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Abstract: Objective. : To determine the ability of a preoperative serum CA125 to predict optimal primary tumor cytoreduction in patients with stage III and IV epithelial ovarian cancer (EOC). Materials and methods. : The records of patients with advanced stage who underwent primary surgery for EOC at Tehran University, Vali-Asr Hospital between 2000 and 2002 were reviewed. Inclusion criteria included FIGO stage III/IV disease, surgery by gynecologic oncology faculty, preoperative CA125, and an operative note clearly defining volume of residual disease. Without optimal cytoreduction was determined using the receiver operator curve (ROC). Results. : One hundred and twenty cases of advanced stage EOC were identified, of which 90 cases of stage III/IV met our inclusion criteria. Serum CA125 ≤400 was identified with OD ≥75% of the time. Conversely, optimal cytoreduction was performed in ≤40% of patients with CA125 ≥4000. The area under the ROC curve for CA125 was 0.680. The optimal cytoreduction rate for those with and without ascites was 38% and 77%, respectively (P <0.001). In a multivariate analysis using CA125, age, and ascites, the area under the curve was 0.696. Conclusion. : We conclude that CA125 level did not reliably predict optimal cytoreduction in patients with stage III–IV EOC. [Copyright &y& Elsevier]