Abstract: CA125 Surveillance Increases Optimal Resectability

upsofloating
upsofloating Member Posts: 466 Member
edited May 2011 in Ovarian Cancer #1
From Gynecol Oncol. 2011 May 1:

CA125 Surveillance Increases Optimal Resectability at Secondary Cytoreductive Surgery for Recurrent Epithelial Ovarian Cancer
Gynecol Oncol. 2011 May 1;121(2):249-252, ND Fleming, I Cass, CS Walsh, BY Karlan, AJ Li

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Results of this single-center, retrospective analysis contradict those of an earlier prospective study, and indicated that early detection of recurrence through surveillance of CA125 levels may improve the likelihood of optimal results, and thus, improve survival, from secondary cytoreductive surgery in patients with epithelial ovarian cancer.

Abstract

Objective: Recent data suggest that serial CA125 surveillance following remission in asymptomatic patients with epithelial ovarian cancer (EOC) does not impact overall survival. However, earlier detection of recurrence may influence resectability at secondary cytoreductive surgery (SCS). We hypothesized that a shorter time interval between CA125 elevation and SCS correlates with a higher likelihood of optimal resection among eligible patients.

Methods: We identified patients with recurrent epithelial ovarian cancer who underwent SCS from 1995 to 2009 at our institution. All patients initially underwent primary cytoreductive surgery followed by platinum-based chemotherapy. CA125 elevation was considered the first value two-times the patient's nadir level. Our “study interval” was the time between CA125 elevation and SCS. Optimal SCS was defined as microscopic residual disease (≤ 0.5 cm). Our analysis compared patients who underwent optimal vs. suboptimal SCS.

Results: Seventy-four patients who underwent SCS for recurrent EOC met inclusion criteria. Median disease-free interval prior to SCS was 19 vs. 12 months for the optimal and suboptimal SCS groups. More patients undergoing suboptimal SCS had ascites (21% vs. 2%, p = 0.01) and carcinomatosis (42% vs. 5%, p < 0.0001). Patients who underwent optimal SCS went to the operating room 5.3 vs. 16.4 weeks (HR 1.03, 95% CI 1.01–1.06, p = 0.04) from the time of their CA125 elevation. Optimal SCS was associated with a longer overall survival (47 vs. 23 months, p < 0.0001).

Conclusions: Each week delay after first CA125 elevation correlated with a 3% increased chance of suboptimal resection at SCS. Serial CA125 surveillance for early detection of recurrence may increase rates of optimal SCS and potentially influence overall surviva

Comments

  • LaundryQueen
    LaundryQueen Member Posts: 676
    THANK YOU!
    Combining this information with the research that Hissy_Fitz posted about predictive value of the slightly increased CA-125 for recurrence (value being 5 points or higher than the nadir CA-125 after chemo) gives me a new appreciation for monitoring the CA-125. Even though it is still not as reliable as one would hope it to be.

    Thanks again for digging this up and posting all of it.

    LQ
  • upsofloating
    upsofloating Member Posts: 466 Member

    THANK YOU!
    Combining this information with the research that Hissy_Fitz posted about predictive value of the slightly increased CA-125 for recurrence (value being 5 points or higher than the nadir CA-125 after chemo) gives me a new appreciation for monitoring the CA-125. Even though it is still not as reliable as one would hope it to be.

    Thanks again for digging this up and posting all of it.

    LQ

    I was thinking about you
    I was thinking about you when I saw this LQ. Glad it helped with decision-making. May you never have a rise to deal with.
    Annie
  • LaundryQueen
    LaundryQueen Member Posts: 676

    I was thinking about you
    I was thinking about you when I saw this LQ. Glad it helped with decision-making. May you never have a rise to deal with.
    Annie

    AMEN to that! And thanks
    AMEN to that! And thanks again for providing information, Annie...as far as I know, no one on this site is a doctor HOWEVER, the information found here has been VERY HELPFUL to me as the whole subject is overwhelming.

    Have a good day,

    LQ
  • Hissy_Fitz
    Hissy_Fitz Member Posts: 1,834

    AMEN to that! And thanks
    AMEN to that! And thanks again for providing information, Annie...as far as I know, no one on this site is a doctor HOWEVER, the information found here has been VERY HELPFUL to me as the whole subject is overwhelming.

    Have a good day,

    LQ

    Wow! Scary stuff. Two
    Wow! Scary stuff. Two times my nadir is 9.6 and my CA125 early this month was 13.

    Someone (sorry....short term memory is intermittent, at best) had a nadir of ONE. I'm not convinced that a CA125 of 2 should set off alarm bells, though. And I'm thinking it would be hard to find a doctor who would take that kind of rise as a serious indicator of disease.

    I will be getting a new number on June 16. I might call my local guy and see if he thinks we should be concerned. My CA125 has progressed in 2 point increments for the last few months, from 7 to 9 to 11, and now 13. My guess is he will pooh-pooh the whole thing.

    I could print out the study and take it to him. That is one thing I can say about Dr M, he will look at anything I shove in his face. He is open-minded that way, bless his heart.

    I just had a CT scan and it was NED. What are the chances anyone would open me up, based on nothing more than a normal range CA125?

