Fax: (412) 641-5417
A Gynecologic Oncology Group study
Article first published online: 20 JAN 2009
Copyright © 2009 American Cancer Society
Volume 115, Issue 5, pages 1028–1035, 1 March 2009
How to Cite
Zorn, K. K., Tian, C., McGuire, W. P., Hoskins, W. J., Markman, M., Muggia, F. M., Rose, P. G., Ozols, R. F., Spriggs, D. and Armstrong, D. K. (2009), The prognostic value of pretreatment CA 125 in patients with advanced ovarian carcinoma. Cancer, 115: 1028–1035. doi: 10.1002/cncr.24084
The following Gynecologic Oncology Group member institutions participated in the primary treatment studies: University of Alabama at Birmingham; Oregon Health Sciences University; Duke University Medical Center; Abington Memorial Hospital; University of Rochester Medical Center; Walter Reed Medical Center; Wayne State University; University of Minnesota Medical School; University of Southern California at Los Angeles; University of Mississippi Medical Center; Colorado Gynecologic Oncology Group, PC; University of California at Los Angeles; University of Miami School of Medicine; Milton S. Hershey Medical Center; Georgetown University Hospital; University of Cincinnati; University of North Carolina School of Medicine; University of Iowa Hospitals and Clinics; University of Texas Southwestern Medical Center at Dallas; Indiana University Medical Center; Wake Forest University School of Medicine; Albany Medical Center; University of California Medical Center at Irvine; Tufts-New England Medical Center; Rush-Presbyterian-St. Luke's Medical Center; Stanford University Medical Center; State University of New York Downstate Medical Center; University of Kentucky; Eastern Virginia Medical School; The Cleveland Clinic Foundation; Johns Hopkins Cancer Center; State University of New York at Stony Brook; Eastern Pennsylvania Gynecology/Oncology Center, PC; Washington University School of Medicine; Cooper Hospital/University Medical Center; Columbus Cancer Council; the University of Texas M. D. Anderson Cancer Center; University of Massachusetts Medical School; Fox Chase Cancer Center; Medical University of South Carolina; and Women's Cancer Center, University of Oklahoma.
Abbreviated results of this study were presented in abstract form at the Annual Meeting of the Society of Gynecologic Oncology, San Diego, California, March 3-7, 2007.
We thank Dr. M. J. Krohn who assisted with the development of the initial concept for this project.
- Issue published online: 18 FEB 2009
- Article first published online: 20 JAN 2009
- Manuscript Accepted: 20 AUG 2008
- Manuscript Revised: 11 AUG 2008
- Manuscript Received: 19 MAY 2008
- National Cancer Institute grants to the Gynecologic Oncology Group Administrative Office. Grant Number: CA-27469
- Gynecologic Oncology Group Statistical Office. Grant Number: CA-37517
- epithelial ovarian cancer;
- CA 125 tumor marker;
- Gynecologic Oncology Group;
- progression-free survival
The objective of the current study was to determine the prognostic significance of a pretreatment serum CA 125 level in patients with advanced epithelial ovarian carcinoma (EOC) who received treatment with a standard chemotherapy regimen.
Patients with International Federation of Gynecology and Obstetrics stage III/IV ovarian carcinoma who were on 1 of 7 Gynecologic Oncology Group (GOG) phase 3 trials and received treatment with a standard regimen of intravenous cisplatin and paclitaxel were included. A Cox regression model was used to assess the impact of CA 125 levels drawn before the initiation of chemotherapy on progression-free survival (PFS) both overall and by subgroup, including surgical debulking status, disease stage, and histologic subtype.
In total, 1299 patients who were on the cisplatin/paclitaxel arms of the GOG trials were eligible. The median CA 125 level was 246 U/mL. Only 7.6% of patients had a normal CA 125 level (≤35 U/mL). The lowest median CA 125 level was observed in the group with mucinous tumors; however, 69% of women who had mucinous tumors had abnormal CA 125 levels. Shorter PFS was observed with increasing CA 125 and persisted in multivariate analysis. Overall and in the serous subgroup, a 1-fold increase in CA 125 level was associated with a 7% increase in the hazard of disease progression (P < .001). This association was even more pronounced in patients who had stage III disease that was debulked to microscopic disease (15%; P = .003) and in patients who had endometrioid tumors (17%; P = .001).
A normal CA 125 level in the setting of advanced EOC was rare even after surgical debulking. The pretreatment CA 125 level was an independent predictor of PFS in patients with advanced EOC who received a standard chemotherapy regimen, particularly in the setting of disease that was debulked to a microscopic residual and in the serous or endometrioid subtypes. Cancer 2009. © 2009 American Cancer Society.