Prognostic significance of CA-125 in the management of patients with recurrent epithelial ovarian carcinoma selected for secondary cytoreduction.

BACKGROUND Despite radical surgical and chemotherapeutic treatment of ovarian cancer, the majority of patients develop recurrence and die due to progressive disease. Routine measurement of the tumor marker CA-125 is often used in the follow-up management. However, the role of preoperative CA-125 as a prognostic factor before secondary cytoreduction of relapsed ovarian cancer has not been determined. PATIENTS AND METHODS CA-125 serum concentration and relevant clinico-pathological variables were analyzed regarding their potential prognostic impact in patients selected for secondary cytoreduction of recurrent epithelial ovarian cancer. RESULTS In total, 48 patients underwent secondary cytoreduction at the University Medical Center Hamburg-Eppendorf between 1996 and 2004 and 36 patients were evaluable for serum CA-125 concentration. Median age was 60 years (range 30-78 years) and median relapse-free survival before secondary cytoreduction was 18 months. The median time to progression after secondary surgery was 22 months (range 1-100 months), and median overall survival was 26 months (range 1-100 months). Serum CA-125 at the time of secondary cytoreduction was elevated (>35 kU/L) in 30 of 36 patients (81%) with a median of 212 kU/L (range 6-3866 kU/L). Multivariate analysis did not reveal a prognostic significance for preoperative CA-125. The only independent prognostic factors of improved survival were progression-free interval before secondary cytoreduction (p=0.047) and minimal residual disease after secondary cytoreduction (p=0.024). CONCLUSION Although most patients had elevated serum CA-125 at the time of secondary cytoreductive surgery, CA-125 had no prognostic relevance.