Published: 2022-10-28

Role of CA 125 in predicting pathological response and recurrence in advanced stage non mucinous epithelial ovarian cancer

Srivalli Ch, Gangadharan V. P., Anupama G.


Background: Ovarian cancer is the most common gynaecological malignancy. Neo adjuvant chemotherapy (NAC) followed by interval cytoreduction is proven to be non-inferior to primary debulking surgery in advanced stage epithelial ovarian cancers (EOC). The data about patterns of reduction of CA125, its cut off value to predict chemotherapy response and recurrence in patients who receive NAC is heterogeneous with varying cut offs. This study aims to evaluate the role of CA125 as a predictive marker of pathological response and recurrence in cases of advanced EOC and to determine cut off for the same.

Methods: This is a prospective study conducted in department of medical oncology, from December 2019 to May 2021. Patients of advanced stage EOC who are on NAC with carboplatin and paclitaxel combination were included (n=33). CA125 values before treatment, after each cycle of chemotherapy, post-surgery, during the course of adjuvant chemotherapy and every 2 months post treatment were noted. As the patient undergoes interval cytoreduction, histopathology reports were followed for chemotherapy response score (CRS). Imaging was done to detect recurrence during follow up, if CA 125 value increases.

Results: The level of CA125 after third cycle of NAC showed significant correlation with chemotherapy response score and DFS in all the patients who were operable at the end of NAC. Patients with normal CA125 value (i.e. <35 U/ml) post 3 cycles chemotherapy had increased chance of having CRS 3 and longer DFS in patients with high grade serous carcinoma. Decline in CA125 value to less than 10 IU/ml post interval cytoreduction also correlates with DFS.

Conclusions: Our study shows that CA125 levels before cytoreductive surgery predicts CRS and DFS of women undergoing NAC for advanced stage EOC.


CA125, Chemotherapy response score, DFS, Epithelial ovarian cancer, NAC

Full Text:



Jemal A, Thomas A, Murray T, Thun M. Cancer statistics, 2002. CA Cancer J Clin. 2002;52(1):23-47.

Hogdall E. Cancer antigen 125 and prognosis. Curr Opin Obstet Gynecol. 2008;20:4-8.

Rodriguez N, Rauh-Hain JA, Shoni M, Berkowitz RS, Muto MG, Feltmate C, et al. Changes in serum CA125 can predict optimal cytoreduction to no gross residual disease in patients with advanced stage ovarian cancer treated with neoadjuvant chemotherapy. Gynecol Oncol. 2012;125:362-6.

Pelissier A, Roulot A, Guéry B, Bonneau C, Bellet D, Rouzier R. Serum CA125 and HE4 levels as predictors for optimal interval surgery and platinum sensitivity after neoadjuvant platinum-based chemotherapy in patients with advanced epithelial ovarian cancer. J Ovarian Res. 2016;9(1):61.

Saygili U, Guclu S, Uslu T, Erten O, Demir N, Onvural A. Can serum Ca-125 levels predict the optimal primary cytoreduction in patients with advanced ovarian carcinoma? Gynecol Oncol. 2002;86(1):57-61.

Furukawa N, Sasaki Y, Shigemitsu A, Akasaka J, Kanayama R, Kawagucji R, et al. CA-125 cut-off value as a predictor for complete interval debulking surgery after neoadjuvant chemotherapy in patients with advanced ovarian cancer. J Gynecol Oncol. 2012;24:141-5.

Osman N, O’Leary N, Mulcahy E, Barrett N, Wallis F, Hickey K, et al. Correlation of serum CA125 with stage, grade and survival of patients with epithelial ovarian cancer at a single centre. Iran Med J. 2008;101(8):245-7.

Friedlander ML, Demno AJ. Prognostic factors in ovarian cancer. Semin Oncol. 1991;18:205-12.

Singh P, Kaushal V, Rai B, Rajwanshi A, Gupta N, Dey P, et al. The chemotherapy response score is a useful histological predictor of prognosis in high-grade serous carcinoma. Histopathology. 2018;72(4):619-25.

