CA 125 in gynecologic practice

Serum CA 125 levels were determined in 64 women with benign ovarian lesions, 92 women with uterine fundal lesions, and six patients who had negative second-look laparotomy for epithelial ovarian carcinoma. Of those with benign lesions, 13 of 31 patients with endometriosis had levels greater than 35 U/ml. Six of 34 patients with endometrial carcinoma had elevated levels before the primary operation, and six of 15 patients with recurrent endometrial carcinoma had elevated levels. The six ovarian cancer patients had had negative findings at second look 7 to 40 months before recurrence. Where close serial levels were available, the level became elevated 2 to 5 months before clinically apparent recurrent disease was noted.     

CA125 antigen levels in obstetric and gynecologic patients

An immunoradiometric assay using a monoclonal antibody detects an antigenic determinant (CA125) that is present in more than 80% of epithelial ovarian cancers. CA125 levels are elevated in the sera of 16% of women in the first trimester of pregnancy and is found in very high concentration in amniotic fluid. In 988 nonpregnant patients with benign gynecologic disorders, CA125 was greater than 65 U/mL in 1% on a single determination and in 0.5% with two determinations. Given the low rate of positivity in benign gynecologic disease, the CA125 assay may deserve further evaluation for the early detection of ovarian carcinoma.     

妇科肿瘤p53基因突变及临床意义初步探讨

检测妇科肿瘤Ｐ５３基因第５－８外显子的突变并探讨其临床意义。方法用聚合酶链反应－单链构象多态性分析银染技术,检测了１４８例子宫平滑肌瘤１６例子宫内膜癌,１５例宫颈癌、１７例卵巢癌的新鲜肿瘤组织Ｐ５３期第５－８外显子的突变。结论人子宫平滑肌瘤存在Ｐ５３基因突变,但不是子宫平滑肌瘤的特征改变。     

Occurrence of CA 125 and CA 19-9 tumor-associated antigens in sera of patients with gynecologic, trophoblastic, and colorectal tumors

The present study was undertaken to test the parallel detectability of ovarian cancer antigen CA 125 and gastrointestinal cancer antigen CA 19-9 in the sera of patients with malignant ovarian tumors, benign ovarian tumors, endometrial cancers, cervical cancers, colorectal cancers, and trophoblastic tumors and in early 1st-trimester pregnant as well as in healthy nonpregnant controls. In all kinds of gynecologic and colorectal tumors raised concentrations of both antigens were found with the exception of malignant nonepithelial ovarian tumors where neither of the antigens showed positive reaction. The most positive cases were found in the group with epithelial ovarian cancers. Of the two antigens CA 125 was the more responsive. No positive cases were found with either of the antigens in nonpregnant healthy controls or in patients with benign ovarian tumors. The parallel determination of the two antigens gives us a better opportunity to recognize pelvic tumors and further may enable us to distinguish ovarian and colorectal tumors.     

Epithelial ovarian tumors and CA125 in premenarchal girls

PURPOSE: This is a review of our 18-year experience with premenarchal girls with epithelial ovarian tumors. Special attention was focused on the predictive value of CA125 serum levels. METHODS: Analysis of premenarchal patients with resected or biopsied ovarian masses from 1988 to 2005 was performed. Patient age, clinical presentation, operative procedures, histologic type of tumor, treatment and outcome were obtained. RESULTS: Six premenarchal girls (aged from 6 to 14 years) were surgically treated for epithelial tumors, representing 13% of all ovarian tumors at this age. Histological findings revealed cystadenoma in four girls, one with a mucinous borderline tumor and one with undifferentiated carcinoma. Tumor volume was higher than 400 cm3 in four girls. Sensitivity, specificity and positive predictive value of CA125 level for ovarian malignant epithelial tumors were 0.50, 0.50, and 0.33, respectively. The premenarchal girl with undifferentiated carcinoma in Stage III died after six months in spite of chemotherapy. CONCLUSION: Ovarian epithelial tumors in premenarchal girls show important growth potential and a relatively high malignancy rate with great influence of borderline neoplasms. CA125 is a tumor marker with low sensitivity and specificity for detection of epithelial ovarian malignancy in this age group.     

