High-Grade Serous Ovarian Cancer: Use of Machine Learning to Predict Abdominopelvic Recurrence on CT on the Basis of Serial Cancer Antigen 125 Levels

J Am Coll Radiol. 2018 Aug;15(8):1133-1138. doi: 10.1016/j.jacr.2018.04.008. Epub 2018 May 19.


Purpose: The aim of this study was to use machine learning to predict abdominal recurrence on CT on the basis of serial cancer antigen 125 (CA125) levels in patients with advanced high-grade serous ovarian cancer on surveillance.

Methods: This institutional review board-approved, HIPAA-compliant, retrospective, hypothesis-generating study included all 57 patients (mean age, 61 ± 11.2 years) with advanced high-grade serous ovarian cancer who underwent cytoreductive surgery from January to December 2012, followed by surveillance abdominopelvic CT and corresponding CA125 levels. A blinded radiologist reviewed abdominopelvic CT studies until recurrence was noted. Four measures of CA125 were assessed: actual CA125 levels at the time of CT, absolute change since prior CT, relative change since prior CT, and rate of change since prior CT. Using machine learning, support vector machine models were optimized and evaluated using 10-fold cross-validation to determine the CA125 measure most predictive of abdominal recurrence. The association of the most accurate CA125 measure was further analyzed using Cox proportional-hazards model along with age, tumor size, stage, and degree of cytoreduction.

Results: Rate of change in CA125 was most predictive of abdominal recurrence in a linear kernel support vector machine model and was significantly higher preceding CT studies showing abdominal recurrence (median 13.2 versus 0.6 units/month; P = .007). On multivariate analysis, a higher rate of CA125 increase was significantly associated with recurrence (hazard ratio, 1.02 per 10 units change; 95% confidence interval, 1.0006-1.04; P = .04).

Conclusion: A higher rate of CA125 increase is associated with abdominal recurrence. The rate of increase of CA125 may help in the selection of patients who are most likely to benefit from abdominopelvic CT in surveillance of ovarian cancer.

Keywords: CA125; CT; Ovarian cancer; machine learning; surveillance.

MeSH terms

  • Biomarkers, Tumor / blood
  • CA-125 Antigen / blood*
  • Cystadenocarcinoma, Serous / blood*
  • Cystadenocarcinoma, Serous / diagnostic imaging*
  • Cystadenocarcinoma, Serous / pathology
  • Cystadenocarcinoma, Serous / surgery
  • Female
  • Humans
  • Machine Learning*
  • Middle Aged
  • Neoplasm Recurrence, Local / blood*
  • Neoplasm Recurrence, Local / diagnostic imaging*
  • Neoplasm Recurrence, Local / pathology
  • Neoplasm Staging
  • Ovarian Neoplasms / blood*
  • Ovarian Neoplasms / diagnostic imaging*
  • Ovarian Neoplasms / pathology
  • Ovarian Neoplasms / surgery
  • Predictive Value of Tests
  • Retrospective Studies
  • Risk Factors
  • Tomography, X-Ray Computed*


  • Biomarkers, Tumor
  • CA-125 Antigen