Peri- and postoperative changes in serum levels of four tumor markers and three acute phase reactants in benign and malignant gynecological diseases

Summary Serum levels of squamous cell carcinoma antigen, carcinoembryonic antigen, CA 125, tissue polypeptide antigen, CRP, α₁-antitrypsin and haptoglobin were determined peri- and postoperatively in patients undergoing surgery for benign gynecological disease (n=18) and postoperatively in women operated for cervical carcinoma (n=23). The only significant changes seen after premedication, during anesthesia and during surgery were a decrease in serum concentrations of α₁-antitrypsin and haptoglobin. We found no post-operative changes in the serum levels of squamous cell carcinoma antigen nor in carcinoembryonic antigen values. However, the latter analyte was influenced by smoking habits. Elevated levels of CA 125 and tissue polypeptide antigen were found in the cancer patients, predominantly within the first 1–3 weeks after surgery. These levels decreased to normal values within 4–6 weeks postoperatively. The median intraindividual coefficients of variation for the tumor markers ranged between 15% and 28% in 30 control women not having surgery. In general, it would seem advisable to wait 6 weeks after surgery before monitoring with CA 125 and TPA is started.     

Differences in symptoms between patients with benign and malignant ovarian neoplasms

OBJECTIVE: The purpose of this study was to determine the symptoms that are experienced by patients who receive a diagnosis of early ovarian cancer and to compare those symptoms with the symptoms that are experienced by patients with late ovarian cancer, borderline ovarian cancer, and benign ovarian neoplasms. STUDY DESIGN: This study used a retrospective case-control design. Cases of invasive and borderline ovarian cancer (n=147 patients) were compared with 76 patients with benign ovarian neoplasms. RESULTS: Patients with early ovarian cancer were significantly more likely to have symptoms of mass effect (urinary frequency, constipation, palpable mass, pelvic pressure) compared with patients with benign ovarian neoplasms (67% vs 15%; P <.001), late stage disease (67% vs 40%; P =.008), and borderline cancer (67% vs 33%; P =.007). CONCLUSION: Mass effect symptoms were the only symptoms that differentiated patients with early-stage ovarian cancer from all other groups of patients. However, one third of the patients with early ovarian cancer did not report any of these symptoms.     

Relation between serum levels of tissue polypeptide antigen (TPA) and cancer antigen 125 (CA125) and their immunohistochemical identification in benign and malignant gynecological disease

Summary We studied immunohistochemical stains for TPA and CA125 in patients with benign and malignant gynecologic diseases. The results were as follows: (1) CA125 was not found in ovarian mucinous cystadenocarcinoma but was demonstrated immunohistochemically in 82% of ovarian serous cystadenocarcinomas and 83% of Krukenberg's tumors. (2) TPA was demonstrated in 65% of ovarian serous and 75% of ovarian mucinous cystadenocarcinomas, and in 58% of endometrial carcinomas. (3) TPA was found in all trophoblastic tumors examined, while CA125 was found in none. Eighty-three percent of patients with trophoblastic diseases had raised serum TPA levels. (4) When serum CA125 levels were raised, CA125 was demonstrated immunohistochemically in 71% of patients with ovarian serous cystadenocarcinomas, 67% of patients with Krukenberg's tumors and 100% of patients with tubal carcinomas. (5) Despite elevated serum levels, CA125 and TPA were not identified by immunohistochemistry in 64% cases of benign ovarian disease and in 80% of patients with uterine myomata. (6) It would seem that CA125 was more easily released from tumor cells than TPA.     

肿瘤标记物联合检测对卵巢恶性肿瘤的诊断价值

应用放免及生化法对１０７例卵巢肿瘤患者及５０例正常健康妇女血清ＳＦ（铁蛋白）、β２－ＭＧ（β２－微球蛋白）、ＣＥＡ、ＬＤＨ、ＡＦＰ和β－ｈＣＧ进行定量检测。结果表明：①卵巢恶性肿瘤组血清ＳＦ、β２－ＭＧ、ＣＥＡ及ＬＤＨ含量均显著高于卵巢良性肿瘤组及正常对照组（Ｐ＜０．０１）；ＳＦ含量与肿瘤分期呈正相关，随卵巢恶性肿瘤临床期别增高而递增。ＡＦＰ、β－ｈＣＧ含量在卵巢良、恶性肿瘤组间及正常对照组间均无显著差异，提示血清ＳＦ、β２－ＭＧ、ＣＥＡ和ＬＤＨ检测，对卵巢恶性肿瘤的诊断及卵巢良、恶性肿瘤的鉴别诊断有一定临床意义。②ＳＦ、β２－ＭＧ、ＣＥＡ及ＬＤＨ诊断卵巢恶性肿瘤的准确性分别为７９．４４％、６９．１６％、６５．４０％及５６．０７％，四项联合准确性可提高到８３．１８％，提示：联合检测可提高临床诊断价值，优于单项检测结果。联合检测并结合病史及临床检查，可作为卵巢癌的初筛检查。     

