J Gynecol Oncol.  2011 Dec;22(4):269-274. 10.3802/jgo.2011.22.4.269.

Prediction of a high-risk group based on postoperative nadir CA-125 levels in patients with advanced epithelial ovarian cancer

• Kang S
• Kim TJ
• Seo SS
• Kim BG
• Bae DS
• Park SY

• KMID: 2173629
• DOI: http://doi.org/10.3802/jgo.2011.22.4.269

Abstract

OBJECTIVE
We aimed to determine the ideal cut-off of nadir serum CA-125 level for prediction of progression free survival.
METHODS
Among 267 patients who achieved complete remission after chemotherapy, the correlation between nadir CA-125 and progression free survival were compared among the subgroups classified according to the distribution of CA-125. The diagnostic odds ratio and area under the receiver operator characteristics curve were compared at various cut-off points.
RESULTS
The nadir CA-125 levels did not have prognostic value under 12 U/mL (to 75 percentile). In contrast, they were significantly correlated with progression free survival only when the CA-125 level was greater than 12, which was 75 percentile (p=0.034). In predicting progression free survival <6 and 12 months, the cut-off value of 18 (90 percentile) showed superior diagnostic performance over 10 or 12 U/mL. Compared with patients who showed nadir levels between 0 and 12 U/mL (0 to 75 percentile), those with nadir >18 U/mL showed a hazard ratio of 2.85 (95% confidence interval, 1.70 to 4.76; p<0.001); patients with nadir levels between 18 and 12 U/mL showed a the hazard ratio of 1.68 (95% confidence interval, 1.11 to 2.56; p=0.015) compared with those whose nadir levels were under 12 U/mL.
CONCLUSION
The predictive power of the traditional cut-off of 10 U/mL to classify a risk group or to identify high risk patients was unsatisfactory. The optimal diagnostic performance was observed at the cut-off of 18 U/mL and this can be proposed to dichotomize cut-off values to predict outcomes among individual patients.

Keyword

Biomarker; CA-125; Ovarian cancer; Prognosis; Progression free survival; Risk factor

MeSH Terms

Disease-Free Survival
Humans
Neoplasms, Glandular and Epithelial
Odds Ratio
Ovarian Neoplasms
Prognosis
Risk Factors
Neoplasms, Glandular and Epithelial
Ovarian Neoplasms

Figure

• 

  Fig. 1 Logarithm transformation of nadir CA-125 levels and estimation of progression free survival function using Kaplan-Meyer curve. (A) Skewed distribution of nadir CA-125 levels. (B) After logarithm transformation, distribution of nadir CA-125 levels showed normal distribution. (C) Kaplan-Meyer survival curve showed significant difference of progression free survival between patients with nadir CA-125<10 U/mL and ≥10 U/mL (Log rank test, p=0.002). (D) The progression free survival of the patients within 50-75 percentile is not different from the group within 0-50 percentile. However, only the patients over 75 percentile showed significant difference of progression free survival according to nadir CA-125 levels (p<0.001).

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