LPA、CA125与经阴道彩色多普勒超声联合诊断卵巢上皮癌的临床价值

目的:探讨血浆溶血磷脂酸(LPA)在卵巢上皮癌患者血浆中的表达水平,及其与血清CA125和经阴道彩色多普勒超声(TV-CDUS)联合应用诊断卵巢上皮癌的临床价值。方法:术前检测卵巢上皮癌48例,卵巢良性肿瘤30例的LPA、CA125,以20例健康者作为对照,卵巢肿瘤患者同时经阴道超声评分和TV-CDUS检查。结果:卵巢癌患者LPA水平明显高于卵巢良性肿瘤组和健康对照组,差异有统计学意义(P0.05),LPA水平在良性肿瘤组与健康对照组之间无显著差异(P0.05)。单独应用LPA、CA125、TV-CDUS检测诊断卵巢癌的敏感性和特异性分别为87.5%、79.16%、81.25%和80%、70%、86%,各组间敏感性和特异性比较,无显著差异(P0.05)。LPA、CA125、TV-CDUS 3项联合检测诊断卵巢癌的敏感性和特异性为95.80%和94%,与单独应用CA125检测特异性比较,差异有统计学意义(P0.05)。LPA诊断卵巢癌的敏感性和特异性与卵巢癌分期和病理类型无关(P0.05),CA125诊断卵巢癌的敏感性和特异性与卵巢癌的分期和病理类型有关(P0.05)。结论:卵巢上皮癌患者血浆LPA水平明显升高,有望成为卵巢上皮癌诊断的敏感指标,联合检测血浆LPA、血清CA125与TV-CDUS有助于术前卵巢癌的诊断。     

Mesovarian hemangioma presenting as massive ascites, pelvic mass, and elevated CA125

Abstract.   Abu J, Brown L, Ireland D, Sizeland E. Mesovarian hemangioma presenting as massive ascites, pelvic mass, and elevated CA125. Int J Gynecol Cancer 2006; 16(Suppl. 1): 412–414.
We present the case of a 48-year-old woman with pelvic mass, ascites, and an elevated CA125 mimicking advanced-stage ovarian cancer. She underwent laparotomy, drainage of ascites, total abdominal hysterectomy, bilateral salpingo-oophorectomy, and infracolic omentectomy. Histology confirmed this to be mesovarian hemangioma, a benign condition.     

Tumor tissue CA125 in ovarian carcinoma patients with normal serum levels

A good correlation between elevated serum CA125 and its immunolocalization in ovarian tumor tissue has been reported. This study was undertaken in order to assess the presence of CA125 in tumor tissue obtained from ovarian carcinoma patients with normal serum levels. Eleven such ovarian carcinoma patients (nine of them serous) were identified. In seven the level was normal prior to the initial operation, and in four, prior to a positive second-look operation. Immunohistochemical staining of paraffin sections for CA125 was positive in seven of the tumor tissue samples. Tumor tissue of most ovarian carcinoma patients with a preoperative normal serum CA125 contains the antigen, but an undetermined mechanism prevents elevated serum levels.     

Peritoneal tuberculosis with pelvic abdominal mass, ascites and elevated CA 125 mimicking advanced ovarian carcinoma: A series of 10 cases

Abstract. Bilgin T, Karabay A, Dolar E, Develioğlu OH. Peritoneal tuberculosis with pelvic abdominal mass, ascites, and elevated CA 125 mimicking advanced ovarian carcinoma.
Ten patients with peritoneal tuberculosis who were operated on for suspected advanced ovarian cancer during a 5-year period were analyzed. These 10 cases constituted 1.4% of the 728 new gynecologic cancer cases diagnosed and treated at our department during the same time period. Data were obtained from patients' files and pathology reports. The mean age of cases was 40.6 ± 6.1 (median 37; range 18–72). Ascites was present together with ill-defined nodularities or thickening in the Douglas pouch and/or in the adnexal areas on pelvic examination in all patients but three, who presented with well-demarcated adnexal masses of about 5 cm in diameter. All patients had elevated serum CA 125 levels with a median of 331 U/ml, (40–560 U/ml). Ultrasound and abdominopelvic CT examinations revealed omental and mesenteric thickening in addition to ascites in all patients, cystic ovarian masses or ovarian enlargement in five, and peritoneal implants in two. Abdominal paracentesis performed in the six cases in whom the findings were felt to be most inconclusive for the diagnosis of ovarian cancer revealed clear exudative fluid with benign cells. Mycobacteria could not be demonstrated on direct preparations. Tuberculosis was diagnosed at laparotomy in all. Patients received antituberculous therapy and serum CA 125 levels returned to normal within 2 months after the beginning of treatment. This case series demonstrates a high rate of misdiagnosis between advanced ovarian cancer and peritoneal tuberculosis. Whereas abdominal paracentesis is useless in ruling out peritoneal tuberculosis, and serum CA 125 levels are not helpful in the differential diagnosis, the latter marker may be useful in the follow-up of patients.     