The diagnostic value of multiple tumor markers in malignant ovarian neoplasms

Ovariancanceristhemostfrequentcauseofdeath fromgynecologicalcancer.Almost90%ofpatientsare diagnosedwithmetastaticdiseaseinthepelvisorabdo menandforthesepatients5yearsurvivalratesareless than30%.Incontrast,thesmallproportionofpatients diagnosedwithstageIovariancancerconfinedtotheo varieshavea5yearsurvivalrateinexcessof90%[1].Tumormarkerisakindofsubstancecorrelatedwiththe occurrenceoftumor.Itarisesfromthetumortissue,ex istsinthetumor,orexcretesintobloodorotherbody fluid[2].Nowadaysmorethan100ki…     

Detection of disseminated tumor cells in patients with gynecological cancers

OBJECTIVES: The presence of disseminated tumor cells (DTC) in breast cancer patients is associated with poor prognosis. However, there are limited data about the prevalence and prognostic impact of DTC in patients with gynecological tumors. The aim of this study was to evaluate the presence of DTC in the bone marrow (BM) of patients with gynecological cancers and to correlate their presence with established prognostic factors. METHODS: BM aspirates of 201 patients with primary ovarian (n=69), cervical (n=54) and endometrial cancer (n=78), undergoing surgery at the Department of Gynecology and Obstetrics, University Hospital, Tuebingen, Germany between 1/2002 and 01/2006, were included into the study. Cytokeratin (CK)-positive cells were identified by immunocytochemistry using the pancytokeratin antibody A45B/B3. RESULTS: The bone marrow positivity rate was 36% in ovarian, 26% in cervical and 17% in endometrial cancer, respectively. Presence of DTC was significantly correlated with FIGO (International Federation of Gynecology and Obstetrics) tumor stage (p<0.05). The recurrence rate was 14% in patients with CK-positive cells compared to 8% in CK-negative patients (p=0.2). There was no correlation between DTC and other established prognostic factors including nodal status or grading except for cervical cancer. Patients with positive lymph node status were more likely to be bone marrow positive compared to those with negative lymph node status (p<0.05). CONCLUSIONS: Disseminated tumor cells seem to be a general phenomenon in epithelial tumors even though their clinical impact remains to be evaluated. The hypothesis that bone marrow is the homing site of disseminated tumor cells is further supported by these data since gynecological tumors only rarely metastasize to the skeletal system.     

Intracystic evaluation of tumor markers in benign and malignant ovarian pathology

OBJECTIVE: To evaluate, in patients with benign and malignant ovarian cysts, serum samples and ovarian intracystic fluids for the presence of tumor markers such as CA 125, CA 15.3, tissue polypeptide antigen (TPA), CA 19.9 and the carcinoembryonic antigen (CEA). MATERIAL AND METHOD: We studied overall 64 patients with ovarian pathology. Sixteen patients were affected by functional cysts, 28 women by benign cystic tumors and 20 by cystoadenocarcinomas. RESULTS: Average serum levels of all but CA 15.3, TPA and CEA tumor markers of benign cystic ovarian tumors were higher than those of functional cysts. All but CA 19.9 mean intracystic fluid markers levels were more elevated in benign tumors than in functional cysts. In patients with malignant cystic tumors, all but CEA mean serum marker levels were higher than those of benign tumors; furthermore even all mean intracystic levels of markers were more elevated than those of benign tumors. CONCLUSION: This study confirmed the high positivity of tumor markers such as CA 125, CA 15.3, TPA, CA 19.9 and CEA in both the serum and intracystic fluid of patients with malignant epithelial ovarian tumors.     

妇科恶性肿瘤化疗后发生糖尿病患者的临床分析

目的 探讨妇科恶性肿瘤患者化疗后发生糖尿病与化疗的关系。方法 采用回顾性分析方法对我院1990年1月至2001年10月收治化疗后发生糖尿病18例妇科肿瘤患者(A组)的化疗的年龄、化疗方案、肿瘤类型及化疗中肝功能、电解质异常情况进行总结,并对其疾病转归进行随访,并与同期化疗且化疗前患糖尿病67例(B组)相比较。结果A组以卵巢恶性肿瘤为主,部分患者化疗结束后糖尿病可缓解;B组以子宫内膜癌为主,部分患者化疗中糖尿病加重,化疗结束后减轻。两者疾病构成比差异有显著性。结论化疗可能对胰腺有影响而诱发糖尿病,应引起重视。     

