Clinical Significance of Postoperative CA125 Level Normalization in Operated Ovarian Cancer Patients with High Preoperative Levels

Öz

Objective: CA125 is a commonly used tumor marker in ovarian cancer patients for both diagnostic evaluation and follow-up period. In this study, we investigated the clinical importance of postoperative serum CA125 level normalization in ovarian cancer patients with high preoperative levels in terms of recurrence risk and disease free survival. Materials and Methods: We retrospectively analyzed operated ovarian cancer patients who were followed up in medical oncology clinic of Izmir Katip Celebi University Ataturk Training and Research Hospital between years 2005 – 2013. Two different analyses were done according to different CA125 cut-off levels; 35 IU/ml and 65 IU/ml. Results: There are 132 and 119 patients who had basal CA125 levels above normal (cut-off levels were >35 IU/ml and 65 IU/ml respectively). The number of patients who had normalized CA125 levels after surgery was 54 and 58, and who had still high levels was 78 and 61, respectively. For both CA125 cut-off values, there were statistically significant differences in disease free survival (32 month vs. 18 month p:0.015 - 32 month vs. 17 months p:0.001) and overall survival (108 month vs. 36 month p:0.015 - 89 month vs. 33 month p:0.000) between patients with normalized and not normalized postoperative CA125 levels. Conclusion: In operated ovarian cancer patients, who had high preoperative CA125 levels, the decrease in this value postoperatively must be evaluated and normalization of this tumor marker may give us an idea about the recurrence of the disease.

Anahtar Kelimeler

• CA125
• Ovarian cancer
• Perioperative
• Recurrence risk

Opere Over Kanseri Hastalarında Preoperatif Yüksek CA125 Değerinin Postoperatif Normal Sınırlara Dönmesinin Klinik Önemi

Öz

Amaç: CA125, over kanseri hastalarında gerek tanı aşamasında gerekse tedavi sonrası takiplerde tümör belirteci olarak kullanılmaktadır. Biz de çalışmamızda preoperatif serum CA125 değeri yüksek olan over kanseri hastalarında operasyondan sonraki değerlerinin normale dönüp dönmemesinin nüks riskini belirleme ve nükse kadar geçen süre açısından önemini araştırdık. Yöntem: Çalışmamızda 2005 – 2013 yılları arasında İzmir Katip Çelebi Üniversitesi Atatürk Eğitim ve Araştırma Hastanesi Tıbbi Onkoloji Kliniğinde opere over kanseri tanısıyla takip ve tedavi edilen hastalar retrospektif olarak taranmıştır. CA125 sınır değeri olarak hem 35 IU/ml hem de 65 IU/ml kullanılarak iki farklı analiz yapılmıştır. Bulgular: Çalışmamıza bazal CA125 değeri yüksek olan (sınır değer >35 IU/ml ve 65 IU/ml alındığında) sırasıyla 132 ve 119 hasta alınmıştır. Preoperatif CA125 değeri yüksek olup postoperatif normale gelen hastaların sayısı sırasıyla 54 ve 58 iken bu değeri normalleşmeyen hastaların sayısı 78 ve 61’dir. Her iki CA125 sınır değeri için, postoperatif CA125 değeri normalleşenlerle normalleşmeyen hastalarda hem nükse kadar geçen süre (32 aya karşı 18 ay p:0,015 - 32 aya karşı 17 ay p:0,001) hem de tüm sağkalım açısından (108 aya karşı 36 ay p:0,015 - 89 aya karşı 33 ay p:0,000) istatistiksel anlamlı fark saptanmıştır. Sonuç: Opere over kanseri hastalarından bazal CA125 değeri yüksek saptanan hastalarda ameliyat sonrasındaki düşüşü değerlendirip, bu değerin normal sınırlara düşüp düşmemesine göre nüks süreci hakkında fikir sahibi olunabilinir.