卵巢癌患者血清中TPS、CA125水平及其临床意义

目的 探讨卵巢癌患者血清TPS、CA125水平的临床应用价值。方法 分别检测15例卵巢良性肿瘤患者（良性对照组）和39例卵巢癌患者（卵巢癌组）初诊、治疗后以及15例卵巢癌复发患者血清TPS、CA125水平，统计结果进行比较。结果卵巢癌组血清TPS、CA125水平显著高于良性对照组（P〈0．01）；TPS对卵巢癌诊断的灵敏度和特异度为71．8％和86，7％，CA125为84．6％和86．7％，两者差异无显著性（P〉0．05）；治疗后患者血清TPS、CA125水平低于治疗前（P〈0．01、P〈0．05），而复发时TPS水平又显著高于治疗后（P〈0．05）。结论 血清TPS检测有助于卵巢癌诊断、疗效观察及预后判断，联合检测CA125可提高其临床应用价值。     

The differential diagnostic value and clinical significance of serum HE4 in ovarian disease with elevated CA125

Archives of Gynecology and Obstetrics - To determine the diagnostic value and clinical significance of serum HE4 levels in differentiating between benign and malignant ovarian disease in patients...     

CA 125 measurement and ultrasonography in borderline tumors of the ovary

OBJECTIVES: Our goal was to perform an analysis of ultrasonographic characteristics and CA 125 levels in ovarian tumors of borderline malignancy. STUDY DESIGN: We performed a retrospective analysis of CA 125 levels and ultrasonographic parameters in 91 patients with borderline tumors. RESULTS: Serous tumors of borderline malignancy were associated with elevated CA 125 levels in 75% of patients before surgery (mean, 156 IU/mL) compared with 30% of mucinous tumors (mean, 28 IU/mL; P =.004). CA 125 was elevated in 35% of stage IA serous tumors (mean, 67 IU/mL) compared with 89% of tumors with spread beyond the ovary (mean, 259 IU/mL; P =.001). Mucinous tumors tended to be bigger (13.1 +/- 7 cm) on ultrasonography than serous tumors (9.3 +/- 6.2 cm, P =.016). Mucinous tumors were multilocular in half the patients and contained papillations in 40% of the patients. Serous tumors were multilocular in 30% of the patients but presented with solid or papillary patterns in 78% of the patients (P =.001). A resistance index of <0.4 was found in 36% of mucinous tumors and half the cases of serous tumors. In 13% of patients, ultrasonographic characteristics were compatible with a simple cyst only, including 1 patient with microinvasion and 1 patient with stage IIIB disease. Sensitivity of gray-scale ultrasonography was 87%, that of CA 125 measurement was 62%, and that of flow was 55%. At least 1 diagnostic test result was abnormal in 93% of patients, 2 were abnormal in 69% of patients, and all 3 were abnormal in 21% of patients. CONCLUSIONS: A high proportion of borderline tumors of the ovary, particularly of the serous type, were associated with elevated CA 125 levels and abnormal ultrasonographic characteristics, although some tumors presented as simple cysts.     

Abnormally high values of CA 125 and CA 19-9 in women with benign tumors

Tumor markers have proved to be generally useful for diagnosing and monitoring malignancy. In contrast, high levels of tumor markers disturb us for differing benign disease from malignancy. We had 5 cases with benign disease who showed high values of tumor markers (CA 125 and CA 19-9). In this report, we illustrated 3 patients with endometriosis who showed high values of CA 125 and 2 patients with dermoid cyst who showed high values of CA 19-9. It was impossible to rule out malignant disease in all cases preoperatively. In diagnosing ovarian tumors, bimanual examination, ultrasound, CT scan and tumor markers should all be considered.     

CA_(125)、CA_(724)、CA_(199)、BFP检测对判定卵巢浆液性囊腺癌疗效的意义

目的:探讨检测CA_(125)、CA_(724)、CA_(199)及BFP对卵巢浆液性囊腺癌患者诊断及疗效监测的意义。方法:用RIA或EIA测定卵巢浆液性囊腺癌患者术前及术后24个月内血CA_(125)、CA_(724)、CA_(199)及BFP,以腹腔镜检查及剖腹探查术为对照,监测上述4项标记物。结果:(1)术前各项标记物的阳性率为57.1%～79.1%,以CA_(125)最高;3项标记物组合阳性率为79.1%～85.7%。(2)Ⅰ期患者组合阳性率达80%,而且3项组合测定(CA_(125)+CA_(724)+BFP)即可达此水平。(3)3例复发病例均有2项以上标记物超过界值,即3项标记物组合阳性率可达100%。(4)每项单独测定均有假阴性。(5)CA_(125)单独测定有1例假阳性。结论:标记物的组合测定可覆盖复发病例,也能有效地提示绝大部分早期病例,但应注意单独检测有假阴性和假阳性的问题。     

Clinical use of CA 125 and its combination assay with other tumor marker in patients with ovarian carcinoma

