Abstract
ObjectivesThe present study investigated the clinical implications of pretreatment carbohydrate antigen 125 (CA-125) levels and CA-125 normalization in patients with ovarian clear cell carcinoma (CCC), and it provides useful information for the improvement of monitoring strategies for this lethal disease.MethodsThe medical records of patients with ovarian CCC who had undergone primary staging surgery or cytoreductive surgery followed by systemic chemotherapy were retrospectively reviewed. A range of clinico-pathological parameters were collected and examined.ResultsA total of 375 women were included in the analysis. FIGO stage (p < 0.001) was identified as the only significant prognostic factor for relapse. Residual tumor and advanced stage (p = 0.001 and p < 0.001, respectively) were identified as independent adverse factors for survival. The potential risk factors associated with elevated pretreatment CA-125 levels included advanced-stage disease, positive residual tumors and negative endometriosis (p < 0.001, p = 0.001 and p <0.001, respectively). Pretreatment CA-125 levels were not associated with relapse-free survival (RFS) or overall survival (OS) (p = 0.060 and p = 0.176, respectively). CA-125 normalization after chemotherapy exhibited a positive linear correlation with advanced stage (r = 0.97, p = 0.001) and residual tumor (r = 0.81, p = 0.027) and a negative relationship with 5-year RFS (r = −0.97, p = 0.002) and 5-year OS (r = −0.97, p= 0.001). Patients with CA-125 levels that normalized before cycle 2 of chemotherapy had a similar prognosis as patients whose CA-125 levels normalized prior to chemotherapy (RFS: p = 0.327; OS: p = 0.654). By contrast, patients with CA-125 levels that normalized after cycle 2 of chemotherapy or never normalized were significantly more likely to experience disease progression.ConclusionsPretreatment CA-125 levels are not very useful for predicting clinical outcome. CA-125 levels following treatment are a valid indicator for treatment monitoring. CA-125 normalization after the completion of cycle 1 of chemotherapy represents a distinct inflection point for decreased RFS and OS.
Highlights
The World Health Organization has defined clear cell carcinoma (CCC) of the ovary as a distinct histological type since 1973 [1]
We investigated the clinical implications of pre- and post-treatment serum carbohydrate antigen 125 (CA-125) levels in patients with ovarian CCC to provide useful information for the improvement of monitoring strategies for this lethal disease
Platinum/taxane chemotherapy was performed on 264 patients (70.4%) as the frontline therapy, and the remaining 111 patients received conventional platinum-based regimens
Summary
The World Health Organization has defined clear cell carcinoma (CCC) of the ovary as a distinct histological type since 1973 [1]. This tumor type accounts for 15% of all epithelial ovarian cancer (EOC) cases [2], and the incidence might be even higher among Asian women [3,4,5]. CCC is one of the most aggressive and malignant types of tumors, and it has a poorer clinical outcome than other types of EOC due to its resistance to platinum-based chemotherapy, in patients with advanced or recurrent disease [2, 6,7,8].
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