6. Šola o ginekoloških rakih SODOBNI PRISTOP K OBRAVNAVI BOLNIC Z RAKOM JAJČNIKOV
}
h
POVEZAVA MED PREDOPERATIVNIMI VREDNOSTMI TUMORKSIH MARKERJEV IN USPEŠNOSTJO KIRURŠKE RESEKCIJE PRI RAKU JAJČNIKOV
asist. dr. Sebastjan Merlo, dr. med. Onkološki inštitut Ljubljana
CA-125 — ZGRADBA
Glikoprotein Kodira gen MUC 16
Sestavni del epitelija reproduktivnega trakta
Tandem repeats >60
(heavily glycosylated)
SEA modules
Putative cleavage site
N-terminal domain (heavily glycosylated)
m mm
Cytoplasmic tail
COOH
Sinteza v celicah mezotela kot posledica mehanskega draženja ali kot posledica vnetnega odgovora (mediatorji TNFa in interleukini)
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C A-125-KLINIČNA UPORABNOST
►	Ocena odziva bolezni na sistemsko zdravljenje
►	Sledenje po zaključenem zdravljenju
>► Presejalno orodje; občutljivosti (61 - 90%), specifičnosti (35-91%).
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CA-125 IN RAK
>► Rak jajčnika in jajcevoda
►	Rak materničnega telesa
►	Rak pljuč
►	Rak dojke
►	Rak GIT
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CA-125 PRI BENIGNIH OBOLENJIH
>► Endometrioza
►	Menstruacija
►	PID (vnetja v medenici)
►	Nosečnost
>► Miomi maternice >► Bolezni jeter
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RAZISKAVA 01 LJUBLJANA
►	Retrospektivna raziskava
►	253 bolnic (Rak jajčnika, FIGO IIIC/IV)
►	Skupine:
►	1. NACT (215 žensk)
►	2. PDS (38 žensk)
>► Korelacija serumskih vrednosti CA-125 in kirurško resekcijo ter obdobje brez ponovitve bolezni (PFS) in celokupnega preživetja (OS)
REZULTATI RAZISKAVE
►	Mediana vrednost CA-125 višja v NACT kot v PDS skupini (972 IU/ml vs. 499 IU/ml)
►	PFS: NACT - PDS (8 mesecev - 18 mesecev)
►	OS: NACT - PDS (25 mesecev - 46 mesecev)
►	Potrdili povezavo med vrednostjo CA-125 in obsegom kirurške resekcije
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TABLE 2. Median and range CA-125 levels in different surgical outcomes in primary debulking surgery (PDS) and = neoadjuvant chemotherapy (NACT) group
Surgical outcomes
PDS(N =38)
NACT (N = 215)
P value
CA-125 at diagnosis lU/ml
Complete gross resection
Optimal resection
Suboptimal resection CA-125 post NACT lU/ml
Complete gross resection
Optimal resection
Suboptimal resection
359 59-5739
512 85-1117
1522 200-3569
943 10-12803
1006 48-24824
1063 28-31481
25 5-2074
36 15-2180
68 9-2657
0.006
I 97,3%
I 96,4% a020
I 93,6%
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TABLE 3. Statistical cut off values of serum CA-125 level and probability to obtain complete gross or optimal cytoreduction
CA-125 level (Ill/ml)	Sensitivity (%)	Number and percentage of patients	
50	96.5	9	3.5%
100	86.5	33	13.0%
250	74.0	66	26.1 %
500	58.0	98	38.7 %
750	50.0	128	50.6 %
1000	42.0	150	59.3 %
ZAKLJUČKI RAZISKAVE
>► Višja vrednost CA-125 -> nI/ verjetnost optimalne citoredukcije
>► CA-125 <500IU/ml -> velika verjetnost optimalne citoredukcije
► nI/ CA-125 po NACT za >96,4% -> visoka verjetnost optimalne citoredukcije
CA-125 PRI RAKU JAJČNIKA — LITER
Received: 12 September 2019
Revised: 5 January 2020 Accepted: 12 January 2020
DOI: 10.1111/aogs.13814
ORIGINAL RESEARCH ARTICLE
CA-125 reduction during neoadjuvant chemotherapy is associated with success of cytoreductive surgery and outcome of patients with advanced high-grade ovarian cancer
Roy Kessous e Michel D. Wissing2 | Sabrina Piedimonte1 | Jeremie Abitbol1 Liron Kogan1 | Ido Laskov1 | Amber Yasmeen1 | Shannon Salvador1 | Susie Lau1 | Walter H. Gotlieb1
Conclusions: Reduction of CA-125 levels during neoadjuvant chemotherapy provides an early predictive tool that strongly correlates with successful cytoreductive surgery and long-term clinical outcome in women with advanced high-grade serous and endometrioid ovarian cancer.
South Asian J Cancer 2020 Jan-Mar; 9(1): 30-33. doi: 10.4103/sajc.sajc_53_17
PMCID: PMC6956573 PMID: 31956617
Does preoperative CA-125 cutoff value and percent reduction in CA-125 levels correlate with surgical and survival outcome after neoadjuvant chemotherapy in patients with advanced-stage ovarian cancer? - Our experience from a tertiary cancer institute
Monisha Gupta, Shilpa Mukesh Patel. Rue hi Arora, Rajneesh Tiwari. Pariseema Dave, Ava Desai. and Meeta Mankad
Conclusion:
Our data showed that >95% fall in CA-125 and an absolute preoperative CA-125 value of <100 U/ml is associated with better surgical and survival outcome in women with advanced EOC. These data are important in patient counseling and treatment planning.
