Prognostic value of Ca 125 levels during primary therapy.

AIM The prognosis of patients with ovarian cancer depends on stage, histological type, age, presence of ascites, performance status and debulking surgery. Complete cytoreductive surgery is the most important prognostic factor. We investigated the suitability of Ca 125 as a prognostic factor in patients with ovarian cancer at various. PATIENTS AND METHODS In a retrospective analysis, the Ca 125 level in 197 patients with epithelial ovarian cancer was determined and evaluated the results statistically. Our patients were diagnosed, treated and followed up for an average of three years at Rostock University Hospital, Germany from 1990 till 2000. Data were analyzed using the Kaplan-Meier curves, Log-rank test, Cox regression and Pearson correlation coefficient. An ELISA was used for the determination of Ca 125. RESULTS The baseline level of 60 patients, the postoperative level of 86 patients and the level of 76 patients after treatment were available. Thirty-three out of 197 patients received a Ca 125 determination during all the above mentioned events. In 20% of the cases, the level of Ca 125 was normal prior to surgery (< 35 U/l). The level was not strongly correlated with FIGO-stage (Pearson correlation coefficient r(prior to surgery) = 0.444, p < 0.001; r(after surgery) = 0.476, p < 0.01; r(after treatment) = 0.244, p < 0.05). Patients with a Ca 125 level above 100 U/l had a significantly lower three-year survival rate (p < 0.05). The number of patients with a normal Ca 125 level increased after surgery (26.7%) and after primary treatment (69.7%). Patients with a Ca 125 > 100 U/l after treatment died significantly sooner. Thirty-three patients showed a decrease in their Ca 125 level after each part of their treatment (baseline/after surgery p < 0.001; baseline/after treatment p < 0.05). The level of Ca 125 after the entire treatment has yet to show significance as a prognostic factor for survival (p < 0.001). CONCLUSION The level of Ca 125 in ovarian cancer correlated with overall survival. A significant difference between patients with Ca 125 > 100 U/l after treatment and a normal Ca 125 was observed. The tumor marker Ca 125 is a prognostic factor. Levels around 100 U/l are indicative of a bad prognosis.