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Annals of Oncology Advance Access originally published online on June 9, 2006
Annals of Oncology 2006 17(8):1234-1238; doi:10.1093/annonc/mdl120
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© 2006 European Society for Medical Oncology

CA 125 half-life and CA 125 nadir during induction chemotherapy are independent predictors of epithelial ovarian cancer outcome: results of a French multicentric study

J. M. Riedinger1,*, J. Wafflart2, G. Ricolleau3, N. Eche4, H. Larbre5, J. P. Basuyau6, I. Dalifard7, K. Hacene8 and M. F. Pichon9

1 Laboratoire de Biologie Médicale, Centre GF. Leclerc, Dijon, France; 2 Laboratoire de Radioanalyse, Institut Bergonié, Bordeaux, France; 3 Laboratoire d' Oncobiologie, Centre René Gauducheau, Nantes, France; 4 Laboratoire de Biologie, Institut Claudius Regaud, Toulouse, France; 5 Laboratoire de Biologie Clinique, Institut J Godinot, Reims, France; 6 Laboratoire de Biologie, Centre H Becquerel, Rouen, France; 7 Laboratoire de Radioanalyse, Centre P. Papin, Angers, France; 8 Service de Statistiques Médicales, Centre René Huguenin, Saint-Cloud, France; 9 Laboratoire d'Oncobiologie, Centre René Huguenin, Saint-Cloud, France

* Correspondence to: Dr J. M. Riedinger, Laboratoire de Biologie Médicale, Centre GF Leclerc, 1 rue du Pr Marion, 21034 Dijon cedex, France. Tel: +33 03 80 73 75 10; Fax: +33 03 80 73 75 26; E-mail: jriedinger{at}dijon.fnclcc.fr


   Abstract
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 Abstract
introduction
 patients and methods
 results
 discussion
 References
 
Background: CA 125 assays enable treatment-response monitoring in ovarian cancer.

Patients and methods: A multicentric study of CA 125 kinetics under induction chemotherapy was performed in 631 patients. CA 125 half-life was calculated by mono-compartmental logarithmic regression. Nadir CA 125 concentration and time to nadir were also studied. Survival analyses for disease-free survival (DFS) and overall survival (OS) used univariate (Kaplan-Meier) and multivariate (Cox) models.

Results: For 553 stage IIC–IV patients, 459 (83.0%) relapsed and 444 (80.3%) died from cancer. Median (range) follow up time was 32 months (2–214 months). Median (range) for CA 125 kinetics were: 263 kU/l (5–52000 kU/l) before 1st course, 15.8 days (4.5–417.9 days) for CA 125 half-life, 16 kU/l (3–2610 kU/l) for nadir and 85 days (0–361 days) for time to nadir. Pre-chemotherapy CA 125, its half-life, nadir concentration and time to nadir all had a univariate prognostic value for DFS and OS (P < 0.0001). In Cox models, CA 125 half-life, residual tumour (P < 0.0001 for both), nadir concentration (P = 0.0002) and stage (P = 0.0118) were the most powerful prognostic factors for DFS. For OS, the significant variables were similar, with age ranking last (P = 0.0319).

Conclusion: Among well-established prognostic factors in ovarian cancers, CA 125 half-life and nadir concentration bear a strong and independent prognostic value.

Key words: CA 125, ovarian cancer, survival


   introduction
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 Abstract
 introduction
patients and methods
 results
 discussion
 References
 
In oncology, treatment responses need to be classified according to standard definitions, such as the widely accepted RECIST (Response Evaluation Criteria in Solid Tumours) guideline [1Go]. However, in ovarian cancer patients without measurable targets, responses cannot be assessed using the RECIST criteria. The CA 125 tumour marker, elevated in 90% of patients with advanced epithelial ovarian cancer, represents an alternative to monitoring treatment responses.

