Measurement of the serum CA 125 level as a tumor marker in patient with epithelial ovarian cancer has been widely discussed regarding its value in predicting survival of patient, However, the relative prognostic significance of various CA 125
parameters
remains controversial. In this retrospective study we compared the prognostic significance of a number of serum CA 125 parameters already shown to be of prognostic value in the published literatures. Between June 1989 and May 1995, sixty-one
patients
with epithelial ovarian cancer were evaluated, who were managed at Asan Medical Center by cytoreductive surgery and at least three cycles of chemotherapy, were serially monitored by serum CA 125 during therapy and had at least 6 months'
follow-up.
The
patients were divided into two or three prognostic group by initial serum CA 125 level(<100U/ml(n=16) vs ≥100U/ml(n=19) vs ≥1000U/ml(n=26), level after cytoreductive surgery(<35U/ml(n=15) vs ≥35U/ml and <100U/ml(n=11) vs ≥100U/ml(n=35), that
after
the first(<35U/ml(n=34) vs ≥35U/ml(n=27)), second(<35U/ml(n=46)) vs ≥35U/ml(n=15)) and third courses of chemotherapy(< 35U/ml(n=53) vs ≥35U/ml(n=8)), ratio of CA 125 level before and after first chemotherapy (<1/4(n=34) vs ≥1/4(n=27)), serum
half-life(<14 days(n=35)) vs ≥14days(n=19)) and CA 125 prognostic score(<5 points(n=35) vs ≥5 points(n=26)). In each group, the 5-year actuarial survival rates were calculated and compared respectively. As a result, there were significant
differences
in groups divided by level after cytoreductive surgery(p=0.012), that after the first(p=0.0001), second(p<0.0001) and third courses of chemotherapy(p<0.0001), serum half-life(p=0.0022) and CA 125 prognostic score(p=0.0006), and no difference was
found
in in those according to initial serum CA 125 level(p=0.12) and ratio of CA 125 level before and after first chemotherapy(p=0.69). On multivariate analysis, level after second course of chemotherapy was revealed to be the most valuable prognostic
parameter(relative risk=6.54). In addition, multivariate analysis with clinicopathological prognostic factors such as FIGO stage, histologic subtype, histologic grade, residual tumor volume after surgery and volume of ascites revealed that CA 125
level
after second course of chemotherapy(relative risk =4.11) and residual tumor after surgery(relative risk=2.23) were independent predictors for survival. In conclusion, serum CA 125 level determined after second course of chemotherapy is most
valuable to
identify a poor-prognostic population among patients with ovarian cancer to whom a more aggressive or only palliative treatment might be beneficial.
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