Prognostic value of CA125 kinetics, half-life, and nadir in the treatment of epithelial ovarian cancer: a systematic review and meta-analysis

Ji Hyun Kim; Hyun-Woong Cho; Eun Young Park; Kyung-Hee Han; Eun Taeg Kim; Jae-Kwan Lee; Sang-Yoon Park; Robert Armbrust; Christina Fotopoulou; Myong Cheol Lim

doi:10.1136/ijgc-2023-004825

Prognostic value of CA125 kinetics, half-life, and nadir in the treatment of epithelial ovarian cancer: a systematic review and meta-analysis

Int J Gynecol Cancer. 2023 Dec 4;33(12):1913-1920. doi: 10.1136/ijgc-2023-004825.

Authors

Affiliations

¹ Center for Gynecologic Cancer, National Cancer Center, Goyang, Korea (the Republic of).
² Obstetrics and Gynecology, Korea University Guro Hospital, Seoul, Korea (the Republic of).
³ Biostatistics Collaboration Team, Research Core Center, National Cancer Center, Goyang, Korea (the Republic of).
⁴ Department of Obstetrics and Gynecology, CHA Ilsan Medical Center, CHA University, Goyang, Korea (the Republic of).
⁵ Department of Obstetrics and Gynecology, Kosin University College of Medicine, Busan, Korea (the Republic of).
⁶ Department of Obstetrics and Gynecology, College of Medicine, Guro Hospital, Korea University, Seoul, Korea (the Republic of).
⁷ Department of Gynecology, Charite University Hospital Berlin, Berlin, Germany.
⁸ Gynaecologic Oncology, Imperial College London Faculty of Medicine, London, UK.
⁹ Center for Gynecologic Cancer, National Cancer Center, Goyang, Korea (the Republic of) gynlim@gmail.com.

PMID: 37949486
DOI: 10.1136/ijgc-2023-004825

Abstract

Objective: To investigate the prognostic value of cancer antigen 125 (CA125) related variables on progression free survival and overall survival in primary and recurrent ovarian cancers.

Method: A comprehensive review of the Medline, Embase, and Cochrane Library databases was conducted to identify relevant literature on survival outcomes according to the ELIMination Rate Constant K (KELIM), Gynecologic Cancer InterGroup (GCIG) CA125 response criteria, CA125 half-life, and CA125 nadir levels during first line or later line chemotherapy. The search included articles published before February 2023. Cut-off values determining the favorable/unfavorable score of each study were extracted, and pooled hazard ratios (HRs) and 95% confidence intervals (CIs) were analyzed using a random effects model to identify the relationship between survival outcomes of the favorable/unfavorable groups, which was determined by an individual model using CA125 kinetics.

Results: A total of 27 studies with 14 444 patients with epithelial ovarian cancer were included in this meta-analysis. In primary ovarian cancer, a favorable KELIM score, determined by individual modeled cut-off values, was associated with a significant progression free survival (HR 0.53, 95% CI 0.45 to 0.62) and overall survival (HR 0.51, 95% CI 0.43 to 0.62) benefit in the primary setting. The favorable KELIM scored group also correlated with a better progression free survival (HR 0.54, 95% CI 0.47 to 0.62) in relapsed disease. We failed to demonstrate a better prognostic value of the GCIG response criteria and the CA125 half-life for progression free survival and overall survival.

Conclusion: Novel chemotherapy response scores, such as KELIM, may be more clinically relevant than other prognostic models using CA125 kinetics, being directly associated with a more favorable survival in both the primary and relapsed setting in patients with epithelial ovarian cancer.

Study registration: The systemic review and meta-analysis were registered in PROSPERO (CRD42023385512).

Keywords: Carcinoma, Ovarian Epithelial; Ovarian Cancer.

Publication types

Meta-Analysis
Systematic Review

MeSH terms

CA-125 Antigen
Carcinoma, Ovarian Epithelial / therapy
Female
Half-Life
Humans
Neoplasm Recurrence, Local / drug therapy
Ovarian Neoplasms* / drug therapy
Prognosis

Substances

CA-125 Antigen