Different prognostic and predictive criteria derived from CA 125 variations under induction chemotherapy have been investigated. Most of the previous studies of CA 125 under chemotherapy included less than 100 patients and there is still no agreement about the prognostic value of post-operative CA 125 [2Go–7Go]. A first approach consisted in defining responses according to precise criteria for CA 125 decrease [8Go–13Go]. Study of CA 125 half-life [2Go, 5Go, 7Go, 14Go–21Go], CA 125 return to normal range after 2 or 3 chemotherapy courses [5Go–7Go, 18Go–19Go, 22Go], nadir CA 125 concentrations [4Go, 23Go] and time to reach the nadir [9Go] were also investigated. We performed a multicentric study with a large cohort of ovarian cancer patients during and after primary treatment to analyse the long term prognostic value of the different criteria linked to CA 125 kinetics.


   patients and methods
Top
 Abstract
 introduction
 patients and methods
results
 discussion
 References
 
patients
Six hundred and thirty-one patients with epithelial ovarian cancer from eight French Cancer Centres were retrospectively studied. Their primary treatment was performed between 1988 and 1996 and patient follow up was censored at May 2005. Diagnostic and treatment procedures, identical in each Centre, followed standard methods included since 1997 in the Standards Options and Recommendations of the French Fédération des Centres de Lutte Contre le Cancer [24Go]. Table 1 summarises patient characteristics. All patients underwent a primary laparotomy and received a first line of chemotherapy including platinum salts and cyclophosphamide. To ensure treatment homogeneity, patients treated by taxanes were excluded from the study.


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  		Table 1. Clinical and pathological characteristics of patients (n = 553)

 
Tumour staging followed the Fédération Internationale de Gynécologie Obstétrique (FIGO) recommendations [25Go]. The number and location of extra-abdominal metastatic sites were recorded. Histological type was determined according to World Health Organisation classification and was grouped into serous, mucinous, endometroid, undifferentiated, clear cell and of unknown histology [26Go]. Tumour grading was not included in the analyses because of insufficient reproducibility [24Go]. Residual tumour after primary surgery was classified into three groups: absence, ≤ 1 cm or > 1 cm.

Induction chemotherapy started 2 to 4 weeks after surgery and patients received 6 ± 1.9 (mean ± SD) chemotherapy courses. Treatment evaluation was based on biological and clinical data recorded at each cycle and on medical imaging. During and after chemotherapy, chest X-rays, abdomino-pelvic scans, MRI or ultrasonography were performed according to identified targets.

Serum CA 125 was measured prior to each cycle (on average each 3 weeks) using the same immunoassay during monitoring.

CA 125 assays
Assays were performed following manufacturer recommendations. All Centres used immunoassays based on monoclonal Centocor/Fujirebio® antibodies but with different assay formats: IRMA-mat CA 125 II (immunoradiometric assay, DiaSorin, Antony, France) was used for 105 patients from Bordeaux Centre, CPE CA 125 II (enzyme-immunoassay, Cis Bio International, Gif sur Yvette, France) was used in Dijon and Toulouse Centres for 199 patients, and ELSA CA 125 II (immunoradiometric assay, Cis Bio International, Gif sur Yvette, France) was used for 327 patients monitored in Angers, Nantes, Reims, Saint-Cloud and Rouen Centres.

All assays were run in duplicate with two levels of control sera in each series. Samples showing more than 10% variation between duplicates were re-assayed. The threshold for CA 125 elevation indicated by the manufacturers was 35 kU/l for all methods.

CA 125 kinetics
Serum CA 125 was measured 1–4 days before the first chemotherapy cycle. Mean interval between the date of surgery and the first chemotherapy course was 20 ± 7 days. The lowest CA 125 concentration reached during or after chemotherapy (nadir) and the time elapsed from start of chemotherapy to nadir were also recorded. CA 125 half-life (T1/2) calculation, considered as an early indicator of tumour chemo-sensitivity, was based on a mono-compartmental model and an exponential regression: T1/2 = Ln 2/s, where s is the slope of the regression line and Ln the natural logarithm. A minimum of three serial and aligned Ln CA 125 concentrations in the first six blood samples was required to enable regression line calculation. The regression was considered significant only if its correlation coefficient r was ≥ 0.95, allowing CA 125 half-life results to be taken into account. To ensure unbiased calculations of CA 125 half-life, only cases with pre-chemotherapy CA 125 ≥ 100 kU/l were included in statistical analyses.

statistical methods
Disease-free survival (DFS) was defined as the time elapsed from the date of the first chemotherapy cycle to the date of clinically proven recurrence. Overall survival (OS) was calculated from the date of the first chemotherapy cycle to the date of cancer-related death. Patients without recurrences or still alive were censored at study endpoint (May 30, 2005).

