125 proved to be a prognostic factor for overall survival of EOC patients, with an adjusted HR of 4.10 (p = 0.03). Adjuvant chemotherapy was another prognostic factor, 1 - 2 cycles having an adjusted HR of 0.17 (p = 0.04) and 3 - 8 cycles HR 0.39 (p = 0.06). Other factors such as age of patients adjusted HR 1.54 (p = 0.32), moderate differentiation (adjusted HR 1.61, p = 0.51) poor differentiation (adjusted HR 3.41, p = 0.15), and stage of disease (adjusted HR 1.98,p=0.27) were statistically not significant. However, this might have been because the power of the study was low. Conclusions: Preoperative level of CA125 is a prognostic factor for overall survival in EOC patients. The best cut-off for prognostic classification of CA125 serum level is 70 U/ml.

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References

  1. Alvarez RD, To A, Boots LR, et al (1987). CA125 assay serum marker for poor prognosis in ovarian malignancies. Gynecol Oncol, 26, 284-9 https://doi.org/10.1016/0090-8258(87)90019-9
  2. Bae HS, Kim HJ, Hong JH, et al (2014). Obesity and epithelial ovarian cancer survival: a systematic review and metaanalysis. J Ovarian Res, 7, 41 https://doi.org/10.1186/1757-2215-7-41
  3. Buller RE (2002). Preoperative CA125 levels: an independent prognostic factor for epithelial ovarian cancer. Obstet Gynecol, 100, 59-64
  4. Chen Y , Zhang L, Liu WX, Xiang-Yu Liu XY (2015). Prognostic significance of preoperative anemia, leukocytosis and thrombocytosis in chinese women with epithelial ovarian cancer. Asian Pac J Cancer Prev, 16, 933-9 https://doi.org/10.7314/APJCP.2015.16.3.933
  5. Chen X, Zhang J, Cheng W, et al (2013). CA-125 Level as a Prognostic Indicator in Type I and Type II Epithelial Ovarian Cancer. Inter J Gynecol Cancer, 23, 815-22 https://doi.org/10.1097/IGC.0b013e31828f7a24
  6. Colombo N, Van GT, Parma G, et al (2006). Ovarian cancer. Crit Rev Oncol Hematol, 60, 159-79 https://doi.org/10.1016/j.critrevonc.2006.03.004
  7. Cooper BC, Sood AK, Davis CS, et al (2002). Preoperative CA 125 levels: an independent prognostic factor for epithelial ovarian cancer. Obstet Gynecol, 100, 59-64.
  8. Cruickshank DJ, Fullerton WT, Klopper A (1987). The climical significance of pre-operative serum CA125 in ovarian cancer. Br J Obstet Gynaecol, 94, 692-5 https://doi.org/10.1111/j.1471-0528.1987.tb03177.x
  9. du Bois A, Reuss A, Pujade-Lauraine E, et al (2009). Role of surgical outcome as prognostic factor in advanced epithelial ovarian cancer: a combined exploratory analysis of 3 prospectively randomized phase 3 multicenter trials. Cancer, 115, 1234-44 https://doi.org/10.1002/cncr.24149
  10. Gadducci A, Zola P, Landoni F, Maggino T (1995). Serum half-life of CA125 during early chemotherapy as an independent prognostic variable for patients with advanced epithelial ovarian cancer: results of a multicentric Italian study. Gynecol Oncol, 58, 42-7 https://doi.org/10.1006/gyno.1995.1181
  11. Gupta D, Lis CG (2009). Role of CA125 in predicting ovarian cancer survival-a review of the epidemiological literature. J Ovarian Res, 2, 13 https://doi.org/10.1186/1757-2215-2-13
  12. Havrilesky LJ, Whitehead CM, Rubatt JM, et al (2008). Evaluation of biomarker panels for early stage ovarian cancer detection and monitoring for disease recurrence. Gynecol Oncol, 110, 374-82 https://doi.org/10.1016/j.ygyno.2008.04.041
  13. Hogdall E (2008). Cancer antigen 125 and prognosis. Curr Opin Obstet Gynaecol, 20, 4-8 https://doi.org/10.1097/GCO.0b013e3282f2b124
  14. Jacobs I, Bast RC (1989). The CA125 tumour-associated antigen: a review of the literature. Hum Reprod, 4, 1-12 https://doi.org/10.1093/humrep/4.suppl_1.1
  15. Jemal A, Siegel R, Ward E, et al (2008). Cancer Statistics, 2008. CA Cancer J Clin, 58, 71-96 https://doi.org/10.3322/CA.2007.0010
  16. Lawiki S, Bedkowska GE, Gacuta-Szmitkowski M (2014). The plasma concentration of VEGF, HE-4 and CA125 as a new biomarkers panel in different stages and subtypes of epithelial ovarian tumors. J Ovar Res, 6, 45
  17. Liu XH, Ya-Nan Man YN, Wu XZ (2014). Recurrence season impacts the survival of epithelial ovarian cancer patients. Asian Pac J Cancer Prev, 15, 1627-32 https://doi.org/10.7314/APJCP.2014.15.4.1627
  18. Makar AP, Kristensen GB, Kaern J, et al (1992). Prognostic value of pre and postoperative serum CA125 levels in ovarian cancer: new aspects and multivariate analysis. Obstet Gynecol, 79, 1002 -10
