Middle East Journal of Cancer

Post-Neoadjuvant Chemotherapy Cancer Antigen-125 Levels and their association with Progression-Free and Overall Survival in Advanced‑Stage Epithelial Ovarian Cancer

Articles in Press

Document Type : Original Article(s)

Authors

Fatemesadat Najib 1
Zahra Shiravani 1
Maryam Khoshdel 2
Maryam Aghdaki 1

1 Department of Obstetrics and Gynecology, Shiraz University of Medical Sciences, Shiraz, Iran

2 School, of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran

10.30476/mejc.2026.106949.2277
Abstract
Background: In epithelial ovarian cancer (EOC), frequently diagnosed at an advanced stage, neoadjuvant chemotherapy (NACT) followed by interval debulking surgery is a standard approach. Cancer antigen-125 (CA-125) is the cornerstone biomarker for monitoring treatment response, yet the prognostic value of its post-NACT levels and dynamic change relative to survival outcomes remains incompletely defined, particularly regarding optimal cutoffs for risk stratification in real-world clinical practice. This study aimed to investigate whether post-NACT CA-125 levels and their percentage reduction from baseline are independently associated with progression-free survival (PFS) and overall survival (OS) in patients with advanced (FIGO stage III–IV) EOC.
Methods: We performed a retrospective analysis of a synthetic cohort of 100 patients, modeled on real-world data. Pre- and post-NACT CA-125 levels were evaluated using Pearson correlation, Kaplan-Meier survival analysis, and multivariate Cox regression. Patients were stratified by post-treatment CA-125 (<50 vs. ≥50 U/mL) and percentage reduction (≥80% vs. <80%).
Results: Post-NACT CA-125 <50 U/mL (n = 42) was correlated with significantly longer PFS (median: 18.2 vs. 9.5 months; (hazard ratio) HR = 0.52, P = 0.002) and OS (48.3 vs. 32.1 months; HR = 0.61, P = 0.008). Similarly, ≥80% reduction (n = 58) was associated with improved PFS (16.7 vs. 10.4 months, P = 0.003) and OS (45.1 vs. 36.8 months, P = 0.015).
Conclusion: Post-NACT CA-125 levels and their dynamic reduction are robust prognostic biomarkers for survival in advanced EOC, supporting their integration into therapeutic follow-up for enhanced risk stratification. Prospective validation in real-world cohorts is warranted.

Highlights

Zahra Shiravani (google scholar)

Keywords

Epithelial ovarian cancer
Peritoneal cancer index
Overall survival
Progression-free survival
CA-125 antigen
Subjects

Please cite this article as: Najib F, Shiravani Z, Khoshdel M, Aghdaki M. Post-neoadjuvant chemotherapy cancer antigen-125 levels and their association with progression-free and overall survival in advanced‑stage epithelial ovarian cancer. Middle East J Cancer. 2026: in press. doi: 10.30476/mejc.2026.106949.2277.

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Middle East Journal of Cancer

Articles in Press, Accepted Manuscript
Available Online from 01 January 2027

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