Santoro A, Angelico G, Piermattei A, Inzani F, Valente M, Arciuolo D, et al. Pathological chemotherapy response score in patients affected by high grade serous ovarian carcinoma: the prognostic role of omental and ovarian residual disease. Front Oncol. 2019;9:778.

Swenerton KD, Hislop TG, Spinelli J, LeRiche JC, Yang N, Boyes DA. Ovarian carcinoma: a multivariate analysis of prognostic factors. Obstet Gynecol. 1985;65:264-9.

Cowan R, Chi D, Kehoe S, Nankivell M, Leary A. Primary surgery or neoadjuvant chemotherapy in advanced ovarian cancer: the debate continues…. Am Soc Clin Oncol Educ Book. 2016;36:153-62.

Riedinger JM, Eche N, Basuyau JP, Dalifard I, Hacene K, Pichon MF. Prognostic value of serum CA 125 bi-exponential decrease during first line paclitaxel/platinum chemotherapy: a French multicentric study. Gynecol Oncol. 2008;109:194-8.

Kessous R, Wissing MD, Piedimonte S, Abitbol J, Kogan L, Laskov I, et al. CA-125 reduction during neoadjuvant chemotherapy is associated with success of cytoreductive surgery and outcome of patients with advanced high-grade ovarian cancer. Acta Obstet Gynecol Scand. 2020;99(7):933-40.

Kang S, Seo SS, Park SY. Nadir CA 125 level is an independent prognostic factor in advanced epithelial ovarian cancer. J Surg Oncol. 2009;100:244-7.

Prat A, Parera M, Peralta S, Perz-Benavente MA, Garcia A, Gil-Moreno A, et al. Nadir CA 125 concentration in the normal range as an independent prognostic factor for optimally treated advanced epithelial ovarian cancer. Ann Oncol. 2008;19:327-31.

Markman M, Frederico M, Liu PY, Hannigan E, Alberts D. Significance of early changes in the serum CA 125 antigen levelon overall survival in advanced ovarian cancer. Gynecol Oncol. 2006;103(1):195-8.

Luvero D, Milani A, Ledermann JA. Treatment options in recurrent ovarian cancer: latest evidence and clinical potential. Ther Adv Med Oncol. 2014;6(5):229-39.

Vasudev NS, Trigonis I, Cairns DA, Hall GD, Jackson DP, Broadhead T, et al. The prognostic and predictive value of CA-125 regression during neoadjuvant chemotherapy for advanced ovarian or primary peritoneal carcinoma. Arch Gynecol Obstet. 2011;284(1):221-7.

Kehoe S, Hook J, Nankivell M, Jayson GC, Kitchener HC, Lopes T, Luesley D, Perren T, Bannoo S, Mascarenhas M, Dobbs S. Chemotherapy or upfront surgery for newly diagnosed advanced ovarian cancer: Results from the MRC CHORUS trial. J Clin Oncol. 2013;31:15s.

Hynninen J, Lavonius M, Oksa S, Grénman S, Carpén O, Auranen A. Is perioperative visual estimation of intra-abdominal tumor spread reliable in ovarian cancer surgery after neoadjuvant chemotherapy? Gynecol Oncol. 2013;128:229-32.

Cohen PA, Powell A, Böhm S, Gilks CB, Stewart CJR, Meniawy TM, et al. Pathological chemotherapy response score is prognostic in tubo-ovarian high-grade serous carcinoma: A systematic review and meta-analysis of individual patient data. Gynecol Oncol. 2019;154(2):441-8.

Zwakman N, van de Laar R, Van Gorp T, Zusterzeel PL, Snijders MP, Ferreira I, et al. Perioperative changes in serum CA125 levels: a prognostic factor for disease-specific survival in patients with ovarian cancer. J Gynecol Oncol. 2017;28(1):e7.

Viral P, Rajanbabu A, Pavithran K, Chithrathara K, Nair IR, Bhaskaran R, et al. Long-term survival outcome of advanced epithelial ovarian cancer: A single institutional study. Indian J Cancer. 2021;58(3):342-8.

Pelissier A, Bonneau C, Chéreau E. CA125 kinetic parameters predict optimal cytoreduction in patients with advanced epithelial ovarian cancer treated with neoadjuvant chemotherapy. Gynecol Oncol. 2014;135:542-6.