    Carlene
  • upsofloating
    upsofloating Member Posts: 466 Member

    Wow! Scary stuff. Two
    Wow! Scary stuff. Two times my nadir is 9.6 and my CA125 early this month was 13.

    Someone (sorry....short term memory is intermittent, at best) had a nadir of ONE. I'm not convinced that a CA125 of 2 should set off alarm bells, though. And I'm thinking it would be hard to find a doctor who would take that kind of rise as a serious indicator of disease.

    I will be getting a new number on June 16. I might call my local guy and see if he thinks we should be concerned. My CA125 has progressed in 2 point increments for the last few months, from 7 to 9 to 11, and now 13. My guess is he will pooh-pooh the whole thing.

    I could print out the study and take it to him. That is one thing I can say about Dr M, he will look at anything I shove in his face. He is open-minded that way, bless his heart.

    I just had a CT scan and it was NED. What are the chances anyone would open me up, based on nothing more than a normal range CA125?

    Carlene

    Yes Carlene I agree with the
    Yes Carlene I agree with the really low number, "doubling" even seems ludicrous to be concerned about. For those of us whose numbers tend to be larger (I for one) this may seem more significant. I do think clinical correlation is quite important, eg symptoms, CT, PET results. This may be of greatest concern with the development of the barely visible carcinomatosis (sp?) throughout peritoneal, abdominal cavities for which rising ca125 may be only notable change. I think at times they are just grasping at straws for a disease that seems to operate with a mind of its own, varying so much from case to case.
    Oh, for some easy answers.
    Annie
  • Tethys41
    Tethys41 Member Posts: 1,380 Member

    Wow! Scary stuff. Two
    Wow! Scary stuff. Two times my nadir is 9.6 and my CA125 early this month was 13.

    Someone (sorry....short term memory is intermittent, at best) had a nadir of ONE. I'm not convinced that a CA125 of 2 should set off alarm bells, though. And I'm thinking it would be hard to find a doctor who would take that kind of rise as a serious indicator of disease.

    I will be getting a new number on June 16. I might call my local guy and see if he thinks we should be concerned. My CA125 has progressed in 2 point increments for the last few months, from 7 to 9 to 11, and now 13. My guess is he will pooh-pooh the whole thing.

    I could print out the study and take it to him. That is one thing I can say about Dr M, he will look at anything I shove in his face. He is open-minded that way, bless his heart.

    I just had a CT scan and it was NED. What are the chances anyone would open me up, based on nothing more than a normal range CA125?

    Carlene

    Yes, this is a tough pill for me to swallow. My nadir was <1. Now I'm up to 3. If I asked for SCS at this point, I doubt I could convince ANY doctor to do it.
  • Hissy_Fitz
    Hissy_Fitz Member Posts: 1,834
    Tethys41 said:

    Yes, this is a tough pill for me to swallow. My nadir was <1. Now I'm up to 3. If I asked for SCS at this point, I doubt I could convince ANY doctor to do it.</p>

    And would we really want SCS
    And would we really want SCS at this point? I don't think there is any way to do it, short of opening us back up, stem-to-stern. I would be really reluctant to sign up for another 14 inch incision at this point, and I am probably as proactive as anyone on this site.

    Carlene
  • Cafewoman53
    Cafewoman53 Member Posts: 735 Member

    And would we really want SCS
    And would we really want SCS at this point? I don't think there is any way to do it, short of opening us back up, stem-to-stern. I would be really reluctant to sign up for another 14 inch incision at this point, and I am probably as proactive as anyone on this site.

    Carlene

    My ca125 was 1 at it's lowest point
    But it has been said on this board anything lower than ten is the same as ten so I consider my doubling would be twenty. I too am on a slow change in the wrong direction . I will be finished with my Avastin in June and then will get a scan so that should let me know if there is a reason to be concerned.
    Colleen
  • pstur1
    pstur1 Member Posts: 37

    My ca125 was 1 at it's lowest point
    But it has been said on this board anything lower than ten is the same as ten so I consider my doubling would be twenty. I too am on a slow change in the wrong direction . I will be finished with my Avastin in June and then will get a scan so that should let me know if there is a reason to be concerned.
    Colleen

    woo hoo...so glad to hear you all have low CA125s
    I always like to hear good news and those low numbers you kids have is great news. I have the low grade invasive serious ovarian, the kind that grows "slowly"....hahahaha. I love that, "slowly"...I would really hate to see what "fast" is....LOL. My numbers don't seem to stay in "normal" range anymore. Today my numbers are around 143, now this might alarm some folks but I am told this is what it is. In fact, both my gyno onc and my chemo onc say this is not the greatest but not a cause for alarm either. My CT shows tiny little spots to the tune that it isn't even worth going in to scrape me out which is a good thing really. So I started chemo again this week. I am doing Gemzar and Carbo this time. My first round this time was Wednesday and so far I haven't thrown up on the cat or curled in a ball so I guess it's all good for now! Ladies, keep those numbers low, your spirits high, and keep sharing those articles....thank you.

    A ONE really? I have never seen a "one" in a pant size, a potato chip, and certainly not my CA125, that is just too cool really.

    Kelley