The serum levels of CA 125 and CA 19-9 were determined by an immunoradiometric assay employing the monoclonal antibody OC 125 and anti-CA 19-9 antibody in 88 patients with ovarian carcinoma. When a cut-off value of CA 125 was set below 35 U/ml in the control group, serum elevated levels of CA 125 were found in 86.7% of the patients with surgically demonstrable ovarian serous cystadenocarcinoma, in 100% (4/4 cases) of clear-cell carcinoma, in 50% (2/4 cases) of endometrioid carcinoma, in 100% (5/5 cases) of undifferentiated carcinoma, and in 80% of the recurrent cases. Using a cut-off value of 37 U/ml, serum elevated levels of CA 19-9 were detected in 68.2% of mucinous cystadenocarcinoma, in 28.9% of serous cystadenocarcinoma, in 75% (3/4 cases) of metastatic ovarian carcinoma, and in 37.5% of the recurrent cases. A statistical analysis of the combination assay using CA 125, CA 19-9, tissue polypeptide antigen (TPA), immunosuppressive acidic protein (IAP), ferritin and CEA was carried out by multivariate method (discriminatory analysis) in 45 patients with ovarian carcinoma and 50 healthy subjects. As a result before treatment, positive rates of a single tumor marker were 79.7% with CA 125, 42.7% with CA-19-9, 73.1% with IAP, 61.7% with TPA, 64.3% with ferritin and 25.4% with CEA, respectively. A combination assay of these markers was useful for detecting identification of ovarian carcinoma, by which it gave a higher accuracy of ovarian cancer detection.     

The significance of serum CA 125 elevation in malignant and nonmalignant diseases

OBJECTIVES: The aims of the study were to investigate whether an elevated CA 125 level signals malignancies other than ovarian cancer and to find the cause of death for 247 women with elevated values among the 5550 women screened in 1986-1988 in the Stockholm population. METHODS: The Swedish Regional Cancer Registry delivered malignancy diagnoses among the 5550 women screened. The Cause of Death Registry gave the cause of death among the women with elevated CA 125 values. RESULTS: Patients with ovarian cancer were excluded. In 44 women with elevated CA 125 values other malignancies were reported to the Cancer Registry. They represent 18% of the entire group with elevated values. Among the 5297 women with normal CA 125 values 13% developed various malignancies. The difference between incidence of malignant disease in women with elevated values and women with normal values is significant, P = 0.02. Especially during the test-related period, from 1 year before to 1 year after the test, malignancies were detected in 6.9% of the population with elevated values and in only 1.6% with normal values (P = < 0.001). Breast cancer and lung cancer were overrepresented among women with elevated CA 125 values (P = 0.015 and < 0.001, respectively). Of the total 5500 women screened, 358 women died with different diagnoses. Elevated CA 125 values had been noted earlier in 25 women, and of these 20 died of malignant diseases, predominantly ovarian, breast, and lung cancer. CONCLUSIONS: Asymptomatic postmenopausal women with elevated CA 125 levels in ovarian carcinoma screening trials should, if ovarian cancer is excluded, be investigated for possible breast or lung cancer. The findings also suggest that elevated CA 125 level is a risk factor for death from malignant disease.     

CA 125 antigen is an effective diagnostic for external endometriosis

We measured serum levels of CA 125 in 26 patients with external endometriosis, using CA 125 RIA Kits. The normal range was instituted below 39 U/ml. The mean CA 125 level (+/- SD) was 55.1 +/- 24.9 U/ml in patients with external endometriosis, the positive rate being 71.4%. Considering the clinical stage of external endometriosis, the mean CA 125 level and positive rate increased to 64.5 +/- 23.2 U/ml and 93.3%, respectively. The CA 125 levels in these patients gradually decreased after surgery and/or Danazol treatment and the levels were below 39 U/ml within four weeks. Thus, progressive external endometriosis can be accurately diagnosed by determining the serum levels of CA 125, and appropriate clinical treatment designed.     

The clinical significance of pre-operative serum CA 125 in ovarian cancer

In a prospective study of 52 patients with ovarian malignancy followed up for 3-18 months the clinical significance of pre-operative serum CA 125 as a tumour marker was assessed. In 41 patients with epithelial ovarian cancer, the level of CA 125 correlated well with tumour load as indicated by FIGO stage. All epithelial histological types, including mucinous, released CA 125 although serous and undifferentiated tumours produced quantitatively more antigen. There was, however, no correlation between CA 125 concentration and histopathological grade, nor did CA 125 level appear to be of any prognostic value in epithelial ovarian cancer. Elevated CA 125 levels were also found in patients with sex cord/stromal tumours. Krukenberg tumours, an ovarian sarcoma and a serous carcinoma of low malignant potential.     

