Preoperative and pre-chemotherapy CA-125 levels in high-risk early-stage ovarian cancer - An NRG/GOG study

John K Chan; Chunqiao Tian; Joshua P Kesterson; Ken Y Lin; Kathleen Darcy; Michael T Richardson; Daniel S Kapp; Bradley J Monk; Leah McNally; Lisa Landrum; Larry Copeland; Joan L Walker; Robert M Wenham; Neil Phippen; Nick M Spirtos; Krishnansu Tewari; Mark Shahin; Laurel Berry; Jeffery G Bell

doi:10.1016/j.ygyno.2023.12.009

Preoperative and pre-chemotherapy CA-125 levels in high-risk early-stage ovarian cancer - An NRG/GOG study

Gynecol Oncol. 2024 Feb:181:54-59. doi: 10.1016/j.ygyno.2023.12.009. Epub 2023 Dec 21.

Authors

John K Chan¹, Chunqiao Tian², Joshua P Kesterson³, Ken Y Lin⁴, Kathleen Darcy⁵, Michael T Richardson⁶, Daniel S Kapp⁷, Bradley J Monk⁸, Leah McNally⁹, Lisa Landrum¹⁰, Larry Copeland¹¹, Joan L Walker¹², Robert M Wenham¹³, Neil Phippen¹⁴, Nick M Spirtos¹⁵, Krishnansu Tewari¹⁶, Mark Shahin¹⁷, Laurel Berry¹⁸, Jeffery G Bell¹⁹

Affiliations

¹ California Pacific/Palo Alto Medical Foundation/Sutter Research Institute, San Francisco, CA, USA. Electronic address: chanjohn@sutterhealth.org.
² NRG Statistical Center, Roswell Park Comprehensive Cancer Center, Buffalo, NY, USA.
³ Penn State Health Milton S. Hershey Medical Center, Hershey, PA, USA. Electronic address: kestersonjp@upmc.edu.
⁴ Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA.
⁵ NRG Statistical Center, Roswell Park Comprehensive Cancer Center, Buffalo, NY, USA. Electronic address: darcyk@whirc.org.
⁶ University of California, Los Angeles School of Medicine, Los Angeles, CA, USA. Electronic address: mtrichardson@mednet.ucla.edu.
⁷ Stanford University School of Medicine, Stanford, CA, USA. Electronic address: dskapp@stanford.edu.
⁸ HonorHealth Research Institute, University of Arizona, Creighton University, Phoenix, AZ, USA. Electronic address: bmonk@gog.org.
⁹ Duke University, Durham, NC, USA. Electronic address: leah.mcnally018@duke.edu.
¹⁰ Indiana University, Indianapolis, IN, USA. Electronic address: llandru@iu.edu.
¹¹ Ohio State University Comprehensive Cancer Center, Columbus, OH, USA. Electronic address: Larry.Copeland@osumc.edu.
¹² University of Oklahoma, Oklahoma City, OH, USA. Electronic address: joan-walker@ouhsc.edu.
¹³ Moffitt Cancer Center and Research Institute, Tampa, FL, USA. Electronic address: Robert.wenham@moffitt.org.
¹⁴ Walter Reed National Military Medical Center, Bethesda, MD, USA. Electronic address: neil.phippen@usuhs.edu.
¹⁵ Womens Cancer Center of Nevada, Las Vegas, NV, USA. Electronic address: nmspirtos@wccenter.com.
¹⁶ University of California Medical Center at Irvine, Irvine, CA, USA. Electronic address: ktewari@hs.uc.edu.
¹⁷ Abington Memorial Hospital, Abington, PA, USA. Electronic address: Mark.Shahin@jefferson.edu.
¹⁸ Wake Forest University Health Sciences, Winston-Salem, NC, USA. Electronic address: lkberry@wakehealth.edu.
¹⁹ Ohio Riverside Methodist Hospital, Columbus, OH, USA.

PMID: 38134754
DOI: 10.1016/j.ygyno.2023.12.009

Abstract

Objectives: To determine clinical significance of preoperative and pre-chemotherapy CA-125 in high-risk early-stage epithelial ovarian cancer patients.

Methods: All patients with stage IA/IB and grade 3, stage IC, clear cell, or completed resected stage II cancer were enrolled in a phase III trial and treated with chemotherapy. Kaplan-Meier method and Cox proportional hazards model were used for statistical analyses.

Results: 427 patients with high-risk early-stage ovarian cancer were enrolled. Of 213 patients with preoperative CA-125 data, 79% had elevated CA-125. Median preoperative CA-125 level was 103 U/mL. Patients with ≤10, 11-15, and > 15 cm tumors had median preoperative CA-125 levels of 62, 131 and 158 U/mL, respectively (p = 0.002). For the 350 patients with data for pre-chemotherapy CA-125 level, 69% had elevated pre-chemotherapy CA-125 above 35 U/mL with median value of 65 U/mL. However, age, race, stage, cell type and grade of disease were not correlated with CA-125 levels before and after surgery. On multivariate analysis, elevated pre-chemotherapy CA-125 independently predicted worse recurrence-free survival (HR = 2.13, 95% CI: 1.23-3.69; p = 0.007) and overall survival (HR = 1.99, 95% CI: 1.10-3.59; p = 0.022) after adjusting for age, stage, cell type and grade of disease. Compared to those with normal CA-125, patients with elevated pre-chemotherapy CA-125 had lower recurrence-free survival (RFS, 87% vs. 75%; p = 0.007) and overall survival (OS, 88% vs. 82%; p = 0.02). However, preoperative CA-125 was not prognostic of RFS (p = 0.699) or OS (p = 0.701).

Conclusions: Preoperative CA-125 was elevated in nearly 80% of high-risk early-stage ovarian cancer patients. Pre-chemotherapy CA-125 was associated with recurrence-free and overall survival; however, preoperative CA-125 was not prognostic.

Keywords: CA-125; Early-stage; Ovarian cancer.

Publication types

Clinical Trial, Phase III

MeSH terms

Carcinoma, Ovarian Epithelial / drug therapy
Carcinoma, Ovarian Epithelial / pathology
Female
Humans
Multivariate Analysis
Neoplasm Staging
Ovarian Neoplasms* / drug therapy
Ovarian Neoplasms* / surgery
Prognosis
Retrospective Studies

Abstract

Publication types

MeSH terms

Grants and funding