Prognostic Significance of Rising Serum CA-125 Levels Within the Normal Range in Patients With Epithelial Ovarian, Primary Peritoneal, and Tubal Cancers, Who, After Initial Treatment, Had a Complete Clinical Response
Prognostic Significance of Rising Serum CA-125 Levels Within the Normal Range in Patients With Epithelial Ovarian, Primary Peritoneal, and Tubal Cancers, Who, After Initial Treatment, Had a Complete Clinical Response
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DOI：
10.1097/igc.0b013e3182691254
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发表时间：
2012-10-01
影响因子：
4.8
通讯作者：
Menczer, Joseph
中科院分区：
文献类型：
--
作者：
Levy, Tally;Weiser, Roi;Menczer, Joseph
目的：本研究旨在评估CA-125水平在参考范围内升高的3个标准对卵巢癌、原发性腹膜癌和输卵管癌患者初始治疗临床反应完全后复发的预测能力。材料和方法：纳入1998年至2008年诊断的符合以下标准的患者：诊断和复发时CA-125水平为35 U/mL或更高，完全的初级治疗并有完整的临床和放射学反应，按计划随访，随访期间至少有2例CA-125结果在参考范围内。CA-125值在参考范围内升高的三个标准用于预测复发：(1)化疗结束时从最低点绝对升高5u /mL或更高；(2)疾病进展的早期信号标准；(3)绝对升高至20u /mL或更高。结果：在82例符合研究纳入标准的患者中，58例（70.7%）出现疾病复发。疾病进展的早期信号和绝对水平上升到20 U/mL或更高是疾病复发的高度具有统计学意义的预测因素（优势比为12.62[95%置信区间，2.71-58.7],P = 0.0012；优势比为6.7[95%置信区间，2.18-20.54],P = 0.001），中位时间分别为3个月和3.3个月。结论：我们的数据表明，疾病进展标准的早期信号和在参考范围内单次上升到20 U/mL或更高的绝对水平是临床复发的高度预测指标，尽管后者更容易使用。然而，这是否具有实际的临床价值还有待证实。
Objective: This study aimed to assess the ability of 3 criteria of rising CA-125 levels within the reference range to predict recurrence in patients with ovarian, primary peritoneal, and tubal carcinomas after complete clinical response to initial treatment.Material and Methods: Included were patients diagnosed during 1998 to 2008 who fulfilled the following criteria: CA-125 levels of 35 U/mL or greater at diagnosis and recurrence, full primary treatment with a complete clinical and radiographic response, follow-up according to schedule, and at least 2 CA-125 results within the reference range during follow-up. Three criteria of rising CA-125 values within the reference range were used for the prediction of recurrence: (1) an absolute increase of 5 U/mL or higher from the nadir value at completion of chemotherapy, (2) early signal of progressive disease criterion, and (3) a rise to an absolute level of 20 U/mL or greater.Results: Of 82 patients who satisfied study inclusion criteria, 58 (70.7%) had disease recurrence. Early signal of progressive disease and a rise to an absolute level of 20 U/mL or greater were highly statistically significant predictors of disease recurrence (odds ratio, 12.62 [95% confidence interval, 2.71-58.7], P = 0.0012; and odds ratio, 6.7 [95% confidence interval, 2.18-20.54], P = 0.001, respectively) and preceded recurrence by a median of 3 and 3.3 months, respectively.Conclusions: Our data indicate that the early signal of progressive disease criterion and a single rise to an absolute level of 20 U/mL or greater within reference limits are highly predictive of clinical recurrence, although the latter is simpler to use. However, whether this is of practical clinical value remains to be proven.