Serum CA 125 concentrations in women of different ages, hormonal statuses, orclinical conditions

Koper NP, Thomas CMG, Massuger LFAG, van der Mooren MJ, Kiemeney LALM,Verbeek ALM. Serum CA 125 concentrations in women of different ages, hormonalstatuses, or clinical conditions. Int J Gynecol Cancer . 1997; 7 : 405–411.
Changes in serum cancer antigen (CA) 125 concentrations during the normalmenstrual cycle, the suppressed or stimulated cycle, pregnancy, and duringhormone replacement therapy (HRT) after menopause were studied to gain abetter understanding of factors that influence serum CA 125 concentrations.The clinical status of 300 women was reviewed and their serum CA 125concentration was determined. In the normal-cycle group and in the oralcontraceptive group CA 125 serum concentrations were higher during the early (follicular) phaseof the menstrual cycle than during the later (luteal) phase. No increase inserum CA 125 concentration was seen in the ovarian stimulation group. Serum CA125 concentrations were higher in the first trimester of pregnancy. In both groupsof postmenopausal women mean serum CA 125 concentrations were below 10 Uml⁻¹. During HRT, serum CA 125 concentrations increased inthe non-hysterectomy group while a decrease was seen in the hysterectomygroup. Ovarian activity is of limited influence on the serum CA 125concentration. Changes taking place within the endometrial tissue may be ofmore importance. The low serum CA 125 concentrations observed in the groupsof postmenopausal women suggest that it may be justified to employ lowerreference values for serum CA 125 in the clinical management and follow-up ofovarian cancer patients.     

Differential diagnosis of pelvic masses: Usefulness of CA125, transvaginal sonography and echo-Doppler

Kusnetzoff D, Gnochi D, Damonte C, Sananes C, Giaroli A, di Paolo G, Sardi JE. Differential diagnosis of pelvic masses: Usefulness of CA125, transvaginal sonography and echo-Doppler. Int J Gynecol Cancer 1998; 8 : 315–321.
The aim of this study was to define the clinical value of physical examination, CA125, transvaginal sonography and echo-Doppler in the preoperative diagnosis of adnexal masses.
One hundred thirty patients with adnexal masses were prospectively studied. Diagnostic tests were performed during the week before surgery. Pre- and postmenopausal patients were evaluated separately. Surgical specimens were the gold standard. The best cut-off points for CA125 and resistance index (RI) were defined with receiver operating characteristic curves. Sensitivities for transvaginal sonography (TVS) were: 87.5% and 82.6% for pre- and postmenopausal patients, while specifity was 75.4% and 64.7%, respectively. For premenopausal patients the CA125 cut-off point that provides the best clinical usefulnesses is 100 IU/ml, yielding 94.4% specificity and 53.3% sensitivity. In postmenopausal women 35 IU/ml provides the highest accuracy and sensitivity. RI cut-off point, defined at 0.40, provided 76% accuracy and 94.8% specificity, in spite of a lower sensitivity. For postmenopausal patients, the cut-off point, defined at 0.60, has the highest accuracy and the best sensitivity-specificity ratio. Combination of TVS and CA125 were: 100% specificity in premenopausal and 91.1% in postmenopausal patients. Sensitivity increased when both results were negative, 93.7% and 95.6% for pre- and postmenopausal patients, respectively. This study did not find the accuracy established by the use of CA125 and TVS is increased by echo-Doppler and this technique should be reserved for cases included in research protocols.     

