Prognostic Value Of Normal Serum CA125 Level In Advanced Epithelial Ovarian Cancer Patients With Complete Clinical Remission After Primary Treatment

Background Ovarian cancer is one of the most common malignancies in women, especially, advanced epithelial ovarian cancer (adEOC) has high recurrence rate and is the leading cause of gynecologic cancer death. At present, primary treatment for women with adEOC consists of cytoreductive surgery and postoperative platinum based combination chemotherapy administered and about 70-80% of patients can reach the complete clinical remission. Although advances in treatment strategies have improved the median overall survival, the majority of patients(70-80%) will eventually relapse. The serum CA125 concentration has been considered as a tool of great importance in the diagnosis, monitoring of relapse and disease progression for EOC. Thus, it is reasonable to investigate whether CA125 may have utility as a prognostic indicator as well in ovarian cancer. Recently a large number of studies have been carried out to this effect. Several reports have recently indicated that it may be possible to define the risk of relapse and death by dividing patients who have achieved a complete remission(CA125<35u/ml) after primary treatment into different groups based on the CA-125 value. Indeed, nadir values have been associated with an increase in progression-free survival (PFS) and overall survival (OS). Objective To evaluate the prognostic value of normal serum CA125 level in advanced epithelial ovarian cancer patients with complete clinical remission after primary treatment.Methods A retrospective analysis was conducted on advanced EOC patients with stageⅢ-Ⅳwho had received primary treatment in Qilu hospital of ShanDong university during October 2001 to December 2008,followed up to October 2009. The eligible criteria were:1) an elevated CA-125 at time of diagnosis (>35u/ml),2) Underwent optimal cytoreductive surgery,3) histological diagnosis of adEOC,4) FIGO stagesⅢandⅣ,5) a combination of platinum based chemotherapy administered,6) achieved clinically defined complete remission (CR) after the initial therapy (ie, no cancer-related symptoms; CA-125<35u/ml; normal physical examination, computed tomography or MRI scan of the abdomen/pelvis and chest x-ray) and 7) at least two serial serum CA-125 level determinations remained within the normal range (<35u/ml).All patients were divided into 2 arbitrary groups according to the serum CA-125 levels after 6 cycles of the chemotherapy: group A, CA125< 10 U/ml; group B,10≤CA125< 35 U/ml. The Chi-Square/Fisher's exact test was used to examine patients' characteristics for categorical variables. Survival analysis was performed by Kaplan-Meier method with long-rank test for determining statistical significance. Cox proportional hazards regression was used in multivariate analysis to determine the prognosis significance of all factors. All P-values presented were two-sided, and associations were considered significant if the P-value was<0.05.Results Eighty six patients were consistent with eligible criteria in this study. Among them, there were 32 patients in group A (CA125<10u/ml) and 54 in group B (10