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糖类抗原125动态变化及术前正常化状态对晚期上皮性卵巢癌新辅助化疗后手术结局和预后的影响
张天骄, 陈川, 李敏, 吴大保, 申震
中国实用妇科与产科杂志 ›› 2026, Vol. 42 ›› Issue (7) : 726-731.
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糖类抗原125动态变化及术前正常化状态对晚期上皮性卵巢癌新辅助化疗后手术结局和预后的影响
Effects of dynamic changes and preoperative normalization of CA125 on surgical outcomes and prognosis after neoadjuvant chemotherapy in advanced epithelial ovarian cancer
目的 探讨晚期上皮性卵巢癌（EOC）患者在新辅助化疗（NACT）期间糖类抗原125（CA125）的动态演变规律，评估CA125动力学指标及术前正常化状态对中间型肿瘤细胞减灭术（IDS）满意切除及无进展生存期（PFS）的预测价值。方法 回顾性分析2017年7月至2025年10月在中国科学技术大学附属第一医院102例接受NACT治疗的晚期EOC患者的临床病理资料及术前实验室检查指标。计算各疗程及术前CA125相对于基线的百分比下降率（PRR）。采用受试者工作特征（ROC）曲线评估各项指标对R0切除的预测效能，采用单因素及多因素Cox比例风险回归模型分析PFS相关因素及独立预后因素。结果 ROC曲线分析显示，基线CA125及各阶段PRR对预测中间型减瘤术实现R0切除的效能均较低（AUC均<0.6），未发现R0切除的独立预测因子。而术前CA125正常化可显著改善患者预后，多因素Cox回归分析证实其为PFS的独立保护因素[风险比（HR）=0.429，95%置信区间（CI） 0.272~0.677，P<0.01）。结论 NACT期间CA125的下降率不能有效预测IDS能否实现R0切除，且未发现R0切除的独立预测因子，提示临床不应将CA125的水平及下降率作为是否能够达到R0切除的决策依据。但术前CA125正常化是评估行NACT的晚期EOC患者PFS的独立预后指标，而非手术预测指标。对术前CA125未能正常化的患者，应警惕复发风险并制定积极的个体化维持治疗策略。
Objective Objective To investigate the dynamic changes in carbohydrate antigen 125 （CA125） during neoadjuvant chemotherapy （NACT） in patients with advanced epithelial ovarian cancer （EOC），and to evaluate the predictive value of CA125 kinetic parameters and preoperative CA125 normalization for achieving R0 resection during interval debulking surgery （IDS） and for progression-free survival （PFS）. Methods A retrospective analysis was conducted on clinicopathological data and preoperative laboratory parameters from 102 patients with advanced EOC who underwent NACT in the first affiliated hospital of USTC from July 2017 to October 2025. The percentage reduction rate （PRR） of CA125 from baseline was calculated after each chemotherapy cycle and before surgery. Receiver operating characteristic （ROC） curve analysis was used to assess the predictive performance of various parameters for achieving R0 resection. Univariate and multivariate Cox proportional hazards regression models were employed to analyze PFS-related factors and independent prognostic factors. Results ROC curve analysis revealed that baseline CA125 and PRR at various stages had low predictive efficacy for achieving R0 resection during interval debulking surgery （all AUC<0.6），and no independent predictors for R0 resection were identified. However，normalization of preoperative CA125 was significantly associated with improved patient prognosis. Multivariate Cox regression analysis confirmed it as an independent protective factor for PFS （HR=0.429，95%CI 0.272-0.677，P<0.01）. Conclusions The reduction rate of CA125 during NACT cannot effectively predict optimal R0 resection，and no independent predictors for R0 resection were found，indicating that the level and reduction rate of CA125 should not be used as the basis for surgical decision-making of achieving R0 resection in clinical practice. Preoperative CA125 normalization serves as an independent prognostic indicator for PFS in advanced EOC patients undergoing neoadjuvant chemotherapy，rather than a predictive indicator for surgical outcomes. Clinicians should be alert to the risk of relapse and tailor more aggressive maintenance therapies for patients failing to achieve CA125 normalization.
