Abstract
e15543
Background: Neoadjuvant chemotherapy (NAC) followed by interval debulking
surgery (IDS) is an accepted treatment for patients with advanced ovarian
cancer. It is unclear, however, whether achieving optimal IDS can be predicted
by preoperative analysis using imaging (CT and MRI) or by measuring cancer antigen
(CA) 125 levels. The aim of the present study was to assess whether CA125
values can be used to identify patients who are candidates for optimal IDS
following NAC for advanced ovarian cancer.
METHODS:
Eighty-one women
diagnosed with ovarian cancer (6 FIGO IIIA and 75 IIIC) between 1995 and 2010,
with serum CA125 levels greater than 40 IU/mL prior to NAC that underwent NAC
followed by IDS, were retrospectively evaluated. After each NAC, CA 125 levels
were measured and CA125 regression rates ([pre first NAC CA125 - pre each NAC
CA125]/pre first NAC CA125) were calculated. Optimal IDS was defined as the
largest volume of residual disease less than 1 cm in the maximal dimension. The
ability of CA125 values and patient and disease characteristics to predict
optimal IDS was determined by univariate and multivariate analyses.
RESULTS:
On univariate
analysis, CA125 regression rates from pre first NAC to pre second NAC and from
pre first NAC to pre third NAC, and CA125 levels before IDS were statistically
significant (p less than 0.01). On multivariate analysis, CA125 level before
IDS was an independent predictor of optimal IDS (p less than 0.01). The CA125
level cut-off point before IDS for optimal IDS calculated using a receiver
operating characteristic curve was 9 IU/mL.
CONCLUSIONS:
In this retrospective study, a pre-IDS CA125 level of 9 IU/mL or less predicted optimal IDS.
