"can preoperative ca-125 predict resectability of tumor in patients with advanced epithelial ovarian carcinoma?"

larger tumor burden leads to higher serum ca-125 levels and the ability to perform optimal tumor cytoreduction of advanced ovarian cancer is also a function of tumor bulk. the purpose of this study was to identify the ability of preoperative serum ca-125 to predict possibility of optimal primary tumor cytoreduction in epithelial ovarian carcinoma (eoc). a total of 90 patients with eoc were evaluated in a prospective study from 2000 to 2002. preoperative serum ca-125 levels were determined, using a solid phase immunoassay. we used a receiver operating characteristic curve to identify the ca-125 level with the maximal prognostic power in predicting optimal versus suboptimal debulking. the median ca-125 level for the 90 patients was 500 u/ml (range 13 to 5000 u/ml). seventy patient (78%) had stage iii or ιv based on staging system of the international federation of gynecology and obstetrics (figo) for ovarian carcinoma. optimal cytoreduction (diameter of largest residual tumor less than 1 cm) was obtained in 44 patients (62.9%) with stage iii-ιv. preoperative ca- 125 value less than 450 u/ml had a positive predictive value for optimal cytoreduction of 78%, but a poor negative predictive value of 50% in advanced eoc. in patients with advanced eoc, at a cutoff 450 u/ml, 78% underwent optimal debulking, whereas 50% of patients with preoperative ca-125 level above 450 u/ml were still able to undergo optimal debulking. preoperative ca-125 does not seem to be a reliable predictor of optimal cytoreduction.