This Article Full Text Full Text (PDF) Purchase Article View Shopping Cart Alert me when this article is cited Alert me if a correction is posted Services Email this article to a colleague Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Save to my personal folders Download to citation manager Rights & Permissions Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Santillan, A. Articles by Bristow, R. E. Search for Related Content PubMed PubMed Citation Articles by Santillan, A. Articles by Bristow, R. E. Social Bookmarking                            What's this?

Risk of Epithelial Ovarian Cancer Recurrence in Patients With Rising Serum CA-125 Levels Within the Normal Range

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.

CiteULike    Complore    Connotea    Del.icio.us    Digg    Facebook    Reddit    Technorati    Twitter    What's this?

This article has been cited by other articles:

				S. MAHNER, L. WOELBER, S. JUNG, C. Z. EULENBURG, M. IHNEN, J. SCHWARZ, J. SEHOULI, and F. JAENICKE Prognostic Significance of CA-125 in the Management of Patients with Recurrent Epithelial Ovarian Carcinoma Selected for Secondary Cytoreduction Anticancer Res, July 1, 2009; 29(7): 2817 - 2821. [Abstract] [Full Text] [PDF]

				A. Prat, M. Parera, B. Adamo, S. Peralta, M. A. Perez-Benavente, A. Garcia, A. Gil-Moreno, J. M. Martinez-Palones, J. Baselga, and J. M. del Campo Risk of recurrence during follow-up for optimally treated advanced epithelial ovarian cancer (EOC) with a low-level increase of serum CA-125 levels Ann. Onc., February 1, 2009; 20(2): 294 - 297. [Abstract] [Full Text] [PDF]

				C. M. Sturgeon, M. J. Duffy, U.-H. Stenman, H. Lilja, N. Brunner, D. W. Chan, R. Babaian, R. C. Bast Jr., B. Dowell, F. J. Esteva, et al. National Academy of Clinical Biochemistry Laboratory Medicine Practice Guidelines for Use of Tumor Markers in Testicular, Prostate, Colorectal, Breast, and Ovarian Cancers Clin. Chem., December 1, 2008; 54(12): e11 - e79. [Abstract] [Full Text] [PDF]

				D. Jackson, R. A. Craven, R. C. Hutson, I. Graze, P. Lueth, R. P. Tonge, J. L. Hartley, J. A. Nickson, S. J. Rayner, C. Johnston, et al. Proteomic Profiling Identifies Afamin as a Potential Biomarker for Ovarian Cancer Clin. Cancer Res., December 15, 2007; 13(24): 7370 - 7379. [Abstract] [Full Text] [PDF]

				P.-Y. Liu, D. S. Alberts, B. J. Monk, M. Brady, J. Moon, and M. Markman An Early Signal of CA-125 Progression for Ovarian Cancer Patients Receiving Maintenance Treatment After Complete Clinical Response to Primary Therapy J. Clin. Oncol., August 20, 2007; 25(24): 3615 - 3620. [Abstract] [Full Text] [PDF]

				B. Y. Karlan and M. McIntosh The Quest for Ovarian Cancer's Holy Grail: Can CA-125 Still Be the Chalice of Early Detection? J. Clin. Oncol., April 10, 2007; 25(11): 1303 - 1304. [Full Text] [PDF]

				M. Markman Normal CA-125 and the Risk of Progression in Ovarian Cancer J. Clin. Oncol., July 10, 2006; 24(20): 3310 - 3310. [Full Text] [PDF]

				A. Santillan and R. E. Bristow In Reply J. Clin. Oncol., July 10, 2006; 24(20): 3310 - 3311. [Full Text] [PDF]