卵巢上皮性癌患者血清CA125值的临床分析

卵巢上皮性癌患者血清ＣＡ１２５值的临床分析刘金玲邬谨慧李君马堪悦徐世杰焦书竹天津医科大学总医院（天津市３０００５２）卵巢癌是危及妇女生命的主要疾病之一。卵巢上皮性癌约占５０％，尽早诊断仍是一难题。血清ＣＡ１２５值是诊断卵巢上皮性癌和术后监测的主要标记...     

血清CA125检测对上皮性卵巢癌预后判断的价值

 目的　探讨血清CA125在上皮性卵巢癌（EOC）中的预后判断价值。方法　采用回顾性分析方法,对2002年1月至2006年6月新疆医科大学第一附属医院妇科收治的40例EOC患者手术前后血清CA125水平并结合其病理、分期及预后等临床资料进行分析 。结果　术前血清CA125水平与组织类型和临床分期相关（P＜0.05）,术后血清CA125半衰期>20 d者复发率（78.6 %）高于半衰期＜20 d者（34.6 %）,多因素分析表明临床分期和CA125半衰期对预后有影响;术后血清CA125水平的升高可预测复发。结论　EOC患者术前测定血清CA125水平可初步判断组织类型及临床分期,术后监测血清CA125水平可及时发现复发,并可判断预后。     

血清CA125在卵巢上皮癌治疗和预后中的作用

CA125是卵巢上皮癌最重要的血清标志物，其在卵巢癌筛查、诊断等方面的价值已被临床所用，但在预测卵巢癌减瘤术满意度、病情监测及评价疗效和预后等方面的价值仍有待进一步探讨。现就CA125在卵巢癌手术及预后中的预测价值，以及病情监测和疗效评价等相关进展进行综述。     

血清CA125测定对肺癌诊断和预后价值的初探

本研究对肺癌患者的血清ＣＡ12 5进行检测 ,并以同期的良性肺疾病患者和健康人作为对照 ,现将结果报告如下。临床资料　病例 :肺癌组为我院 1999年 4月至 2 0 0 1年 10月住院患者 69例 ,男性 5 2例 ,女性 17例 ,平均年龄 5 6岁。全部病例均经细胞学或组织学确诊。其中鳞癌 3 9例 ,Ⅰ、Ⅱ、Ⅲ、Ⅳ期各为 7、7、2 1、4例 ;腺癌 2 3例 ,Ⅰ、Ⅲ、Ⅳ期各为 2、14、7例 ;小细胞肺癌 7例 ,Ⅰ、Ⅲ期各为 1、6例。良性肺疾病组为同期住院患者 3 8例 ,男性 2 9例 ,女性 9例 ,平均年龄 48岁 ;其中肺炎 11例 ,哮喘 9例 ,肺结核 4例 ,支气管炎 12例 ,肺气…     

超声检查与血清CA125检测在卵巢恶性肿瘤诊断中的价值

目的 探讨超声检查与血清肿瘤标志物CA125检测在卵巢恶性肿瘤诊断中的价值。方法 收集我院2012年10月至2013年12月收治的卵巢肿瘤患者113例,其中恶性53例,良性60例,于术前1周内均行超声检查及血清CA125检测。采用倾向得分匹配法（propensity score matching,PSM）均衡组间协变量,获得34对匹配成功的患者并对其诊断结果与病理检查进行比较。结果 CA125检测在卵巢恶性肿瘤诊断中的灵敏性、特异性、阳性预测值（positive predictive value,PPV）、阴性预测值（negative predictive value,NPV）、准确性分别为88.2%、61.8%、69.8%、84.0%、75.0%;超声检查在卵巢恶性肿瘤诊断中的灵敏性、特异性、PPV、NPV、准确性分别为85.3%、88.2%、87.9%、85.7%、86.8%;超声检查联合CA125检测在卵巢恶性肿瘤诊断中的灵敏性、特异性、PPV、NPV、准确性分别为94.1%、64.7%、72.7%、91.7%、79.4%。超声检查单独应用的特异性明显高于CA125检测及二者联合检查的特异性,差异有统计学意义（P均〈0.05）;而灵敏性、PPV、NPV及准确性在两两检查比较中的差异均无统计学意义（P均〉0.05）。结论 CA125检测联合超声检查并不能提高卵巢恶性肿瘤的诊断符合率。     

血清CA125在卵巢上皮癌治疗和预后中的作用

CA125是卵巢上皮癌最重要的血清标志物,其在卵巢癌筛查、诊断等方面的价值已被临床所用,但在预测卵巢癌减瘤术满意度、病情监测及评价疗效和预后等方面的价值仍有待进一步探讨.现就CA125在卵巢癌手术及预后中的预测价值,以及病情监测和疗效评价等相关进展进行综述.     

