What is the prognosis for a patient with elevated Cancer Antigen 125 (CA 125) levels and ascites suggestive of ovarian cancer?

From the Guidelines

The prognosis for a patient with elevated CA 125 levels and ascites suggestive of ovarian cancer is generally poor, with a median survival of 2-4 years, as the presence of ascites typically indicates advanced disease. The management of such patients involves cytoreductive surgery followed by platinum-based chemotherapy, with the goal of achieving optimal debulking and improving survival outcomes 1. It is essential to note that the prognosis depends heavily on disease stage at diagnosis, tumor type, and patient factors, including age, performance status, and response to initial treatment.

When diagnosed at stage III or IV, which is common when ascites is present, five-year survival rates are less than 30% 1. The combination of elevated CA 125 and ascites strongly suggests advanced disease, as ascites typically develops when cancer has spread throughout the peritoneal cavity. However, definitive diagnosis requires pathological confirmation, and prognosis can only be accurately determined after surgical staging and histopathological assessment.

Patient age, performance status, and response to initial treatment significantly impact outcomes. While these findings are concerning, some patients with advanced disease do achieve long-term remission with appropriate treatment, and newer targeted therapies like PARP inhibitors have improved outcomes for certain genetic subtypes. The role of CA 125 monitoring and imaging in surveillance is still debated, with some studies suggesting that early intervention based on elevated CA 125 levels may not improve overall survival 1.

Key factors that influence prognosis include:

• Disease stage at diagnosis
• Tumor type
• Patient age
• Performance status
• Response to initial treatment
• Presence of ascites, which typically indicates advanced disease
• Genetic subtypes, which may be eligible for targeted therapies like PARP inhibitors. The most recent and highest quality study, published in 2013, provides guidance on the management of ovarian cancer, including the role of CA 125 monitoring and imaging in surveillance 1.

From the FDA Drug Label

The safety and efficacy of paclitaxel followed by cisplatin in patients with advanced ovarian cancer and no prior chemotherapy were evaluated in 2, Phase 3 multicenter, randomized, controlled trials In an Intergroup study led by the European Organization for Research and Treatment of Cancer involving the Scandinavian Group NOCOVA, the National Cancer Institute of Canada, and the Scottish Group, 680 patients with Stage IIB-C, III, or IV disease (optimally or non-optimally debulked) received either paclitaxel 175 mg/m2 infused over 3 hours followed by cisplatin 75 mg/m2 (Tc) or cyclophosphamide 750 mg/m2 followed by cisplatin 75 mg/m2 (Cc) for a median of 6 courses. Table 2A Efficacy in the Phase 3 First-Line Ovarian Carcinoma Studies Intergroup (non-optimally debulked subset) GOG-111 T 175/3a c75 (n=218) C750a c75 (n=227) T 135/24a c75 (n=196 ) C750a c75 (n=214 ) • Clinical Responseb - rate (percent)- p-valuec (n=153)58 0.016 (n=153)43 (n=113)62 0.04 (n=127)48 •Time to Progression - median (months)- p-valuec - hazard ratio (HR)c - 95% CIc 13.2 0.00600.760.62-0.92 9. 9 16 .6 0.00080.700.56-0.86 13.0 • Survival - median (months)- p-valuec - hazard ratio (HR)c - 95% CIc 29.5 0.0057730.58-0.91 21.9 35.5 0.00020.640.50-0.81 24. 2

The prognosis for a patient with elevated Cancer Antigen 125 (CA 125) levels and ascites suggestive of ovarian cancer is poor.

• Median survival time for patients with advanced ovarian cancer who received paclitaxel and cisplatin was around 29.5 months in one study and 35.5 months in another study 2.
• Time to progression was around 13.2 months in one study and 16.6 months in another study 2.
• The clinical response rate was around 58% in one study and 62% in another study 2. It is essential to note that these results are based on clinical trials and may not reflect the individual patient's prognosis. The patient's overall health, disease stage, and response to treatment will influence their prognosis.

From the Research

Prognosis for Ovarian Cancer with Elevated CA 125 Levels and Ascites

The prognosis for a patient with elevated Cancer Antigen 125 (CA 125) levels and ascites suggestive of ovarian cancer is generally poor.

• Elevated CA 125 levels are associated with advanced stages of epithelial ovarian cancer (EOC) 3.
• The presence of ascites is also a sign of advanced disease and is often associated with a poor prognosis.

Survival Outcomes

Several studies have investigated the prognostic value of CA 125 levels in ovarian cancer patients.

• One study found that patients with CA 125 levels above 500 IU/ml had a lower median overall survival (25 months) compared to those with levels below 500 IU/ml (46 months) 3.
• Another study found that the CA 125 level after 3 cycles of chemotherapy was a significant predictor of survival, with patients having normal CA 125 levels at 3 months having a median survival of 15+ months compared to 6 months for those with elevated CA 125 levels 4.
• A study published in 2008 found that patients who failed to normalize CA 125 after finishing primary chemotherapy had shortened progression-free survival and overall survival 5.
• A 2017 study found that patients with low post-neoadjuvant chemotherapy CA 125 levels (<35 U/mL) had a higher probability of optimal debulking surgery and longer progression-free survival compared to those with high CA 125 levels (>100 U/mL) 6.

Predictive Value of CA 125

CA 125 levels can be used to predict the outcome of debulking surgery and survival in ovarian cancer patients.

• A preoperative CA 125 cut-off value of 500 IU/ml has been suggested as a promising threshold to predict a successful primary debulking surgery 3.
• Elevated preoperative CA 125 levels have been associated with advanced-stage disease and poor prognosis in patients with serous borderline ovarian tumors 7.