Prognostic value of CT-PCI and CA-125 changes following neoadjuvant chemotherapy in advanced epithelial ovarian cancer: A retrospective study from Vietnam

Abstract

Introduction

This study aimed to evaluate the prognostic significance of CT-based Peritoneal Cancer Index (CT-PCI) scores and serum CA-125 levels, assessed before and after neoadjuvant chemotherapy (NACT), in relation to surgical outcomes and survival among patients with advanced-stage epithelial ovarian cancer (EOC).

Methods

This retrospective study included 96 patients with advanced EOC who received NACT followed by interval debulking surgery (IDS) at Hanoi Medical University Hospital and the National Cancer Hospital (K Hospital), Vietnam, between 2019 and 2024. CT-PCI scores and CA-125 levels were assessed both pre- and post-NACT. The associations between these changes and surgical outcomes, particularly optimal cytoreduction, were analyzed.

Results

The mean age was 59.17 years (SD = 9.78), with 94.8 % of patients diagnosed with high-grade serous carcinoma and 51.0 % classified as FIGO stage IIIC. Median CT-PCI scores decreased from 14.0 (IQR: 7.0–19.0) to 4.0 (IQR: 2.0–8.0), and median CA-125 levels declined from 1248 U/ml (IQR: 389–2855) to 31.25 U/ml (IQR: 16.75–147.3) post-treatment (both p < 0.01). Optimal cytoreduction was achieved in 84.4 % of cases. Post-NACT CT-PCI scores and CA-125 levels > 35 U/ml were significantly associated with suboptimal cytoreduction (cOR = 1.15, 95 % CI: 1.03–1.27, p = 0.01; and cOR = 5.26, 95 % CI: 1.38–33.00, p = 0.02, respectively). Median progression-free survival was 20.5 months; median overall survival was 36.7 months.

Conclusion

Post-treatment CT-PCI scores and CA-125 levels are valuable prognostic indicators in advanced epithelial ovarian cancer. Their reduction following NACT correlates significantly with improved progression-free and overall survival. These findings support their potential role in informing clinical decision-making and tailoring personalized treatment strategies.