Screening for ovarian cancer using serum CA125 and vaginal examination: report on 2550 females

This study was undertaken to assess the effectiveness of using serum CA125 and vaginal examination as a screening test for ovarian cancer in apparently healthy females. Two thousand five hundred and fifty healthy females aged 40 and over were recruited to participate in a screening study involving a questionnaire, serum CA125 measurement and vaginal examination. Females with either an elevated CA125 level or abnormal vaginal examination had a pelvic ultrasound performed as a secondary procedure. The positive predictive values of an elevated serum CA125 level, and a combination of CA125 level measurement and vaginal examination for ovarian cancer, were 1/100 and 1/3, respectively. The specificities of serum CA125 levels, vaginal examination and both in combination were 96.1%, 98.5% and 99.9%, respectively. In postmenopausal females the positive predictive values were improved with CA125 measurement alone, giving a positive predictive value of 1/24. Seventeen females underwent operative procedure as a result of the screening—only one of these was for an ovarian cancer. The combination of serum CA125 measurement and vaginal examination is not an effective screening test in the general population, although in postmenopausal females it does achieve acceptable specificities and positive predictive values.     

Elevated CA125 level associated with Meigs' syndrome: case report and review of the literature

Abstract.   Morán-Mendoza A, Luna GA, Ruiz GC, Olvera AS, López Graniel CM, Rincón DG. Elevated CA125 level associated with Meigs' syndrome: case report and review of the literature. Int J Gynecol Cancer 2006; 16(Suppl. 1): 315–318.
Meigs' syndrome is the association of ovarian fibroma, pleural effusion, and ascites. Meigs' syndrome with marked elevation of CA125 is an unusual clinical condition reported in 27 cases in the literature. The patient was a 46-year-old woman with right pleural effusion, ascites, ovarian tumor, and CA125 level of 1808 U/mL. Tomography revealed ascites and bilobate pelvic tumor of approximately 25 cm. The diagnosis of advanced epithelial ovarian cancer was considered, and the patient was treated with chemotherapy. Three chemotherapy schemes were applied due to the total lack of response in tumor volume; however, CA125 decreased to 90 U/mL. Thus, surgery was performed with resection of 25 cm of the left ovarian tumor, with intact capsule and without implants; the result of histopathologic analysis was fibroma. Postoperative CA125 was 11 U/mL. Patients with elevated CA125 and ascites cytology positive for malignancy must be cautiously treated due to the possibility of false positives, even if the probability is low. Therefore, minimally invasive surgery for biopsy collection must be considered. Although the association between ovarian tumor, pleural effusion, ascites, and marked elevation of CA125 is highly indicative of epithelial ovarian cancer, Meigs' syndrome must be considered in the differential diagnosis.     

What should be the cut-off level of serum CA125 to evaluate the disease status before second-look laparotomy in epithelial ovarian carcinoma?

To assess the predictive value of serum CA125 level prior to second-look laparotomy in epithelial ovarian carcinoma, 45 patients who were clinically or radiologically tumor-free prior to a second-look laparotomy were studied. Serum CA125 levels were measured 10 days prior to the operation, and were compared with the surgico-pathological results. Twenty-eight (62%) patients were found to have tumor at surgery. The serum CA125 levels were  35 U ml⁻¹ (42%) patients. Tumors were found in 14 (74%) of these 19 patients. Although a serum CA125 level  35 U ml⁻¹ was a strong predictor of the presence of an intraperitoneal tumor, a level <35 U ml⁻¹ was not predictive of a tumor-free state. When the cut-off level was accepted as 20 U ml⁻¹, 28 patients (62%) were found to have elevated CA125 level. The sensitivity, the specificity, the positive and negative predictive value and the false negative ratio were calculated as 79%, 65%, 79%, 65% and 21% respectively. The threshold value for a raised CA125 level was considered and a lower level of 20 U ml⁻¹ was suggested as a cut-off level prior to second-look laparotomy in evaluating patients with known epithelial ovarian cancer.     

