"CAN PREOPERATIVE CA-125 PREDICT RESECTABILITY OF TUMOR IN PATIENTS WITH ADVANCED EPITHELIAL OVARIAN CARCINOMA?"

Abstract

Larger tumor burden leads to higher serum CA-125 levels and the ability to perform optimal tumor cytoreduction of advanced ovarian cancer is also a function of tumor bulk. The purpose of this study was to identify the ability of preoperative serum CA-125 to predict possibility of optimal primary tumor cytoreduction in epithelial ovarian carcinoma (EOC). A total of 90 patients with EOC were evaluated in a prospective study from 2000 to 2002. Preoperative serum CA-125 levels were determined, using a solid phase immunoassay. We used a receiver operating characteristic curve to identify the CA-125 level with the maximal prognostic power in predicting optimal versus suboptimal debulking. The median CA-125 level for the 90 patients was 500 U/ml (range 13 to 5000 U/ml). Seventy patient (78%) had stage III or ΙV based on staging system of the International Federation of Gynecology and Obstetrics (FIGO) for ovarian carcinoma. Optimal cytoreduction (diameter of largest residual tumor less than 1 cm) was obtained in 44 patients (62.9%) with stage III-ΙV. Preoperative CA- 125 value less than 450 U/ml had a positive predictive value for optimal cytoreduction of 78%, but a poor negative predictive value of 50% in advanced EOC. In patients with advanced EOC, at a cutoff 450 U/ml, 78% underwent optimal debulking, whereas 50% of patients with preoperative CA-125 level above 450 U/ml were still able to undergo optimal debulking. Preoperative CA-125 does not seem to be a reliable predictor of optimal cytoreduction.