上皮性卵巢癌 / 新辅助化疗 / 中间型肿瘤细胞减灭术 / 糖类抗原125动力学 / 无进展生存期
epithelial ovarian cancer / neoadjuvant chemotherapy / interval debulking surgery / CA125 kinetics / progression-free survival
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Ovarian cancer patients with elevated serum CA125 levels after operation have a high incidence of relapse or metastasis. 18F‐FDG PET/CT is an effective imaging method for identifying recurrent or metastatic lesions. This study systematically investigated the diagnostic value of 18F‐FDG PET/CT in this patient population.
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刘浚源, 刘原, 张祎, 等. 糖类抗原125动力学变化在卵巢癌初次肿瘤细胞减灭术患者预后评估中的应用研究[J]. 中国实用妇科与产科杂志, 2023, 39(5):547-551. DOI:10.19538/j.fk2023050114.
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BRCA mutation and homologous recombination deficiency (HRD) are the criteria for the administration of PARP inhibitor (PARPi) maintenance therapy. It is known that PARPi efficacy is related to platinum sensitivity and that the latter can be demonstrated from the CA-125 elimination rate constant (KELIM). This study aims to investigate if KELIM can be another tool in the identification of patients that could be benefit from PARPi therapy. Retrospective analysis of patients with high-grade serous advanced ovarian cancer that underwent cytoreduction and was further tested for HRD status. The HRD status was tested either by myChoice HRD CDx assay or by RediScore assay. KELIM score was measured in both neoadjuvant and adjuvant settings with the online tool biomarker-kinetics.org. A total of 39 patients had available data for estimating both HRD status and KELIM score. When assuming KELIM as a binary index test with the value 1 as the cut-off point, the sensitivity was 0.86, 95% CI (0.64–0.97) and the specificity was 0.83, 95% CI (0.59–0.96). On the other hand, when assuming KELIM as a continuous index test, the area under the curve (AUC) was 81% and the optimal threshold, using the Youden index, was identified as 1.03 with a sensitivity of 85.7% and a specificity of 83.3%. KELIM score seems to be a new, cheaper, and faster tool to identify patients that can benefit from PARPi maintenance therapy.
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In patients with recurrent advanced ovarian cancer, there is a need for companion tests to guide the development of innovative chemotherapy‐free treatments. The modeled longitudinal CA‐125 ELIMination rate constant K KELIM‐B was a major prognostic factor for progression‐free survival (PFS) and overall survival (OS) in recurrent advanced ovarian cancer patients treated with bevacizumab, olaparib, and durvalumab in the BOLD trial. The objective was to determine if a joint semi‐mechanistic model with tumor size and CA‐125 kinetics would increase KELIM‐B accuracy/prognostic value. The BOLD phase II trial (NCT04015739) investigated the triplet regimen in 74 patients with recurrent platinum‐sensitive/resistant advanced ovarian cancer. Two kinetic‐pharmacodynamic models were developed to fit the data collected during the first 100 treatment days: (1) a CA‐125 longitudinal kinetics model, and (2) a joint model integrating both CA‐125 kinetics and tumor size. The prognostic value of KELIM‐B and KELIM‐joint was assessed using univariate/multivariate analyses (PFS/OS). The modeling of CA‐125 and tumor size dynamics was feasible with adequate quality checks. The prognostic value of the categorical KELIM‐joint, binarized by the median (PFS, HR = 0.29, 95% CI [0.12–0.72]; OS, HR = 0.24, 95% CI [0.08–0.74]), was not clinically different from that of KELIM‐B (PFS, HR = 0.35, 95% CI [0.14–0.84]; OS, HR = 0.34, 95% CI [0.12–0.99]). Interactions between tumor size changes and CA‐125 kinetics could be assessed in the joint model. However, the improvement in prognostic value was not sufficient to justify the higher complexity of the joint model. Assessing early longitudinal CA‐125 kinetics alone remains the best pragmatic strategy for future development.
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张若, 杨茜, 张国楠. KELIM评分在晚期卵巢癌治疗中的应用价值[J]. 中国实用妇科与产科杂志, 2024, 40(8):855-858. DOI:10.19538/j.fk2024080117.
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所有作者均声明不存在利益冲突
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