Since the post-operative CA 125 distribution was not Gaussian, non-parametric statistics were used. The Chi-square test was used for comparison of observed frequencies. Receiver operating characteristics curves (ROC) were used to define the thresholds of CA 125 kinetics parameters in view of survival analyses.

Univariate survival analyses were performed using the Kaplan-Meier method and log-rank test [27Go]. Cox models were used for multivariate survival analyses [28Go]. For all statistical tests, the level of significance was P ≤ 0.05. Statistical softwares used were SAS v. 8.2 (Cary, NC, USA) and MedCalc v. 8.0 (Mariakerke, Belgium).


   results
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 Abstract
 introduction
 patients and methods
 results
discussion
 References
 
patients
Six hundred and thirty one patients were included in this multicentric study. Thirty-three patients (5%) were removed because of incomplete serial CA 125 measures, absence of chemotherapy, treatment including taxanes, or deaths unrelated to ovarian cancer. For prognostic studies, only stage IIC to IV patients were included (n = 553). Their main characteristics are summarised in Table 1. Ascites was noted for 393 (62.3%) patients. Eighty-four percent of the patients received chemotherapy including cyclophosphamide + platinum salts, 16 % cyclophosphamide + platinum salts + anthracycline with a mean ± SD number of cycles of 6.1 ± 1.9 and 5.4 ± 2.3 respectively.

comparison of patients and CA 125 concentrations in the different centres
Mean number of CA 125 determinations per patient was 12 ± 4. As three different immunoassays were used by the participating centres, the homogeneity of patient characteristics with regard to CA 125 results was tested. Median CA 125 was 214 kU/l (range 5–52 000, n = 172) for CPE CA 125 II, 230 kU/l (range 9–14 000, n = 278) for ELSA CA 125 II and 350 kU/l (range 25–21 200, n = 103) for IRMA-mat CA 125 II (significant difference, P = 0.008). Pairwise comparisons showed non significant differences between CPE CA 125 II and ELSA CA 125 II methods but significant differences with IRMA-mat CA 125 II. The IRMA method was used by a single centre which included 94 of 103 (91.3%) of stage IIIC or IV patients with 84.5% of residual tumour after surgery, whereas the mean proportions were respectively 324 of 450 (72.0% stage IIIC or IV) and 321 of 450 (71.3%) with residual tumour for the other methods. These proportions are significantly different (P = 0.0001 for stage IIIC or IV and P = 0.009 for residual tumour). It was thus considered that the higher median CA 125 level obtained with IRMA-mat CA 125 II was due to the high proportion of advanced stages and positive residual tumour, and consequently all CA 125 results were pooled for statistical analyses.

distribution of CA 125-related parameters during ovarian cancer monitoring
For stage IIC–IV patients, median CA 125 measured before first chemotherapy course was 263 kU/l, (range 5–52 000 kU/l), median CA 125 half-life was 15.8 days (range 4.5–417.9 days), median CA 125 nadir concentration was 16 kU/l (range 3–2610 kU/l) and median time to nadir was 85 days (range 0–361 days). Median CA 125 before first chemotherapy course was related to residual tumour mass: absence of residual tumour: 78 kU/l (range 5–2985 kU/l), residual tumour ≤ 1 cm: 165 kU/l (range 18–1911 kU/l), residual tumour > 1 cm: 915 kU/l (range 40–52000 kU/l) (P < 0.0001).