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> South Asian J Cancer. Jan-Mar 2020;9(l):30-33. doi: 10.4103/sajc.sajc_53_17.
Does preoperative CA-125 cutoff value and percent reduction in CA-125 levels correlate with surgical and survival outcome after neoadjuvant chemotherapy in patients with advanced-stage ovarian cancer? - Our experience from a tertiary cancer institute
Monisha Gupta 1, Shilpa Mukesh Patel 1, Ruchi Arora 1, Rajneesh Tiwari 1, Pariseema Dave 1, Ava Desai 1, Meeta Mankad -
Conclusion: Our data showed that >95% fall in CA-125 and an absolute preoperative CA-125 value of <100 U/ml is associated with better surgical and survival outcome in women with advanced EOC. These data are important in patient counseling and treatment planning.
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> Int J Gynecol Cancer. 2015 Jun;25(5):823-9. doi: 10.1097/IGC.0000000000000434.
The Impact of Percent Reduction in CA-125 Levels on Prediction of the Extent of Interval Cytoreduction and Outcome in Patients With Advanced-Stage Cancer of Miillerian Origin Treated With Neoadjuvant Chemotherapy
Haider Mahdi 1, Kathryn A Maurer, Benjamin Nutter, Peter G Rose
Conclusions: A reduction in CA-125 of at least 90% is associated with complete IDS, favorable pathologic response, and fewer bowel resections. A preoperative CA-125 < 20 suggests improved outcome. These findings are helpful for treatment planning and patient counseling.
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Multicenter Study > Gynecol Oncol. 2014 Dec;135(3):542-6. doi: 10.1016/j.ygyno.2014.09.005. Epub 2014 Sep 16.
CA125 kinetic parameters predict optimal cytoreduction in patients with advanced epithelial ovarian cancer treated with neoadjuvant chemotherapy
Aurélie Pelissier 1, Claire Bonneau 2, Elisabeth Chéreau 3, Thibault de La Motte Rouge 4, Virginie Fourchotte 5, Emile Daraï 6, Roman Rouzier 7
Conclusion: Our data indicate that for advanced ovarian cancer, a CA125 level less than 75 Ul/ml after the 3rd NAC was an independent predictor factor for complete IDS,
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Meta-Analysis > J Surg Oncol. 2010 Jan l;101(l):13-7. doi: 10.1002/jso.21398.
Preoperative serum CA-125 levels and risk of suboptimal cytoreduction in ovarian cancer: a meta analysis
Sokbom Kang Tae-Joong Kim, Byung-Ho Nam, Sang-Soo Seo, Byoung-Gie Kim, Duk-Soo Bae, Sang-Yoon Park
Results: A total of 2,192 patients were included in the analysis. The pooled optimal cytoreduction rate and the mean of median CA-125 levels were 53.7% and 580 U/ml, respectively. At the cut-off of 500 U/ml, overall sensitivity and specificity were 68.9% (95% confidence interval [CI] 62.0-75.1%) and 63.2% (95% CI 53.7-71.7%), respectively. Positive and negative likelihood ratios were 1.87 (95% CI 1.40-2.50) and 0.49 (95% CI 0.37-0.66). The CA-125 >500 U/ml showed strong association with a risk of suboptimal cytoreduction with an odds ratio of 3.69 (95% CI 2.02-6.73).
Conclusions: The current analysis indicates that CA-125 is a strong risk factor of suboptimal cytoreduction and it may be applied in preoperative counseling and treatment planning. However, it also shows that CA-125 lacks the ability to predict optimal cytoreduction accurately.
\
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Gynecologic Oncology
Volume 112, Issue 1, January 2009, Pages 11-15
ELSEVIER
Can the preoperative Ca-125 level predict optimal cytoreduction ill patients with advanced ovarian carcinoma? A single institution cohort study
George Vorgias A Christos iavazzo. Panagiotis Sawopoulos, Eva Myriokefalitaki, Michael Katsoulis. Nickolas Kalinoglou, Thrassivoulos Akrivos
Results
Preoperative Ca-125 proved to be a reliable predictor for optimal cytoreduction. Tlie area under curve of" the ROC cur\re was 0.S9, 95% C.I. = [0.828—0.952], indicating very-good discriminating capability7. The level of"500 IU/ml was found to have the most predictive power. The sensitivity7 of Ca-125 at that level was 78.5%, the specificity 89.6%, the positive predictive value 84.296, the negative predictive value 85.4% and its accuracy 85%. Furthermore, the likelihood ratio for correct discrimination between optimal and sub-optimal cytior eduction, dropped sharply from 6.33, 95% C.I. [5.19-10.91] at the level of 500 IU/ml to 0.58, 95% C.I. [0.21-1.63] at the level of 600 IU/ml.
Conclusions
Our data indicate that preoperative Ca-125 is a good predictor for optimal cy^toreduction. The best threshold for this prediction proved to be 500 IU/ml. These patients may be candidates for neo-adjuvant chemotherapy7 treatment. Nevertheless, all clinical and radiological findings must be co-evaluated.
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