Can serum CA-125 levels predict the optimal primary cytoreduction in patients with advanced ovarian carcinoma?

Objective. The aim of this study was to investigate the predictive value of serum CA-125 levels to ability of optimal primary cytoreduction in patients with advanced epithelial ovarian carcinoma. Methods. Preoperative serum CA-125 levels were determined by a commercial enzyme immunoassay kit in a series of 92 patients with stage IIIC epithelial ovarian carcinoma. The abilities of various cutoff value of CA-125 to predict suboptimal cytoreductive surgery were determined. A receiver operating characteristic curve was used to find the most clinically useful CA-125 cutoff value. Results. Optimal cytoreduction was obtained in 48 patients (52%) using the diameter of the largest residual tumor nodule less than 1 cm. Receiver operating characteristic curve showed that the most clinically suitable CA-125 cutoff value was 500 U/ml. Forty-seven patients (51%) had preoperative serum CA-125 levels below 500 U/ml. Of these patients, optimal cytoreductive surgery was performed in 36 (77%). Of the 45 patients with serum CA-125 levels greater than 500 U/ml, optimal cytoreductive surgery was achieved in 12 (27%). True- and false-positive rates were 73 and 23%, respectively. Conclusions. Although our results showed that preoperative serum CA-125 levels might predict the optimal resectable patients, larger prospective studies are needed to prove its predictivity. Gynecologic oncologists should evaluate the sum of all criteria until more data are available. (C) 2002 Elsevier Science (USA).