对子宫腺肌病患者血清CA125及EMAb的临床评价

目的：探讨血清CA125及子宫内膜抗体（EMAb)测定，对子宫腺肌病的诊断及疗效评估的临床价值。方法：经术后病理学检查确诊子宫腺肌病患者63例和子宫肌瘤患者45例，均于术前及术后测定两组血清CA125水平和EMAb。结果：子宫腺肌病组术前血清CA125平均水平及EMAb阳性率均高于子宫肌瘤组，两者相比差异有显著性（P＜0．001及P＜0．01）。联合测定血清CA125水平和EMAb，以两者均阳性为诊断标准，诊断子宫腺肌病的敏感性为54．63％，特异性为100％。子宫腺肌病组术后血清CA125水平和EMAb阳性率均较术前下降，差异有显著性（P＜0．01及P＜0．05）。结论：测定血清CA125及EMAb对子宫腺肌病有较好的辅助诊断价值，联合检测更能提高诊断的正确性，并可作为评价子宫腺肌病疗效的敏感指标。     

血清CA125半衰期判定卵巢上皮性癌预后的价值

目的 探讨血清ＣＡ１２５半衰期在卵巢上皮性癌中的预后价值。方法 回顾性分析３０例卵巢上皮性癌患者在化疗过程中血清ＣＡ１２５半衰期值（ｔ１／２）与生存时间的关系。结果 血清ＣＡ１２５半衰期值（ｔ１／２）≤２０天组的中位生存时间为３６个月,ｔ１／２〉２０天组中完全缓解率为２７．３％,两者存在极显著差异（ｐ＝０．００１）。多因素生存分析表明：ＣＡ１２５半衰期和细胞分级、残余瘤灶大小均是独立的预后因素。结     

CA125 parameters in survivors and non-survivors with epithelial ovarian cancer

Abstract. Cruickshank DJ. CA125 parameters in survivors and non-survivors with epithelial ovarian cancer. Int J Gynecol Cancer 1991; 1 : 279–284.
The relationship between different CA125 parameters and survival in patients with epithelial ovarian cancer was investigated in a prospective study. This involved 161 patients of whom 64 died and 97 remained alive. The established prognostic factors of stage and residual disease were controlled for and the population characteristics (age, follow-up/survival duration, histologic subtype, grade) were comparable in the 'dead' and 'alive' groups. For patients with stage I and II disease preoperative serum CA125, pre-chemotherapy serum CA125, plateau serum CA125 and time to reach the plateau level were all higher in the non-survivors when compared with survivors. In contrast, preoperative serum CA125 and pre-chemotherapy serum CA125 were significantly higher in survivors with stage III and IV disease. A possible explanation for these results includes the suggestion that early- and late-stage ovarian cancer may be different 'diseases' with different natural histories rather than being a continuum. Alternatively, the tumor-associated antigen CA125 being a membrane glycoprotein may have a beneficial, perhaps immunologic role in advanced disease.     

Evaluation of serum CA 125 level as a tumor marker in borderline tumors of the ovary

Serum CA 125 was evaluated as a tumor marker in 85 patients with borderline ovarian tumors. Serum CA 125 levels were elevated preoperatively in 18 of 20 (90%) samples (median 66, range 5–272 U ml⁻¹). Preoperative serum CA 125 levels did not correlate to FIGO stage. Preoperative serum CA 125 levels were elevated in seven of nine (78%) with serous tumors (median 131, range 5–272 U ml⁻¹) and in all 11 with mucinous tumors (median 62, range 41–157 U ml⁻¹). There was no significant difference in the CA 125 levels between these two histologic types. Postoperative serum CA 125 levels, measured 3–6 weeks after primary laparotomy, were significantly lower than the preoperative ones ( P < 0.001). No difference in the postoperative CA 125 levels was found between those with and those without residual disease after surgery. Postoperative serum CA 125 levels were elevated in eight of 60 (13%) without residual tumor. None of these had relapsed at the time of analysis (26–87 months after surgery). Serum CA 125 levels tended to correlate with disease evolution during chemotherapy. Two with disease remissions had falling levels, one with stable disease had falling level and one with disease progression had rising level. Serum CA 125 samples were obtained before second-look laparotomy in seven patients. Two with negative findings at second-look had normal levels. Of five with positive findings at laparotomy only two had elevated serum CA 125 levels. Disease relapse was associated with elevated serum CA 125 levels in only one of six patients.     

