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Prognostic Role of CA-125 Nadir in Stage IV Epithelial Ovarian Cancer

Department of Medical Oncology, Vall d’Hebron University Hospital, Barcelona, Spain

To the Editor:

We read the article by Winter et al¹ with great interest. The authors identified factors predictive of poor prognosis in a relatively homogeneous population of 360 stage IV epithelial ovarian cancer (EOC) patients treated with primary cytoreductive surgery and platinum/taxane-based chemotherapy. Multivariate regression analysis revealed that mucinous/clear cell histology, malignant pleural effusion, and intraparenchymal liver metastasis were associated with poor prognosis. More interestingly, patients with more than 5 cm of residual disease (RD) presented the shortest progression-free survival (PFS) and overall survival (OS), whereas patients with microscopic RD (< 0.1 cm) had the best outcome. Those patients with an RD of 0.1 to 5.0 cm had an intermediate prognosis.

Prognostic factors included in the univariate analysis were stage IV site, race, age, performance status, histology, tumor grade, and RD; whereas in the multivariate analysis the prognostic factors evaluated were only histology, RD, and stage IV site. In any case, Winter et al¹ did not consider the serum CA-125 nadir concentration after primary treatment as a potential prognostic factor.

Previous retrospective reports have examined the role of CA-125 nadir values in predicting PFS and OS for EOC.^2-6 For example, Markman et al⁴ observed that the amount of RD and the baseline CA-125 level before initiation of maintenance chemotherapy strongly predicted the risk of subsequent relapse in 384 patients with advanced EOC. Patients with premaintenance baseline CA-125 values of 10 kU/L had a superior PFS compared with higher levels in the normal CA-125 range (11 to 20 kU/L v 21 to 35 kU/L). In a subsequent report, Juretzka et al⁵ found that the CA-125 level in the normal range at the end of primary therapy for EOC stage I to IV was predictive of OS before the initiation of intraperitoneal consolidation therapy. Finally, we have recently reported that in patients with EOC stage III to IV treated with optimal cytoreductive surgery (< 1 cm of RD) and platinum/taxane-based chemotherapy, CA-125 nadir 10 kU/L (v 11 to 35 kU/L) after primary treatment was a reproducible predictor of longer PFS and OS.⁶

Therefore, we suggest that stratification of patients according to CA-125 nadir after primary treatment could help better define the efficacy of cytoreductive surgery plus platinum/taxane-based chemotherapy for stage IV EOC patients. By doing so, Winter et al¹ might identify subgroups of patients within a similar range of RD with different prognoses and subgroups of patients within different ranges of RD with similar prognoses.

AUTHORS’ DISCLOSURES OF POTENTIAL CONFLICTS OF INTEREST

The author(s) indicated no potential conflicts of interest.

REFERENCES

1. Winter WR, Maxwell G, Tian C, et al: Tumor residual after surgical cytoreduction in prediction of clinical outcome in stage IV epithelial ovarian cancer: A Gynecologic Oncology Group study. J Clin Oncol 26:83-89, 2008[Abstract/Free Full Text]

2. Crawford SM, Paul J, Reed NS, et al: The prognostic significance of the CA125 nadir in patients that achieve a CA125 response. J Clin Oncol 23:9s, 2004 (suppl; abstr 5001)

3. Crawford SM, Peace J: Does the nadir CA125 concentration predict a long-term outcome after chemotherapy for carcinoma of the ovary? Ann Oncol 16:47-50, 2005[Abstract/Free Full Text]

4. Markman M, Liu PY, Rothenberg ML, et al: Pretreatment CA-125 and risk of relapse in advanced ovarian cancer. J Clin Oncol 24:1454-1458, 2006[Abstract/Free Full Text]

5. Juretzka MM, Barakat RR, Chi DS, et al: CA125 level as a predictor of progression-free survival and overall survival in ovarian cancer patients with surgically defined disease status prior to the initiation of intraperitoneal consolidation therapy. Gynecol Oncol 104:176-180, 2007[CrossRef][Medline]

6. Prat A, Parera M, Peralta S, et al: Nadir CA-125 concentration in the normal range as an independent prognostic factor for optimally treated advanced epithelial ovarian cancer. Ann Oncol 19:327-331, 2008[Abstract/Free Full Text]

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Related Reply

• In Reply
  William E. Winter, III, G. Larry Maxwell, and Chunqiao Tian
  JCO 2008 26: 1772 [Full Text]
• In Reply
  William E. Winter, III, G. Larry Maxwell, and Chunqiao Tian
  JCO 2008 26: 1772 [Full Text]

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