Indian Journal of Obstetrics and Gynecology Research


Is preoperative CA-125 level a predictor of cytoreduction in carcinoma ovary?


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Author Details: Premalatha T S,Sumangala G*,Geeta Acharya,Kiran Kulkarni,Vishakha Bidkar

Volume : 5

Issue : 4

Online ISSN : 2394-2754

Print ISSN : 2394-2746

Article First Page : 516

Article End Page : 519


Abstract

Optimal cyto-reduction of advanced EOC has profound impact on the survival and prognosis of patients3. Suboptimal cyto-reduction of advanced ovarian cancer is related to initial tumor bulk which indirectly correlates with serum CA125 levels. Can assessment of level of CA 125 in pre-opererative period predict optimal cyto-reduction is the aim of the study. The mean age of the 70 patients in this study was 49.9 years (SD- 11.75, Range: 21-69 years). Fourty four (63%) had stage III-?V disease. Sixty five (93%) patients had papillary serous ovarian cancer. The serum CA125 levels ranged from 6- 5300 U/ml with median pre-operative serum CA-125 level for all the patients being 259 U/ml (IQR- 682.98U/ml). The level was elevated (>35 U/ml) in 49% of patients with stage ?-? compared with 93% of patients with stage ? or ?V disease. Optimal tumor cyto-reduction was obtained in 61/70 cases (87%) of total patients and in 35/44 (80%) of patients with stage III-?V disease. Diaphragmatic stripping, appendecetomy, recto-sigmoid resection and anastomosis, pelvic peritonectomy, peritoneal stripping/ debulking of peritoneal disease, hemi-colectomy, ileo colic anastomosis and partial nephrectomy. Most of our patients were in intermediate surgical complexity category with a score between 4-7. In 9 patients all belonging to advanced stage, sub-optimal cyto-reduction was done due to multiple co-morbidities, multiple mesenteric lymphnode involvement, multiple small bowel and liver parenchymal deposits and patient not willing for colostomy. An ROC curve analysis showed threshold value of CA125 of 411U/ml. With a cut-off of 411U/ml, 97% of total patients with CA125 levels lower than 411U/ml were able to undergo optimal cyto-reduction. Also, in 76% of patients with CA125 level more than 411U/ml optimal cyto-reduction could be achieved. When only advanced stages (stage III-IV) were considered, with a cut-off of 411U/ml, 88% of patients with CA125 levels lower than 411U/ml were able to undergo optimal cyto-reduction. Also, in 73% of patients with CA125 level more than 411U/ml optimal cyto-reduction could be achieved. With a pre-operative cut-off value of CA125 more than 411U/ml, the sensitivity, that is, probability to predict sub-optimal cyto-reduction was 65% and specificity, that is, probability to predict optimal cyto-reduction was only 67%. Which showed poor predictability for resectability which was in concordance with other studies. Though it is difficult to draw definite conclus

Keywords: Carcinoma ovary, CA125, Cyto-reduction, Surgical complexicity score.

Doi :-https://doi.org/10.18231/2394-2754.2018.0116