Objectives

The amount of residual tumor after cytoreductive surgery (CRS) for advanced-stage ovarian cancer is correlated with overall survival. This study aims to describe the predictive value of pre-treatment serum cancer antigen 125 (CA-125) and the normalization of serum CA-125 after neoadjuvant chemotherapy (NAC) on surgical outcome.

Methods

A systematic review and a prospective clinical study were performed. The Embase, Medline, Web of science, Cochrane Library and Google Scholar databases were searched from database inception to April 2022. The clinical study is part of a randomized controlled trial, the PlaComOv-trial. Patients with FIGO stage IIIB-IV ovarian cancer who underwent CRS were enrolled from 2018 to 2020. A regression analysis was performed to demonstrate correlations between preoperative serum CA-125, reduction of serum CA-125 after NAC and surgical outcome.

Results

Fourteen relevant articles were analyzed of which eleven reported that the lower preoperative serum CA-125 the higher the probability of achieving complete CRS. In the prospective clinical study, patients who underwent interval CRS with preoperative serum CA-125 ≤ 35kU/L had a higher probability of achieving complete CRS than patients with serum CA-125 >35kU/L (85% vs 67%, OR2.791, 95%CI 1.439–5.414, P=0.002). In multivariable analysis, absence of ascites and peritoneal carcinomatosis, FIGO stage and use of PlasmaJet during surgery appeared to be independent predictive factors for complete CRS.

Conclusions

In literature, preoperative serum CA-125 ≤35kU/L was associated with a significant higher percentage of complete CRS. In the present study, preoperative serum CA-125 ≤35kU/L did not present as an independent predictor for complete CRS in multivariable analysis.

EP274/#330 Preoperative cancer antigen 125 level as a predictor for complete cytoreduction in ovarian cancer? A prospective cohort study and systematic review