Saliva and serum CA 125 assays for detecting malignant ovarian tumors

The aim of this study was to determine whether CA 125 was present in saliva and, if it was present, to compare saliva and serum levels in patients with pelvic masses in order to determine whether saliva assays would be useful in identifying patients with ovarian malignancies. Saliva and serum CA 125 levels were assayed in specimens obtained from 55 normal healthy women, 92 patients with benign pelvic masses, and 41 patients with malignant pelvic tumors. We defined a serum CA 125 value greater than 65 U/mL and a saliva CA 125 value greater than 3000 U/mL as the positivity criteria. No serum or saliva assay was positive in the 55 normal women. The sensitivities of the saliva and serum CA 125 assays in 16 patients with epithelial ovarian cancer were 81.3 and 93.8%, respectively. A linear correlation was observed between serum and saliva CA 125 levels. The false-positive rates of serum CA 125 in patients with endometriomas and pelvic tuberculosis were 72.7 and 80%, respectively, but the false-positive rates for saliva CA 125 assays were only 13.6 and 10%, respectively. Therefore, the saliva CA 125 assay had a better diagnostic value than the serum CA 125 assay. In addition, collection of saliva is simple, noninvasive, and inexpensive, and samples could be obtained easily and repeatedly. For these reasons, assays of saliva CA 125 levels may be a new way of screening for malignant ovarian tumors.     

血清CA125检测在子宫内膜癌中的价值

目的探讨血清CA125在子宫内膜癌中的价值.方法选取1992年3月～2002年3月在北京大学第一附属医院、北京大学人民医院住院经手术治疗的子宫内膜癌患者141例,术前及随访中用放射免疫法测定血清CA125水平,CA125≥35 U/ml 为阳性结果.对其中14例行子宫内膜癌组织CA125免疫组化方法检测.收集患者的临床病理资料,分析CA125与这些资料的关系以及复发患者复发前后CA125变化.结果 CA125免疫组化检测14例均呈阳性,阳性细胞着色率与血清CA125之间无明显相关.141例患者术前血清CA125阳性32例(22.7%), Ⅰ、Ⅱ、Ⅲ和Ⅳ期患者血清CA125阳性(阳性率)分别为11例(12.1%)、6例(31.6%)、12例(46.2%)和3例(60.0%). 血清CA125阳性率随子宫内膜癌期别的增加而升高.深肌层浸润、宫颈受累、附件转移、腹腔洗液细胞学阳性、盆腔淋巴结转移及宫内肿瘤病灶≥2 cm者,血清CA125阳性率增加.随访中13例复发,其中9例术前血清CA125＞35 U/ml者复发时均伴血清CA125水平升高,而另4例术前血清CA125正常者,复发后血清CA125水平仍正常.结论子宫内膜癌患者术前血清CA125的测量有助于了解肿瘤的侵犯范围.术前血清CA125水平异常的子宫内膜癌患者,术后定期复查血清CA125水平,将有助于子宫内膜癌病情的监测.     

Clinical significance of tumor associated antigen TA-4 in gynecologic tumors

Serum levels of TA-4, a tumor associated antigen of cervical squamous cell carcinoma, were measured in various gynecologic tumors with a RIA kit (DAINABOT). Immunohistochemical localization of TA-4 was also evaluated in the squamous cell carcinoma of the cervix. Serum TA-4 levels were elevated in 8.3% of patients with CIS, in 25% with stage Ia, in 56% with stage Ib, in 83% with stage II, in 75% with stage III and IV and in 100% with recurrent squamous cell carcinoma of the cervix, respectively. No patients were positive for TA-4 in endometrial and ovarian cancers. Serum TA-4 levels declined distinctively after treatment in accordance with the disappearance of initial tumors in some patients with advanced carcinoma. TA-4 was demonstrated immunohistochemically in 2 out of 8 CIS, 3 out of 8 microinvasive carcinoma, 4 out of 4 keratinizing type, 7 out of 7 large cell type and 3 out of 6 small cell type of invasive squamous cell carcinoma, respectively. In each type of carcinoma, TA-4 was positive in the differentiated cells. Similarly, it was found in the differentiated layers of normal squamous epithelium excluding the immature cells of the basal layer.     

C—反应性蛋白测定用于妇科恶性肿瘤诊断的初步观察

通过检测51例妇科良性肿瘤及32例妇科恶性肿瘤患者血清C—反应性蛋白(CRP),发现妇科恶性肿瘤病人血清CRP含量明显增高。良性肿瘤病人血清CRP均为阴性,CRP含量的变化反映妇科恶性肿瘤的严重程度,CRP含量越高妇科恶性肿瘤患者期别越晚。其中卵巢癌病人C—反应性蛋白的阳性检测率100％,但3例恶性葡萄胎病人CRP为阴性,其原因有待于进一步探讨。本文提示:CRP的检测可用于妇科恶性肿瘤的辅助诊断、良恶性肿瘤的鉴别、恶性肿瘤的预后及恶性肿瘤病人化疗疗效的预测。