univariate survival analyses
Survival analyses were performed according to four criteria: pre-chemotherapy CA 125, CA 125 half-life, CA 125 nadir and time to nadir. In order to delineate dichotomised subgroups for Kaplan-Meier analysis, ROC curves for each parameter were performed with relapse or death as classification variables. With relapse as classification variable, area under ROC curves (AUC) were 0. 680 (95% confidence interval (CI) 0.640–0.719) for pre-chemotherapy CA 125, 0.810 (95% CI 0.769–0.847) for CA 125 half-life, 0.731 (95% CI 0.692–0.767) for CA 125 nadir and 0.677 (95% CI 0.636–0.716) for time to nadir. With death as classification variable AUC and 95% CI were 0.689 (0.648–0.727) for pre-chemotherapy CA 125, 0.770 (0.727–0.810) for CA 125 half-life, 0.721 (0.682–0.758) for CA 125 nadir and 0.669 (0.628–0.708) for time to nadir. Cut-offs obtained were the following: 230 kU/l for pre-chemotherapy CA 125, 14 days for CA 125 half-time, 20 kU/l for CA 125 nadir and 72 days for time to CA 125 nadir.

Among stages IIC–IV patients, 459 (83.0%) relapsed and 444 (80.3%) died from ovarian cancer. Median DFS was 19 months (range 1–214 months) and median OS was 32 months (range 2–214 months). The four parameters linked to CA 125 kinetics had a strong prognostic value for DFS and OS with P < 0.0001 (Table 2).


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  		Table 2. Results of Kaplan–Meier analysis (stage IIC-IV ovarian cancers)

 
multivariate survival models
For the variable CA 125 half-time, only cases with validated half-life calculation (i.e. pre-chemotherpy CA 125 ≥ 100 kU/l) were included (n = 415). During follow up, 459 recurrences and 444 deaths were recorded in the IIC–IV group, including 364 recurrences and 356 deaths in the subgroup with validated half-life calculation. Clinico-pathological variables introduced in the Cox models were: age, (continuous or dichotomised with 50 years as cut-off), FIGO stage, residual tumour mass and tumour histology in three groups (serous, mucinous or undifferenciated). Parameters related to CA 125 kinetics were introduced as continuous and as dichotomised variables. For the whole population (n = 553), the models obtained were identical for DFS and OS, with CA 125 nadir and residual tumour ranking first (all with P < 0.0001) followed by age as a continuous variable (P = 0.0236 for DFS and P = 0.0019 for OS) and FIGO stage (P = 0.0236 for DFS and P = 0.0072 for OS). Table 3 shows the results of Cox models for DFS and OS in the subgroup with validated CA 125 half-life.


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  		Table 3. Results of Cox models for 415 patients with validated half-life

 

   discussion
Top
 Abstract
 introduction
 patients and methods
 results
 discussion
References
 
It is now widely accepted that the tumour marker CA 125 is a predictive and prognostic factor in CA 125 positive ovarian cancers. Different criteria derived from CA 125 kinetics during primary treatment have been investigated [2Go, 5Go, 11Go, 17Go, 19Go]. When calculating CA 125 half-life most of the authors, except Buller, used only two selected time points, i.e. before chemotherapy and up to 3 months later. This implies that the CA 125 decrease under chemotherapy always follows a mono-compartmental model. Our results provide the basis for this assumption. Rustin proposed another set of criteria based on assigned proportions of CA 125 decrease with two or three serial samples [10Go].

All objective criteria derived from CA 125 kinetics under induction chemotherapy were compared in a large series of patients with a long follow up time. Our results show that, among other well-established prognostic factors in ovarian cancers, two parameters bear a strong and independent prognostic value: CA 125 half-life and CA 125 nadir concentration. To be reliable, the CA 125 half-life should be calculated from the start of chemotherapy on a minimum of three serial samples enabling the calculation of a regression line and a correlation coefficient. This method is now widely accessible through software provided with immunoassay equipment or by using popular spreadsheets. Its only drawback is when the pre-chemotherapy CA 125 is too low (< 100 kU/l) to enable half-life calculations. However, most of the ovarian cancers are detected in advanced stages, 70% in stages III and IV, and show elevated CA 125 levels after primary surgery [6Go]. Furthermore, the CA 125 nadir, the second powerful criteria from our results, is available even if CA 125 half-life cannot be ascertained. It is noteworthy that the discriminant cut-off found for CA 125 nadir (20 kU/l) for DFS and OS in stage IIC–IV patients is significantly lower than the usual cut-off proposed by manufacturers (35 kU/l). The latter was established for untreated ovarian cancer patients without taking into account patient menopausal status.

