Can Optimal Primary Cytoreduction Be Predicted in Advanced Stage Epithelial Ovarian Cancer? Role of Preoperative Serum CA-125 Level

The aim of this study was to determine the ability of preoperative serum CA-125 levels to predict optimal cytoreduction in patients with stage III epithelial ovarian cancer. A retrospective review was made of the records of 40 patients with FIGO stage III ovarian carcinoma who underwent primary cytoreductive surgery. A receiver operating characteristic (ROC) curve was used to determine the most useful CA-125 level in predicting optimal versus suboptimal tumour cytoreduction. Twenty-two (55%) patients were optimally cytoreduced (residual disease ≤1 cm). A preoperative serum CA-125 level of 500 U/ml was found to be the value with the most predictive power. Optimal cytoreduction was obtained in 16 of the 21 cases (76%) with a CA-125 <500 U/ml compared to only 6 of the 19 cases (32%) with a CA-125 >500 U/ml. At this threshold, preoperative serum CA-125 level was able to predict optimal versus suboptimal cytoreduction with a sensitivity of 72%, specificity of 73%, positive predictive value of 68%, and negative predictive value of 76%. In the management of patients with advanced epithelial ovarian carcinoma, preoperative serum CA-125 level may help to predict optimal primary cytoreduction and to identify candidates for alternative approaches other than traditional primary cytoreductive surgery, such as neoadjuvant chemotherapy.