The diagnostic value of multiple tumor markers in malignant ovarian neoplasms

Objective:To study the diagnostic value of multiple tumor markers in malignant ovarian neoplasm.Methods:Sera obtained from 430 patients with ovarian masses (110 cases were malignant ovarian tumors,320 cases were benign ovarian tumors) before operation,and from 50 healthy women as control.Serologic examination of tumor markers included CA125,TSGF,SA,CEA,AFP,HCG and Fer.Results:The serum levels of CA125,TSGF,SA and Fer in patients with ovarian cancer were higher than those in patients with benign ovarian tumors (P<0.05),also in control group (P<0.05).In the diagnostic value of application for malignant ovarian neoplasm,CA125,TSGF and SA were better than the others.The sensitivity,specificity and accuracy in diagnosis of ovarian cancer were 86.4%,82.8%and 83.7% respectively for CA125 alone,78.2%,81.3%and 80.5% for TSGF alone,74.5%,81.9%and 80.0% for SA alone,whereas 95.5%,45.6%and 58.4% for multiple tumor markers combined in which 1 or more indices showed positive,93.6%,80.6%and 84.0% for that in which 2 or more indices showed positive,and 87.3%,90.3%and 89.5% for that in which 3 or more indices show positive.Conclusion:multiple tumor markers examination could improve the diagnosis of ovarian cancer,and examination of CA125,TSGF and SA combined is most ideal.     

Ethics in three-dimensional obstetric and gynecological ultrasound

Ethics is an essential dimension of the practice of three-dimensional obstetric ultrasound. This paper addresses three topics to which ethics is especially relevant competence and referral, disclosure, and confidentiality.     

Serum ribonuclease in patients with malignant tumor of the ovary

The clinical significance of serum ribonuclease (RNase) was studied in patients with malignant tumor of the ovary, and the result was compared with serum sialic acid (SA). Serum RNase and SA level were determined in 190 women consisting of 35 normal women, 34 patients with ovarian cancer, 39 patients with other malignant gynecological tumors, 38 ovarian cancer patients with clinical remission after treatment and 44 patients with benign gynecological tumor. The sensitivity of serum RNase was 82.4% in the diagnosis of malignant tumor of the ovary. Serum RNase was positive in 42.9% of patients with minimal residual tumor and 88.9% those with residual tumors greater than 2 cm in diameter. Serum RNase assay is a simple, rapid and reliable method useful in monitoring the course of disease.     

Seven tumor markers in benign and malignant germ cell tumors of the ovary

Seven tumor markers were analyzed clinically in 135 patients with germ cell tumors of the ovary who were treated in Tokai Ovarian Tumor Study Group, an association comprising Nagoya University and its affiliated hospitals, between January 1979 and September 1990. Positive rate of AFP was 100% (36/36) in yolk sac tumor, 61.9% (13/21) in immature teratoma, and 11.8% (2/17) in dysgerminoma, but there were no positive cases of mature cystic teratoma with malignant transformation (0/7) and mature cystic teratoma (0/31). Positive rate of CA125 was over 50% in all tumor types except mature cystic teratoma, which showed a positive rate of 23.7%. CA125 was useful for the screening of malignant germ cell tumors. CA19-9 showed a high positive rate in teratomatous tumors, which were immature teratoma, mature cystic teratoma with malignant transformation, and mature cystic teratoma. Dysgerminoma and yolk sac tumor, especially dysgerminoma, had a high positive rate of LDH. TPA and CEA were not considered useful tumor markers for germ cell tumors of the ovary.     

卵巢上皮性癌血清肿瘤标志物谱变化的临床意义

目的 探讨卵巢上皮性癌(卵巢癌)患者化疗后肿瘤标志物谱的变化及其潜在的临床意义.方法 选择1999年1月至2007年7月期间经肿瘤细胞减灭术及规范化疗的卵巢癌患者102例,对其术前、术后、每次化疗前、随访期间和复发前后的血清肿瘤标志物CA125、CA19-9和CP2的水平进行检测、分析,其中48例患者的肿瘤标志物记录完整而纳入分析,复发患者为28例,初治化疗患者20例(均为耐药病例).根据肿瘤标志物谱变化与否,分别将复发和初治化疗患者分为肿瘤标志物谱变化组与未变化组.平均随访时间为25个月.结果 (1)肿瘤标志物谱的主要变化表现为标志物的数最变化和(或)标志物的种类改变.28例复发患者中肿瘤标志物谱发生变化者占46%(13/28),20例初治化疗患者中标志物谱发生变化者占45%(9/20).(2)肿瘤标志物谱变化的复发患者中,病理类型以浆液性癌所占比例最高,为77%(10/13),而初治化疗患者中,以黏液性癌所占比例最高,为4/9.(3)复发患者肿瘤标志物谱变化组的无疾病进展期和中位总生存时间分别为22.2、60.0个月,较未变化组(分别为17.4、46.0个月)明显延长(P均<0.05);初治化疗患者肿瘤标志物谱变化组的中位总生存时间较未变化组(分别为15.9、25.0个月)明显缩短(P<0.05).结论 卵巢癌化疗期间和复发后肿瘤标志物谱可发生变化,化疗及随访期间应对肿瘤标志物进行联合检测.     

