The value of serum CA125 for the development of virtual follow-up strategies for patients with epithelial ovarian cancer: a retrospective study

Journal of Ovarian Research

Andreas Obermair¹  Srinivas Kondalsamy-Chennakesavan¹  Elizabeth Varughese² 

[1] The University of Queensland, School of Medicine, Brisbane, Queensland, Australia;Greenslopes Private Hospital, Greenslopes, Brisbane, Queensland, Australia

关键词: Follow-up;    Diagnosis;    Recurrence;    CA-125;    Ovarian cancer;   

Others  :  815127
DOI  :  10.1186/1757-2215-5-11

 received in 2011-12-06, accepted in 2012-03-22,  发布年份 2012

【 摘 要 】

Background

Serum CA125 is routinely used in the follow up of ovarian cancer. The objective of the present study was to evaluate the usefulness of CA125 in the detection of ovarian cancer recurrence.

Methods

This retrospective case study was carried out at a tertiary gynaecological cancer centre in Australia. Patients with all cell types of epithelial ovarian cancer (EOC) treated between 2003 and2010 were considered eligible. We excluded patients whose aim of treatment was palliative, had no follow-up, had no pre-operative CA125 reading or had pre-operative CA125 levels < 35 U/mL. After primary treatment, patients were followed up as per guidelines suggested by National Comprehensive Cancer Network (NCCN). We recorded if symptoms, findings from physical examination, imaging or serum CA125 levels led to the diagnosis of recurrence. An increase in CA125 levels to twice the postoperative nadir was considered as "doubling" at any time during follow up.

Results

Analysis is based on 56 patients who completed primary treatment and who presented for a total of 274 follow-up episodes. Of those, 29 patients (52%) developed a recurrence within the follow up period. Recurrence was diagnosed by CA125 alone in 14 of 29 patients (48%). CA125 was not elevated in 7 patients (24%) who recurred. Doubling of CA125 from nadir was observed in 27/29 patients. Of those 27 patients the doubling from nadir occurred within the normal range of 35 U/ml in 3 cases and outside the normal range in 24 cases. Multivariate analysis suggests that doubling of serum CA125 (OR 5.10, p 0.036) and nadir CA125 > 10 U/ml (OR 2.86, p 0.01) remained the only independent factors to predict ovarian cancer recurrence.

Conclusions

The present paper proposes the validation of a novel CA125 algorithm aiming to detect recurrent EOC. These data may allow us to investigate novel ways of follow up that do not require a patient's physical attendance at a clinic (virtual follow-up).

【 授权许可】

   
2012 Varughese et al; licensee BioMed Central Ltd.

【 参考文献 】

• [1]GLOBOCAN 2008, Cancer Incidence and Mortality Worldwide: IARC CancerBase No. 10 [http://globocan.iarc.fr] webcite
• [2]Holschneider CH, Berek JS: Ovarian cancer: epidemiology, biology, and prognostic factors. Semin Surg Oncol 2000, 19:3-10.
• [3]National Comprehensive Cancer Network: Uterine neoplasms. In Book Uterine neoplasms (Editor ed.^eds.). City: National Comprehensive Cancer Network; 2011.
• [4]Chan KK, Tam KF, Tse KY, Ngan HY: The role of regular physical examination in the detection of ovarian cancer recurrence. Gynecol Oncol 2008, 110:158-161.
• [5]Menczer J, Chetrit A, Sadetzki S, Golan A, Levy T: Follow-up of ovarian and primary peritoneal carcinoma: the value of physical examination in patients with pretreatment elevated CA125 levels. Gynecol Oncol 2006, 103:137-140.
• [6]Rustin GJ, Nelstrop AE, McClean P, Brady MF, McGuire WP, Hoskins WJ, Mitchell H, Lambert HE: Defining response of ovarian carcinoma to initial chemotherapy according to serum CA 125. J Clin Oncol 1996, 14:1545-1551.
• [7]Paramasivam S, Tripcony L, Crandon A, Quinn M, Hammond I, Marsden D, Proietto A, Davy M, Carter J, Nicklin J, et al.: Prognostic importance of preoperative CA-125 in International Federation of Gynecology and Obstetrics stage I epithelial ovarian cancer: an Australian multicenter study. J Clin Oncol 2005, 23:5938-5942.
• [8]Gibb R, Brooks RA, Rosenblum K, Lawson I, Quang Y, Mutch DG, Virgo KS, Johnson FE: Patterns of postoperative surveillance for ovarian cancer: What we do and why we do it. In Book Patterns of postoperative surveillance for ovarian cancer: What we do and why we do it (Editor ed.^eds.). Volume 101. City: Gynecol Oncol; 2006::S108-S109.
• [9]Evaluation of progression according to CA 125: definitions agreed by GCIG November 2005 [http://www.gcig.igcs.org/CA125/respdef_nov2005.pdf] webcite
• [10]Fehm T, Heller F, Kramer S, Jager W, Gebauer G: Evaluation of CA125, physical and radiological findings in follow-up of ovarian cancer patients. Anticancer Res 2005, 25:1551-1554.
• [11]Gadducci A, Fuso L, Cosio S, Landoni F, Maggino T, Perotto S, Sartori E, Testa A, Galletto L, Zola P: Are surveillance procedures of clinical benefit for patients treated for ovarian cancer?: A retrospective Italian multicentric study. Int J Gynecol Cancer 2009, 19:367-374.
• [12]Crawford SM, Peace J: Does the nadir CA125 concentration predict a long-term outcome after chemotherapy for carcinoma of the ovary? Ann Oncol 2005, 16:47-50.
• [13]Riedinger JM, Eche N, Basuyau JP, Dalifard I, Hacene K, Pichon MF: Prognostic value of serum CA 125 bi-exponential decrease during first line paclitaxel/platinum chemotherapy: a French multicentric study. Gynecol Oncol 2008, 109:194-198.
• [14]Riedinger JM, Wafflart J, Ricolleau G, Eche N, Larbre H, Basuyau JP, Dalifard I, Hacene K, Pichon MF: CA 125 half-life and CA 125 nadir during induction chemotherapy are independent predictors of epithelial ovarian cancer outcome: results of a French multicentric study. Ann Oncol 2006, 17:1234-1238.
• [15]Kew FM, Galaal K, Manderville H, Verleye L: Professionals' and patients' views of routine follow-up: a questionnaire survey. Int J Gynecol Cancer 2007, 17:557-560.
• [16]Lydon A, Beaver K, Newbery C, Wray J: Routine follow-up after treatment for ovarian cancer in the United Kingdom (UK): patient and health professional views. Eur J Oncol Nurs 2009, 13:336-343.