The Importance of CA125 Normalization During Neoadjuvant Chemotherapy Followed by Planned Delayed Surgical Debulking in Patients With Epithelial Ovarian Cancer

Objectives: To examine the prognostic significance, in patients with ovarian cancer, of normalization of CA125 levels in serum during neoadjuvant chemotherapy treatment combined with delayed primary surgical debulking. Methods: We carried out a retrospective chart review to identify ovarian cancer patients treated between 1997 and 2005 with neoadjuvant chemotherapy and delayed surgical debulking. Serum levels of CA125 were measured at baseline, prior to each cycle of chemotherapy, and before surgery. "CA125 normalization" was defined as a reduction in serum CA125 levels, in patients with elevated levels at diagnosis, to less than 35 kU/L. Cox proportional hazard models were built to model progression-free survival and overall survival. Results: Ninety patients met the inclusion criteria. Sixteen patients (17.8%) had CA125 normalization before surgery, and 52 patients (57.8%) had normalization at the conclusion of all primary chemotherapy. Cox regression showed that CA125 normalization from neoadjuvant chemotherapy before surgery did not significantly predict survival. Patients who failed to normalize CA125 after finishing primary chemotherapy had shortened progression-free survival (HR 3.1; 95% CI 1.9-5.1, P < 0.001) and overall survival (HR 2.6; 95% CI 1.0-6.9, P < 0.05). The estimated median survival was 72 months (95% Cl 64.6-79.40) in patients with normal CA125 at the end of chemotherapy, whereas in those with persistently elevated CA125 the corresponding estimated median survival was 46.8 months (95% CI 38.2-55.3). Conclusion: CA125 normalization after neoadjuvant chemotherapy is not an independent predictor of either progression-free or overall survival. Patients with persistently elevated CA125 after completing primary treatment had significantly inferior survivals compared with those who normalized CA125.