Journal of Clinical Oncology, Vol 23, No 36 (December 20), 2005: pp. 9338-9343
© 2005 American Society of Clinical Oncology.
DOI: 10.1200/JCO.2005.02.2582
Risk of Epithelial Ovarian Cancer Recurrence in Patients With Rising Serum CA-125 Levels Within the Normal Range
Antonio Santillan,
Ruchi Garg,
Marianna L. Zahurak,
Ginger J. Gardner,
Robert L. Giuntoli, II,
Deborah K. Armstrong,
Robert E. Bristow
From the Kelly Gynecology Oncology Service, Johns Hopkins Medical Institutions, Baltimore, MD
Address reprint requests to Antonio Santillan, MD, 600 N Wolfe St, Phipps 281, Baltimore, MD 21287-1281; e-mail: asantil1{at}jhmi.edu
PURPOSE: To evaluate the risk of epithelial ovarian cancer (EOC) recurrence in patients with rising serum cancer antigen 125 (CA-125) levels that remain below the upper limit of normal (< 35 U/mL).
PATIENTS AND METHODS: All patients treated for EOC between September 1997 and March 2003 were identified and screened retrospectively for the following: (1) elevated serum CA-125 at time of diagnosis, (2) complete clinical and radiographic response (CR) to initial treatment with normalization of serum CA-125, (3) at least three serial serum CA-125 determinations that remained within the normal range, and (4) clinical and/or radiographic determination of disease status at the time of last follow-up or recurrence. For statistical analyses, univariate regression models were used to compare absolute and relative changes in CA-125 levels among patients with recurrent disease and those without EOC recurrence.
RESULTS: A total of 39 patients satisfied study inclusion criteria; 22 patients manifested EOC recurrence at a median interval from complete response of 11 months. The median follow-up time from complete response to last contact was 32 months for the 17 patients in the no recurrence group. A relative increase in CA-125 of 100% (odds ratio [OR] = 23.7; 95% CI, 2.9 to 192.5; P = .003) was significantly predictive of recurrence. From baseline CA-125 nadir levels, an absolute increase in CA-125 of 5 U/mL (OR = 8.4; 95% CI, 2.2 to 32.6; P = .002) and 10 U/mL (OR = 71.2; 95% CI, 4.8 to > 999.9; P = .002) were also significantly associated with the likelihood of concurrent disease recurrence.
CONCLUSION: Among patients with EOC in complete clinical remission, a progressive low-level increase in serum CA-125 levels is strongly predictive of disease recurrence.
Supported by The Elizabeth Frost Ovarian Cancer Research Fund.
Presented at the Annual Meeting on Women's Cancer (Society of Gynecologic Oncologists) March 22, 2005, Miami, FL.
Authors' disclosures of potential conflicts of interest are found at the end of this article.
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