Anahtar Kelimeler

• Over kanseri
• CA125
• Perioperatif

Kaynakça

1. 1. Osman N, O'Leary N, Mulcahy E, et al. Correlation of serum CA125 with stage, grade and survival of patients with epithelial ovarian cancer at a single centre. Ir Med J. 2008;101:245-7.
2. 2. Gundogdu F, Soylu F, Erkan L, et al. The role of serum CA-125 levels and CA-125 tissue expression positivity in the prediction of the recurrence of stage III and IV epithelial ovarian tumors (CA-125 levels and tissue CA-125 in ovarian tumors). Arch Gynecol Obstet. 2011;283:1397-402.
3. 3. Ghaemmaghami F, Akhavan S. Is postoperative CA125 level in patients with epithelial ovarian cancer reliable to guess the optimality of surgery? Eur J Gynaecol Oncol. 2011;32:192-5.
4. 4. May T, Stewart JM, Bernardini MQ, et al. The prognostic value of perioperative, pre-systemic therapy CA125 levels in patients with high-grade serous ovarian cancer. Int J Gynaecol Obstet. 2018;140:247-52.
5. 5. Guo N, Peng Z. Does serum CA125 have clinical value for follow-up monitoring of postoperative patients with epithelial ovarian cancer? Results of a 12-year study. J Ovarian Res. 2017;10:14.
6. 6. Yang ZJ, Zhao BB, Li L. The significance of the change pattern of serum CA125 level for judging prognosis and diagnosing recurrences of epithelial ovarian cancer. J Ovarian Res. 2016;9:57.
7. 7. Pelissier A, Bonneau C, Chéreau E, et al. Dynamic Analysis of CA125 Decline During Neoadjuvant Chemotherapy in Patients with Epithelial Ovarian Cancer as a Predictor for Platinum Sensitivity. Anticancer Res. 2016;36:1865-71.
8. 8. Arits AH, Stoot JE, Botterweck AA, et al. Preoperative serum CA125 levels do not predict suboptimal cytoreductive surgery in epithelial ovarian cancer. Int J Gynecol Cancer. 2008;18:621-8.

9. 9. Barlow TS, Przybylski M, Schilder JM, et al. The utility of presurgical CA125 to predict optimal tumor cytoreduction of epithelial ovarian cancer. Int J Gynecol Cancer. 2006;16:496-500.
10. 10. Memarzadeh S, Lee SB, Berek JS, et al. CA125 levels are a weak predictor of optimal cytoreductive surgery in patients with advanced epithelial ovarian cancer. Int J Gynecol Cancer. 2003;13:120-4.
11. 11. Zwakman N, van de Laar R, Van Gorp T, et al. Perioperative changes in serum CA125 levels: a prognostic factor for disease-specific survival in patients with ovarian cancer. J Gynecol Oncol. 2017;28:e7.
12. 12. Petri AL, Høgdall E, Christensen IJ, et al. Preoperative CA125 as a prognostic factor in stage I epithelial ovarian cancer. APMIS. 2006;114:359-63.
13. 13. Cramer DW, Vitonis AF, Welch WR, et al. Correlates of the preoperative level of CA125 at presentation of ovarian cancer. Gynecol Oncol. 2010;119:462-8.
14. 14. Cooper BC, Sood AK, Davis CS, et al. Preoperative CA 125 levels: an independent prognostic factor for epithelial ovarian cancer. Obstet Gynecol. 2002;100:59-64.
15. 15. Wang Q, Wu Y, Zhang H, et al. Clinical Value of Serum HE4, CA125, CA72-4, and ROMA Index for Diagnosis of Ovarian Cancer and Prediction of Postoperative Recurrence. Clin Lab. 2019;65(4).
16. 16. Xu XR, Wang X, Zhang H, et al. The clinical significance of the combined detection of serum Smac, HE4 and CA125 in endometriosis-associated ovarian cancer. Cancer Biomark. 2018;21:471-7.
17. 17. Lee M, Chang MY, Yoo H, et al. Clinical Significance of CA125 Level after the First Cycle of Chemotherapy on Survival of Patientswith Advanced Ovarian Cancer. Yonsei Med J. 2016;57:580-7.
18. 18. Tsuda H, Hashiguchi Y, Nakata S, et al. The CA125 regression rate to predict overall survival differ between paclitaxel-containing regimen and nonpaclitaxel regimen in patients with advanced ovarian cancer. Int J Gynecol Cancer. 2002;12:435-7.
19. 19. vanAltena AM, Kolwijck E, Spanjer MJ, et al. CA125 nadir concentration is an independent predictor of tumor recurrence in patientswith ovarian cancer: a population-basedstudy. Gynecol Oncol. 2010;119:265-9.
20. 20. Pelissier A, Bonneau C, Chéreau E, et al. CA125 kinetic parameters predict optimal cytoreduction in patients with advanced epithelial ovarian cancer treated with neoadjuvant chemotherapy. Gynecol Oncol. 2014;135:542-6.
21. 21. Le T, Faught W, Hopkins L, et al. Importance of CA125 normalization during neoadjuvant chemotherapy followed by planned delayed surgical debulking in patients with epithelial ovarian cancer. J Obstet Gynaecol. Can 2008;30:665-70.
22. 22. Wang J, Liu Y, Li J, et al. Prediction effects of serum CA125 decrease ratio during different cycles in relapsed ovarian cancer. J Obstet Gynaecol Res. 2019;45:1006-11.
23. 23. Yuan Q, Song J, Yang W, et al. The effect of CA125 on metastasis of ovarian cancer: old marker new function. Oncotarget. 2017;8:50015-22.
24. 24. Colaković S, Lukiç V, Mitroviç L, et al. Prognostic value of CA125 kinetics and half-life in advanced ovarian cancer. Int J Biol Markers. 2000;15:147-52.