To conclude, CA 125 half life and nadir concentration are powerful independent prognostic factors which warrants to be compared to the classical prognostic factors in prospective protocols of ovarian cancers treatment.


Figure 1
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  		Figure 1. Kaplan-Meier cumulative survival plot for OS according to CA 125 half-life during induction chemotherapy in stage IIC–IV patients (n = 415). Cut-off 14 days, • ≤ 14 days, {circ} > 14 days.

 

Figure 2
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  		Figure 2. Kaplan-Meier cumulative survival plot for OS according to CA 125 nadir concentration during or after induction chemotherapy in stage IIC–IV patients (n = 553). Cut-off 20 kU/l, • ≤ 20 kU/l, {circ} > 20 kU/l.

 
Received for publication July 13, 2005. Revision received March 22, 2006. Accepted for publication April 13, 2006.


   References
Top
 Abstract
 introduction
 patients and methods
 results
 discussion
 References
 
1. Therasse P, Susan G, Arbuck SG et al. New guidelines to evaluate the response to treatment in solid tumors. J Natl Cancer lnst 2000; 92: 205–16.[Abstract/Free Full Text]

2. Van Den Burg MEL, Lammes FB, Van Putten WLJ, Stoter G. Ovarian Cancer: the prognostic value of the serum half-life of CA 125 during induction chemotherapy. Gynecol Oncol 1988; 30: 307–312.[CrossRef][Web of Science][Medline]

3. Makar AP, Kristensen GB, Kaern J et al. Prognostic value of pre- and postoperative serum CA 125 levels in ovarian cancer: new aspects and multivariate analysis. Obstet Gynecol 1992; 79: 1002–10.[Web of Science][Medline]

4. Gard GB, Houghton CR. An assessment of the value of serum CA 125 measurements in the management of epithelial ovarian carcinoma. Gynecol Oncol 1994; 53: 283–289.[CrossRef][Web of Science][Medline]

5. Gadducci A, Zola P, Landoni F et al. Serum half-life of CA 125 during early chemotherapy as an independent prognostic variable for patients with advanced epithelial ovarian cancer: Results of a Multicentric Italian Study. Gynecol Oncol 1995; 58: 42–47.[CrossRef][Web of Science][Medline]

6. Munstedt K, Krisch M, Sachsse S, Vahrson H. Serum CA 125 levels and survival in advanced ovarian cancer. Arch Gynecol Obstet 1997; 259: 117–23.[CrossRef][Web of Science][Medline]

7. Colakovic S, Lukic V, Mitrovic L et al. Prognostic value of CA125 kinetics and half-life in advanced ovarian cancer. Int J Biol Markers 2000; 15: 147–52.[Web of Science][Medline]

8. Makar AP, Kristensen GB, Bormer OP, Trope CG. Serum CA 125 level allows early identification of nonresponders during induction chemotherapy. Gynecol Oncol 1993; 49: 73–79.[CrossRef][Web of Science][Medline]

9. Frasci G, Conforti S, Zullo F et al. A risk model for ovarian carcinoma patients using CA 125. Time to normalization renders second-look laparotomy redundant. Cancer 1996; 77: 1122–30.[CrossRef][Web of Science][Medline]

10. Rustin GJS, Nelstrop AE, McClean P et al. Defining response of ovarian carcinoma to initial chemotherapy according to serum CA 125. J Clin Oncol 1996; 14: 1545–1551.[Abstract/Free Full Text]

