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Prognostic significance of CA-125 re-elevation after interval debulking surgery in patients with advanced-stage ovarian cancer undergoing neoadjuvant chemotherapy

 Yong Jae Lee  ;  Young Shin Chung  ;  Jung-Yun Lee  ;  Eun Ji Nam  ;  Sang Wun Kim  ;  Sunghoon Kim  ;  Young Tae Kim 
 EJSO, Vol.45(4) : 644-649, 2019 
Journal Title
Issue Date
Adult ; Aged ; Aged, 80 and over ; Antineoplastic Combined Chemotherapy Protocols/therapeutic use ; CA-125 Antigen/blood* ; Carcinoma, Ovarian Epithelial/blood* ; Carcinoma, Ovarian Epithelial/secondary ; Carcinoma, Ovarian Epithelial/therapy* ; Chemotherapy, Adjuvant ; Cytoreduction Surgical Procedures ; Female ; Humans ; Middle Aged ; Neoadjuvant Therapy ; Neoplasm Staging ; Ovarian Neoplasms/blood* ; Ovarian Neoplasms/pathology ; Ovarian Neoplasms/therapy* ; Preoperative Period ; Prognosis ; Progression-Free Survival ; Retrospective Studies ; Survival Rate
CA-125 ; Chemotherapy ; Interval debulking surgery ; Ovarian cancer ; Prognosis
AIMS: We evaluated the prognostic significance of postoperative re-elevation of cancer antigen-125 (CA-125) levels in patients with ovarian cancer and preoperative normalization of CA-125 levels after neoadjuvant chemotherapy (NAC).

METHODS: The data of 103 patients with preoperative CA-125 normalization after NAC at the Yonsei Cancer Hospital (2006-2017) were analyzed. We compared the clinical characteristics and survival outcomes among patients with normal postoperative CA-125 levels and those with re-elevated CA-125 levels after interval debulking surgery (IDS). CA-125 elevation was defined as levels >35 U/mL.

RESULTS: Among 103 patients, 52 (50.5%) and 51 (49.5%) had normal and re-elevated CA-125 levels after IDS, respectively. Patients with CA-125 re-elevation underwent more radical surgeries during IDS than those with normal CA-125 levels (p = 0.018). We found no significant differences in progression-free survival (PFS; p = 0.726) or overall survival (OS; p = 0.293) between the two groups. Moreover, patients with persistent CA-125 elevation (3 weeks after IDS) did not have inferior PFS (p = 0.171 and p = 0.208, respectively) or OS (p = 0.128 and p = 0.095, respectively) compared to patients with early normalization (within 3 weeks of IDS) or normal CA-125 levels. Multivariate regression showed that CA-125 re-elevation had no effect on recurrence (hazard ratio [HR], 0.75; 95% confidence interval [CI], 0.43-1.30) or death (HR, 0.99; 95% CI, 0.33-2.98).

CONCLUSION: Among patients with preoperative CA-125 normalization after NAC, postoperative CA-125 re-elevation had no prognostic value. Novel and reliable biomarkers reflecting the tumor response after IDS should be identified.
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1. College of Medicine (의과대학) > Dept. of Obstetrics and Gynecology (산부인과학교실) > 1. Journal Papers
Yonsei Authors
Kim, Sang Wun(김상운) ORCID logo https://orcid.org/0000-0002-8342-8701
Kim, Sung Hoon(김성훈) ORCID logo https://orcid.org/0000-0002-1645-7473
Kim, Young Tae(김영태) ORCID logo https://orcid.org/0000-0002-7347-1052
Nam, Eun Ji(남은지) ORCID logo https://orcid.org/0000-0003-0189-3560
Lee, Yong Jae(이용재) ORCID logo https://orcid.org/0000-0003-0297-3116
Lee, Jung-Yun(이정윤) ORCID logo https://orcid.org/0000-0001-7948-1350
Chung, Young Shin(정영신)
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