  19. Menon U, Jacobs IJ (2001). Ovarian cancer screening in the general population. Curr Opin Obstet Gynecol, 13, 61-4 https://doi.org/10.1097/00001703-200102000-00009
  20. Moebus V (1988). Evaluation of CA125 as a prognostic and predictive factor in ovarian cancer. J Tumor Marker Oncol, 3, 251-8.
  21. Nagele F, Petru E, Medl M, et al (1995). Preoperative CA125: an independent prognostic factor in patients with stage I epithelial ovarian cancer. Obstet Gynecol, 86, 259-64 https://doi.org/10.1016/0029-7844(95)00126-C
  22. Nustad K, Bast RC Jr, Brien TJ, et al (1996). Specificity and affinity of 26 monoclonal antibodies against the CA 125 antigen: first report from the ISOBM TD-1 workshop. international society for oncodevelopmental biology and medicine. Tumour Biol, 17, 196-219 https://doi.org/10.1159/000217982
  23. Osman N, O'Leary N, Mulcahy E, et al (2008). Correlation of serum CA125 with stage, grade and survival of patients with epithelial ovarian cancer at a single centre. Ir Med J, 101, 245-7
  24. Parker D, Patel K, Alred EJ, et al (1988). CA125 and survival in ovarian cancer. J Royal Soc Med, 82, 22.
  25. Petri AL, Hogdall E, Christensen IJ, et al (2006): Preoperative CA125 as a prognostic factor in stage I epithelial ovarian cancer. APMIS, 114, 359-63 https://doi.org/10.1111/j.1600-0463.2006.apm_397.x
  26. Pradjatmo H (2015). Methylation status and expression of brca2 in epithelial ovarian cancers in indonesia. Asian Pac J Cancer Prev, 16, 8599-604
  27. Pongsanon K, Benjapibal M, Ruengkhachorn I (2011). Prognostic significance of hemoglobin levels in patients with primary epithelial ovarian carcinoma undergoing platinumbased chemotherapy. Asian Pac J Cancer Prev, 12, 131-6
  28. Rapkiewicz AV, Espina V, Petriconin EF, Liotta LA (2004). Biomarkers of ovarian tumours. Eur J Cancer, 40, 2604-12 https://doi.org/10.1016/j.ejca.2004.05.021
  29. Redman CWE, Blackledge GR, Kelly K, et al (1990). Early CA125 response and outcome in epithelial ovarian cancer. Eur J Cancer, 26, 593-6 https://doi.org/10.1016/0277-5379(90)90085-8
  30. Rustin GJ, van der Burg ME (2009). A randomized trial in ovarian cancer (OC) of early treatment of relapse based on CA125 level alone versus delayed treatment based on conventional clinical indicators (MRC OV05/EORTC 55955 trials). J Clin Oncol, 27, 1 https://doi.org/10.1200/JCO.2009.22.1515
  31. Rustin G, van der Burg M, Griffin C., et al (2010). Early versus delayed treatment of relapsed ovarian cancer (MRC OV05/ EORTC 55955): a randomized trial. Lancet, 376, 1155-63 https://doi.org/10.1016/S0140-6736(10)61268-8
  32. Sarwar SCM, Siddiqui N, Khokhar RA, Badar F (2006) Epithelial ovarian cancer at a cancer hospital in a developing country. Asian Pac J Cancer Prev, 7, 595-8
  33. Sevelda P, Schemper M, Spona J (1989). CA125 as an independent prognostic factor for survival in patients with epithelial ovarian cancer. Am J Obstet Gynaecol, 161, 1213-6. https://doi.org/10.1016/0002-9378(89)90668-6
  34. Siegel RL, Miller KD, Jemal A, (2015). Cancer statistics, 2015. CA Cancer J Clin, 65, 5-29 https://doi.org/10.3322/caac.21254
  35. Sihombing M, Sirait AM (2007). Angka ketahanan hidup penderita kanker ovarium di RS Dr. Ciptomangunkusumo, Jakarta. Maj Kedok Indon, 57, 346-52
  36. Tang A, Kondalsamy-Chennakesavan S, Ngan H, et al (2012). Prognostic value of elevated preoperative serum CA125 in ovarian tumors of low malignant potential: A multinational collaborative study (ANZGOG0801). Gynecol Oncol, 126, 36-40 https://doi.org/10.1016/j.ygyno.2012.02.031
  37. Tingulstad S, Skjeldestad FE, Halvorsen TB, Hagen B (2003). Survival and prognostic factors in patients with ovarian cancer. Obstet Gynecol, 101, 885-91
  38. Urban N (2003). Specific keynote: Ovarian cancer risk assessment and the potential for early detection. Gynecol Oncol, 88, 75-9 https://doi.org/10.1006/gyno.2002.6689
  39. Verheijen RH, Mensdorff-Pouilly S, van Kamp GJ, Kenemans P (1999). CA125: fundamental and clinical aspects. Semin Cancer Biol, 9, 117-24 https://doi.org/10.1006/scbi.1998.0114
  40. Whitehouse C, Solomon E (2003). Current status of the molecular characterization of the ovarian cancer antigen CA125 and implications for its use in the clinical setting. Gynecol Oncol, 88, 152-7 https://doi.org/10.1006/gyno.2002.6708

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