11. Peters-Engl C Obermair A, Heinzl H et al. CA 125 regression after two completed cycles of chemotherapy: lack of prediction for long-term survival in patients with advanced ovarian cancer. Br J Cancer 1999; 81: 662–666.[CrossRef][Web of Science][Medline]

12. Bridgewater JA, Nelstrop AE, Rustin GJS et al. Comparison of standard and CA-125 response criteria in patients with epithelial ovarian cancer treated with platinum or paclitaxel. J Clin Oncol 1999; 17: 501–508.[Abstract/Free Full Text]

13. Rustin GJS. Use of CA-125 to assess response to new agents in ovarian cancer trials. J Clin Oncol 2003; 21: 187s–193s.[Abstract/Free Full Text]

14. Hawkins RE, Roberts K, Wiltshaw E et al. The prognostic significance of the half-life of serum CA 125 in patients responding to chemotherapy for epithelial ovarian carcinoma. Br J Obstet Gynaecol 1989; 96: 1395–9.[Web of Science][Medline]

15. Hogberg T, Kagedal B. Serum half-life of the tumor marker CA 125 during induction chemotherapy as a prognostic indicator for survival in ovarian carcinoma. Acta Obstet Gynecol Scand 1990; 69: 423–9.[Medline]

16. Markowska J, Kopczynski Z, Manys G, Szewierski Z. CA 125 in monitoring chemotherapy of patients with ovarian cancer: early response to the treatment. Neoplasma 1990; 37: 687–92.[Web of Science][Medline]

17. Buller RE, Berman ML, Bloss JD et al. CA 125 regression: a model for epithelial ovarian cancer response. Am J Obstetr Gynecol 1991; 165: 360–367.[Web of Science][Medline]

18. Rosman M, Hayden CL, Thiel RP et al. Prognostic indicators for poor risk epithelial ovarian carcinoma. Cancer 1994; 74: 1323–1328.[CrossRef][Web of Science][Medline]

19. Buller RE, Vasilev S, DiSaia PJ. CA 125 kinetics: a cost-effective clinical tool to evaluate clinical trial outcomes in the 1990s. Am J Obstetr Gynecol 1996; 174: 1241–125.[CrossRef][Web of Science][Medline]

20. Riedinger JM, Barillot I, Coudert B et al. Prognostic value of CA 125 initial half-life measured during first-line chemotherapy in 62 patients with epithelial ovarian cancer stage III or IV. Bull Cancer 1996; 63: 654–663.

21. Gadducci A, Cosio S, Fanucchi A et al. The predictive and prognostic value of serum CA 125 half-life during paclitaxel/platinum-based chemotherapy in patients with advanced ovarian carcinoma. Gynecol Oncol 2004; 93: 131–6.[CrossRef][Web of Science][Medline]

22. Ferrero JM, Largillier R, Ramaioli A et al. Prognostic value of early normalization of CA 125 during chemotherapy in stages III and IV ovarian tumors. Bull Cancer 1997; 84: 722–728.[Web of Science][Medline]

23. Crawford SM, Peace J. Does the nadir CA125 concentration predict a long-term outcome after chemotherapy for carcinoma of the ovary? Ann Oncol 2005; 16(1): 47–50.[Abstract/Free Full Text]

24. Standards Options et Recommandations. Ovarian Cancer. Kerbrat P, Lhomme C, Fervers B et al. French National Fédération of cancer (FNCLCC). Br J Cancer 2001; 84 Suppl 2: 18–23.

25. International Federation of Gynaecology and Obstetrics (FIGO). Changes in definitions of clinical staging for carcinoma of the cervix and ovary. Am J Obstet Gynecol 1987; 156: 263–264.[Medline]

26. World Health Organization Classification of Tumours. Pathology and Genetics of Tumours of the Breast and Female Genital Organs. IARC Press: Lyon 2003.

27. Kaplan EL and Meier P. Nonparametric estimation from incomplete observations. J Am Stat Assoc 1958; 53: 457–481.[CrossRef][Web of Science]

28. Cox DR. Regression models and life tables (with discussion). J Royal Stat Soc 1972; B 34: 187–220.


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