The significance of the pattern of serum CA125 level ascent to above the normal range in epithelial ovarian, primary peritoneal and tubal carcinoma patients

Objective A rise of the CA125 marker above the normal range during follow-up of ovarian, primary peritoneal and tubal carcinoma patients with a complete clinical response after initial treatment signifies recurrence. We assessed whether the pattern of CA125 ascent to above the normal range at recurrence is associated with outcome. Methods The records of all recurrent ovarian primary peritoneal and tubal carcinoma patients diagnosed during 1998-2007 were abstracted. Included were patients who fulfilled the following criteria: CA125 levels were ≥ 35 U/mL at diagnosis and at recurrence, they had full primary treatment with a complete clinical and radiographic response, were followed-up according to schedule, and had at least two CA125 results within the normal range during follow-up. Two patterns of CA125 ascent to above the normal range were compared: a gradual rise and an abrupt rise. Results 52 patients with recurrent disease who met the inclusion criteria were identified. The median progression free and overall survival were significantly longer in patients with a gradual than in those with an abrupt rise (22.96 vs 14.07; P = 0.0014; and 44.37 vs. median not yet reach, respectively). Multivariate analysis showed that the pattern of CA125 ascent is an independent predictor of progression free and overall survival. Conclusions Our data seem to indicate that at recurrence the pattern of ascent of serum CA125 levels to above the normal range in patients in complete clinical remission is of prognostic value.