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Effects of dynamic changes and preoperative normalization of CA125 on surgical outcomes and prognosis after neoadjuvant chemotherapy in advanced epithelial ovarian cancer
ZHANG Tian-jiao, CHEN Chuan, LI Min, WU Da-bao, SHEN Zhen
Chinese Journal of Practical Gynecology and Obstetrics ›› 2026, Vol. 42 ›› Issue (7) : 726-731.
PDF(2232 KB)
PDF(2232 KB)
Effects of dynamic changes and preoperative normalization of CA125 on surgical outcomes and prognosis after neoadjuvant chemotherapy in advanced epithelial ovarian cancer
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.
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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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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倪丽, 王莹莹, 朱晨辰, 等. 卵巢癌高风险患者行预防性手术105例临床资料分析[J]. 中国实用妇科与产科杂志, 2025, 41(7):738-741. DOI:10.19538/j.fk2025070115.
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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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