CA-125: an inaccurate surveillance tool immediately after cytoreductive surgery and hyperthermic intraoperative chemotherapy (CRS-HIPEC)?

Figures & data

Table 1. Previous studies comparing pre and post-operative CA-125 levels.

Study	Cohort	Relevant findings
[10]	873 patients undergoing abdominal surgical treatment for benign disease and cancer	Raised in 62% of patients with normal pre-operative CA-125 Maximum levels of CA-125 seen 2–4 h after operation with elevations persisting up to 3 months
[12]	Patients undergoing second-look laparotomy in ovarian cancer (n = 28), radical hysterectomy in cervical cancer (n = 42) or aortic surgery for atherosclerotic occlusive disease or aneurysm (n = 14)	Rising CA-125 seen in 82% regardless of primary diagnosis, type of operation or sex Highest levels during second week after operation normalised 8 weeks post-surgery
[15]	Patients with ovarian cancer (n = 50), uterine cancer (n = 60), gastrointestinal cancers (n = 20) and benign gynaecological diseases (n = 40)	Significant increases in CA-125 for ovarian (18%), uterine (30%), and gastrointestinal (75%) cancers, and for benign gynaecological diseases (23%)
[16]	17 patients with ovarian cancer	Increased CA-125 in 5 patients (29%) Increased CA-125 observed after initial postoperative fall in 9 patients (53%)
[17]	Patients undergoing abdominal surgery (n = 19) vs. patients undergoing extra-abdominal surgery (n = 21)	Increased CA-125 in 53.5% of patients undergoing peritonectomy vs. 16.7% of patients undergoing extra-peritoneal surgery (p < 0.03)
[11]	94 patients undergoing hysterectomy for benign gynaecological conditions	No change in CA-125 at 24 h after operation

Table 2. Patient demographics.

Category	Parameter	Mean ± SD	Range	Median
Patient characteristics	Age (years)	51 ± 11	19–75	52
	Gender	15 Male (18%)	70 Female (82%)
Intra-operative parameters	Duration (h)	460 ± 150	200–800	460
	PCI score	12 ± 7.5	0–31	10
Surgical procedures	40 sub-diaphragmatic stripping (47%), 46 Colectomy (54%), 23 small bowel resection (27%), 18 cholecystectomy (21%), 19 splenectomy (22%), 21 THBSO (25%), 4 gastrectomy (4.7%), 2 bladder/ureteric resection (2.4%) and 52 Others (61%)
Primary	26 ovarian (31%), 26 colorectal (31%), 14 appendiceal (16%), 8 primary peritoneal (9.4%), 3 mesothelioma (3.5%) and 8 other (9.4%)
Short-term post-operative outcomes	Serious morbidity	14 (16%)
	60 d mortality	0 (0%)
	Incomplete cytoreduction	0 (0%)
	SICU stay	1.3 ± 2.2	0–16	1
	Total hospital stay	19 ± 18	6–77	14

Table 3. Number of patients with normal or raised pre- and post-operative CA-125 (>35 U/ml). normal = CA-125 < 35 U/ml, raised = CA-125 > 35 U/ml that subsequently normalised, raised (persistent)=CA-125 > 35 U/ml that failed to normalise.

	Pre-operative		Post-operative reading when normal pre-operative			Post-operative reading when raised pre-operative
	Normal	Raised	Normal	Raised	Raised (persistent)	Normal	Raised	Raised (persistent)
Appendiceal	9 (64.3%)	5 (35.7%)	3 (33.3%)	5 (55.6%)	1 (11.1%)	1 (20%)	1 (20%)	3 (60%)
Colorectal	22 (84.6%)	4 (15.4%)	14 (63.6%)	6 (27.3%)	2 (9.1%)	1 (25%)	1 (25%)	2 (50%)
Ovarian	11 (42.3%)	15 (57.7%)	7 (63.6%)	3 (27.3%)	1 (9.1%)	2 (13.3%)	5 (33.3%)	8 (53.3%)
Mesothelioma	3 (100%)	0 (0%)	2 (66.7%)	0 (0%)	1 (33.3%)	na	na	na
Primary Peritoneal	6 (75%)	2 (25%)	5 (83.3%)	1 (16.7%)	0 (0%)	0 (0%)	0 (0%)	2 (100%)
Others	6 (75%)	2 (25%)	4 (66.7%)	1 (16.7%)	1 (16.7%)	0 (0%)	1 (50%)	1 (50%)
Total	57 (67.1%)	28 (32.9%)	35 (61.4%)	16 (28.1%)	6 (10.5%)	4 (14.3%)	8 (28.6%)	16 (57.1%)

Table 4. Average pre- and post-operative CA-125 reading in (n = 85 patients total).

	Pre-operative		Post-operative		Pre- to post-operative change
	Average CA-125	Range	Average CA-125	Range	Average change in CA-125	Range
Appendiceal	36.8	6.3–109	39.2	6.7–64.7	+2.4	−88.9–+44.9
Colorectal	29.9	3–178	40.4	8.6–217.0	+10.5	−120.9–+193.0
Ovarian	353.0	11.9–6131	55.4	13.1–275.7	−297.6	−5.855.3–+35.0
Mesothelioma	8.9	5.5–11.4	40.9	6.0–102.0	+32.1	−3.7–+90.6
Primary Peritoneal	38.9	5.7–149	24.6	6.9–52.6	−14.3	−112.0–+13.9
Others	18.8	0.7–63.4	42.3	11.4–122.4	+23.5	+5.9–+59.0
Overall	128.9	0.7–6.131	43.5	6.0–275.7	−85.4	−5.855.3–+193.0

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