Does a Decrease in CA-125 in Advanced Ovarian Cancer Following Neoadjuvant Chemotherapy Predict the Clinical Outcome of Patients? A Cross-sectional Study

Objectives: Although ovarian cancer is the sixth most common cancer among women, in most cases, it is not diagnosed until it covers the entire peritoneum. In the present study, it was examined the clinical outcomes of the women with epithelial ovarian cancer (EOC) in stage IIIC-IV treated with neoadjuvant chemotherapy (NACT) and its association with decreased ovarian cancer antigen (CA-125). Materials and Methods: In this cross-sectional study, 78 women with EOC (Stage IIIC-IV) who underwent NACT at Imam Khomeini hospital, Tehran, Iran were evaluated. Demographic characteristics, aged at diagnosis, severity and stage of disease, serum CA-125 level, histological type, tumor pathology before and after chemotherapy, overall survival, and recurrence of disease was examined. Results: In total, 78 women with mean age of 52.83 ± 10.18 (between of 29 to 77) years were evaluated. The majority of the patients had positive initial ascitic fluid cytology for malignancy (68.9%). After surgery, papillary serous was the most common histologic finding (73, 81.1%). CA-125 level post NACT (median of 25 U/mL) was significantly reduced compare to before NACT (median of 980 U/mL; P<0.0001), and the rate of CA-125 reduction was significantly lower in older participants’ ages (r=0.274, P=0.017). Survival time showed a significant and strong negative correlation with the CA-125 levels before (r=-0.363, P=0.003) and after NACT (r=- 0.383, P=0.002). Moreover, there was a significant negative correlation between survival time and chemotherapy courses (r=-0.363, P=0.003) and age (r=-0.474, P=0.000). Conclusions: The results of this study showed that the clinical outcomes of patients with advanced ovarian cancer can be predicted by a decrease in serum CA-125 levels after NACT.