Stage- and CA125–related survival in patients with epithelial ovarian cancer treated at a cancer center

Abstract.   Board RE, Bruijns CTPH, Pronk AE, Ryder WDJ, Wilkinson PM, Welch R, Shanks JH, Connolly G, Slade RJ, Reynolds K, Kitchener HC, Jayson GC. Stage- and CA125–related survival in patients with epithelial ovarian cancer treated at a cancer center. Int J Gynecol Cancer 2006; 16(Suppl. 1): 18–24.
Current accepted prognostic indicators in ovarian cancer include performance status, surgical (FIGO) staging, and residual disease after operation. Here we present data from a prospective analysis of patients with ovarian cancer treated at the Christie Hospital. We confirm the independent prognostic effects of FIGO staging, performance status, and residual disease in our group of patients and furthermore show that CA125 levels at presentation to the oncology service are of independent prognostic significance ( P = 0.02). We present survival data and show that the 3-year, cancer-specific survival for stage I disease is 90%. We postulate that this good survival may in part be due to the use of computed tomography scanning at presentation to allow accurate staging. Further clinical trials are needed to test whether combinations of surgical, histologic, biochemical, and radiologic parameters can be used to identify a population with such a good prognosis that adjuvant therapy is not required.     

Preoperative discrimination between ovarian carcinoma, non-ovarian gynecological malignancy and benign adnexal masses using serum levels of CA125 and the polymorphic epithelial mucin antigens CASA, OSA and MSA

Serum levels of the tumor associated antigens CA125, CASA, OSA and MSA were determined preoperatively in a non-consecutive series of patients with: invasive epithelial ovarian cancer (OC, n = 87), ovarian tumors of low malignant potential (LMP, n = 9), benign adnexal masses (BAM, n = 48) and other peritoneal and pelvic malignancies ( n = 48). In addition, serum levels of CASA, OSA, and MSA were determined in 3477 asymptomatic well women. Ninety-eight percent of the asymptomatic women had CASA levels < 6.0 U ml⁻¹, OSA levels < 5.5 U ml⁻¹ and MSA levels < 80.0 U ml⁻¹. Serum CA125 levels were> 35 U ml⁻¹ in 89% of OC, in 44% of LMP, and in 23% of BAM. Serum CASA levels were> 6.0 U ml⁻¹ in 58% of OC, in 0% of LMP, and in 0% of BAM. Serum OSA levels were> 5.5 U ml⁻¹ in 61% of OC in 0% of LMP and in 4% of BAM. Serum MSA levels were> 80.0 U ml⁻¹ in 56% of OC, in 11% of LMP, and in 10% of BAM. When cut-off levels were set to exclude all patients with BAM, the best discrimination from OC using a single assay was achieved using CASA (58%). However, a combination of CASA and CA125 gave positive levels in 69% of OC at levels which precluded BAM. All markers were also elevated in some colon cancers, cervical cancers, uterine cancers and other peritoneal malignancies. A combination of CA125 and CASA levels, obtained preoperatively may assist the general gynecologist in avoiding potentially difficult oncologic surgery.     

Artificial neural network computer prediction of ovarian malignancy in women with adnexal masses.

OBJECTIVE: Assessment of the usefulness of a neural model to predict which ovarian tumors are malignant. METHOD: Age, menopausal status, body mass index, grayscale and Doppler ultrasonographic features, as well as levels of specific markers (CA 125, tissue polypeptide specific antigen) were examined in 686 women with adnexal masses. The probability of malignancy was calculated using an artificial neural network software and the diagnostic efficiency of the received model was estimated using a receiver-operating characteristics (ROC) curve. RESULT: Of the 686 women, 431 (62.8%) had a benign and 255 (37.2%) had a malignant ovarian tumor. The significant malignancy predictors are age, menopausal status, maximum tumor diameter, internal wall structure of tumor, presence of septa and/or solid elements, tumor location, location of vessels, and blood flow indexes. The best network provided 96.0% sensitivity and 97.7% specificity. The area under the curve for the received model was 0.9716. CONCLUSIONS: An artificial neural network model based on clinical and ultrasonographic data allows to calculate the probability of tumor malignancy.