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Prognostic Significance of Rising Serum CA-125 Levels Within the Normal Range in Patients With Epithelial Ovarian, Primary Peritoneal, and Tubal Cancers, Who, After Initial Treatment, Had a Complete Clinical Response
  1. Tally Levy, MD*,,,
  2. Roi Weiser, MD,§,
  3. Mona Boaz, PhD,,
  4. Erez Ben Shem, MD*,,,
  5. Abraham Golan, MD, FRCOG, and
  6. Joseph Menczer, MD*,,
  1. *Division of Gynecologic Oncology and
  2. Department of Obstetrics and Gynecology, Edith Wolfson Medical Center, Holon;
  3. Sackler Faculty of Medicine, Tel Aviv University;
  4. §Division of General Surgery, Sourasky Medical Center, Tel Aviv;
  5. Epidemiology and Research Unit, Edith Wolfson Medical Center, Holon; and
  6. Nutrition Department, School of Health Sciences, Ariel University Center, Ariel, Israel.
  1. Address correspondence and reprint requests to Tally Levy, MD, Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, E. Wolfson Medical Center, Holon, Israel. E-mail: levyt{at}


Objective This study aimed to assess the ability of 3 criteria of rising CA-125 levels within the reference range to predict recurrence in patients with ovarian, primary peritoneal, and tubal carcinomas after complete clinical response to initial treatment.

Material and Methods Included were patients diagnosed during 1998 to 2008 who fulfilled the following criteria: CA-125 levels of 35 U/mL or greater at diagnosis and recurrence, full primary treatment with a complete clinical and radiographic response, follow-up according to schedule, and at least 2 CA-125 results within the reference range during follow-up. Three criteria of rising CA-125 values within the reference range were used for the prediction of recurrence: (1) an absolute increase of 5 U/mL or higher from the nadir value at completion of chemotherapy, (2) early signal of progressive disease criterion, and (3) a rise to an absolute level of 20 U/mL or greater.

Results Of 82 patients who satisfied study inclusion criteria, 58 (70.7%) had disease recurrence. Early signal of progressive disease and a rise to an absolute level of 20 U/mL or greater were highly statistically significant predictors of disease recurrence (odds ratio, 12.62 [95% confidence interval, 2.71–58.7], P = 0.0012; and odds ratio, 6.7 [95% confidence interval, 2.18–20.54], P = 0.001, respectively) and preceded recurrence by a median of 3 and 3.3 months, respectively.

Conclusions Our data indicate that the early signal of progressive disease criterion and a single rise to an absolute level of 20 U/mL or greater within reference limits are highly predictive of clinical recurrence, although the latter is simpler to use. However, whether this is of practical clinical value remains to be proven.

  • Ovarian
  • Primary peritoneal and tubal carcinoma
  • Complete clinical response
  • Rising CA-125 within reference limits
  • Recurrence

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  • This work was performed in partial fulfillment of Roi Weiser’s MD thesis requirements of the Sackler Faculty of Medicine, Tel Aviv University.

  • The authors declare no conflicts of interest.