Serum CA125 in malignant ovarian tumor--periodical monitoring and correlation with other tumor markers

CA125 is a new unique tumor marker for epithelial ovarian cancer, and its clinical use has recently increased considerably. We have periodically monitored 14 cases of ovarian cancer (7 cases of serous cystadenocarcinoma, 4 cases of clear cell carcinoma, 1 case of endometrioid carcinoma and 1 case of metastatic ovarian cancer) using CA125, before and after surgery, during chemotherapy, and in follow-up. The serum CA125 was measured with a radioimmunoassay kit. As a result of this monitoring, we have discovered the following facts: The ten cases in which the titer of CA125 dropped to 35U/ml, which is cut off, by 60 days after surgery, when we had finished 2 courses of chemotherapy, showed good progress. In contrast to this, in the other cases, the degree of CA125 was still high 60 days after the surgery and did not drop after that. In these 4 cases, the tumor growth was found. It was therefore concluded that with this method a prognosis could be made much earlier than with the current system, and that relapse could be detected far earlier. We have also examined the mutual relations between CA125 and other tumor markers, IAP, TPA, HBDH, CEA, Ferritin, alpha 1AT, ESR, and LDH. Although we could see some usefulness in periodic monitoring with IAP, unlike CA125 it did not reflect the condition of a disease. The coefficients of correlations between CA125 and other tumor markers are as follows: IAP 0.5268, TPA 0.4541, HBDH 0.4551, CEA 0.2942, Ferritin -0.1005, alpha 1AT 0.5321, ESR -0.0619, LDH 0.5994.(ABSTRACT TRUNCATED AT 250 WORDS)     

Cancer associated serum antigen (CASA) levels in patients with breast carcinoma and in 3 control groups without breast cancer

We have examined the predictive value of measurements of CASA (Cancer Associated Serum Antigen) levels in patients with breast carcinoma. The measurement uses monoclonal antibodies that bind to an epitope on the polymorphic epithelial mucin. CASA levels were of less value compared with the levels of other tumor markers (CA 15-3, CA 549 and CEA) in the management of patients with early breast cancer. Received: 21 October 1997 / Accepted: 20 January 1998     

绝经后生殖系统恶性肿瘤患者骨代谢的变化

目的探讨绝经后生殖系统恶性肿瘤患者骨代谢的变化.方法分别采用放射免疫法、Behr's法及ACP酶学测定法检测了32例自然绝经患者(绝经组)和32例自然绝经后发生女性生殖系统恶性肿瘤患者(肿瘤组)血清雌二醇(E2)、骨性碱性磷酸酶(bonealkalinephosphatase,BALP)和抗酒石酸酸性磷酸酶(tartrateresistentacidphosphatase,TRAP)浓度.结果绝经组与肿瘤组血清E2浓度无显著差异(P＞0.05).肿瘤组血清BALP显著低于绝经组(P＜0.05).绝经组与肿瘤组血清TRAP无显著差异(P＞0.05).结论自然绝经后患者骨代谢紊乱程度较未发生肿瘤者更为严重.     

Serum prolactin levels in patients with fibrocystic breast disease

In 193 patients suffering from fibrocystic breast disease, basal serum prolactin concentrations were determined and compared to serum prolactin levels in 193 healthy women. In 45 additional patients and 23 healthy control subjects, a thyrotropin-releasing hormone (TRH) stimulation test was performed. The response to TRH in seven healthy female volunteers and in one patient with fibrocystic breast disease, was correlated with the mean serum prolactin levels over 24 hours. Serum prolactin levels were above normal in 45.6% of the patients and in 21.2% of the control subjects. Mean values of the two groups were significantly different (P less than .001). The maximum prolactin response to TRH stimulation was significantly higher in the study patients than in the control subjects (P less than .001). The TRH-stimulated prolactin response correlated positively with the mean 24-hour level (P less than .01, r = 0.8705). These results indicate that a high proportion of patients with fibrocystic breast disease exhibit increased daily prolactin secretion.     

Serum ACTH levels in patients with polycystic ovarian disease

Serum adrenocorticotrophic hormone levels were assayed in 8 patients with polycystic ovaries and a similar number of control subjects. Serum ACTH concentrations were normal in 6 patients and marginally elevated in 1. Investigations of markedly elevated readings in another patient showed this to be due to an interfering factor rather than the ACTH molecule itself.