血清CA125,CA199,CA153在卵巢浆,粘液性囊腺癌诊断和动态观察中的价值

目的：探讨血清ＣＡ１２５、ＣＡ１９９、ＣＡ１５３对卵巢癌浆、粘液性囊腺癌的诊断和动态观察中的价值。方法：采用微粒子酶免疫测定法，于术前对４５例卵巢浆、粘液性囊腺癌和２３例附件良性疾病患者血清中的ＣＡ１２５、ＣＡ１９９、ＣＡ１５３水平进行测定，以观察其在诊断上的敏感性和特异性。对１８例卵巢浆液囊腺癌和１５例粘液囊腺癌行上述三种抗原作治疗中的动态观察，以探讨其价值。结果：此三项指标对浆、粘液卵巢癌诊断     

术前血清CA125水平与上皮性卵巢癌临床病理特征及预后的关系

[目的] 分析上皮性卵巢癌患者术前血清 CA125 水平和临床病理特征及预后之间的关系.[方法] 回顾性分析 279 例上皮性卵巢癌患者术前血清 CA125 水平与组织类型、分级、FIGO 分期、腹腔积液以及生存的关系.[结果] 患者的术前 CA125 水平波动范围3.6～20 220.0U/ml,中位数值为 339.2 U/ml.浆液性癌术前血清 CA125 水平明显高于非浆液性癌(P＜0.05);对非浆液性癌中不同组织类型的分析显示,黏液性癌及透明细胞癌 CA125 水平明显低于浆液性癌(P＜0.01),其余类型与浆液性癌并无明显区别(P＞0.05).早期卵巢癌(Ⅰ期)术前血清 CA125 水平明显低于中、晚期癌患者(Ⅱ～Ⅳ期) (P=0.000),在非黏液/透明细胞癌患者中,早期患者常常表现出低水平 CA125 值,预后较好;晚期患者更多表现出较高水平的血清 CA125 值,但晚期患者中,那些术前血清 CA125 水平较高的患者较那些中等水平的患者表现出更好的预后.[结论] 上皮性卵巢癌患者术前血清 CA125 水平可以反映浆液性以及其他非黏液/透明细胞癌的肿瘤负荷.     

血清CA125检测在肺癌中的价值

目的了解血清CA125水平在原发性肺癌患者预后判断中的价值.方法对50例健康人、64例肺部良性疾病患者、130例未经治疗的肺癌患者进行血清CA125测定.结果CA125平均浓度在肺癌患者中为(76.9±118.37)×103U/L.在肺良性病变中为(22.52±22.55)×103U/L,两者间差异非常显著(P＜0.01).在健康人群中CA125平均浓度为(2.65±3.29)×103U/L.以60×103U/L为临界值,肺癌组与正常组比较敏感性为34.6%、特异性为100%、阳性预测值100%、阴性预测值37%、正确性52.8%.肺癌组与肺良性病变组比较上述值分别为34.6%、92.19%、90%、40.97%、53.6%.本组资料中几乎所有CA125水平升高肺癌患者都是晚期(43/45),其生存率明显低于CA125水平正常的肺癌患者,两者间差异非常显著(P＜0.01).结论血清CA125是一个显示疾病程度的指标,其血清水平与生存期呈负相关.     

磁共振成像结合血清CA125水平检测在卵巢肿瘤诊断中的价值

目的探讨磁共振成像（MRI）结合血清CA125水平检测在卵巢肿瘤诊断中的价值。方法对健康人40名、卵巢良性病变患者52例及卵巢恶性肿瘤患者43例进行MRI及血清CA125水平检测,判定联合检查及单一检查对卵巢肿瘤诊断的准确性。结果CA125对卵巢肿块的诊断敏感度为79．3％,特异度为72．6％、准确率为75．1％;MRI的敏感度为73．8％、特异度为81．2％、准确率为82．6％;二者联合检查的敏感度为69．4％、特异度为97．3％、准确率为88．6％,联合检查与单一检查的尤登指数差异有统计学意义（MRI联合血清CA125检查卵巢肿块与单独使用MRI检查比较,u=1．97,P=0．0125;联合检查较单一使用血清CA125检查比较,u=1．96,P=0．0120）。结论MRI与血清CA125联合检查能提高卵巢肿瘤诊断的准确性,在临床上减少误诊率,是一种值得推广的检查方法。     

血清MIC-1和CA125在卵巢上皮癌诊断及预后中的应用研究

目的：探讨巨噬细胞抑制因子-1（MIC-1）和CA125的卵巢癌诊断和预后判断价值。方法通过检测92例未经治疗的卵巢上皮癌患者（观察组）和96例健康女性（对照组）血清样本中的MIC-1和CA125水平,分析血清MIC-1和CA125水平与卵巢癌的关系;通过ROC曲线评价MIC-1和CA125单项及联合应用的卵巢癌诊断效能;通过对其中74例卵巢癌患者按术后残瘤大小和首次化疗敏感性结果分组,比较两组治疗前MIC-1和CA125水平,评价MIC-1和CA125的疗效评价价值;并通过分析68例患者的MIC-1和CA125水平与无瘤生存时间（relapse free survival,RFS）的关系评价其预后判断价值。结果观察组血清MIC-1水平显著高于对照组（P＜0.001）;MIC-1诊断卵巢癌的ROC（AUC=0.945）与CA125的ROC（AUC=0.966）比较差异无统计学意义,MIC-1和CA125联合应用的卵巢癌诊断效能显著提高（AUC=0.966）。术前CA125水平与术后残瘤大小显著相关（P=0.07）;术前血清MIC-1水平与化疗敏感性显著相关（P=0.001）,并且血清MIC-1水平与患者RFS呈负相关。结论 MIC-1和CA125联合检测可提高卵巢癌的诊断率,MIC-1高水平预示卵巢上皮癌患者存在较大的耐药风险,且MIC-1可作为预测卵巢癌患者生存期的独立指标。     

血清ＣＡ１２５在卵巢上皮性癌中的应用研究进展

卵巢恶性肿瘤是女性常见的恶性肿瘤,发病率在女性生殖道肿瘤中位于第３位,但死亡率却位居女性生殖道肿瘤之首。由于早期症状隐匿,接近２／３的患者诊断时已为Ⅲ期或Ⅳ期,５年生存率明显低于Ⅰ期或Ⅱ期。由于早期卵巢癌的预后要明显好于晚期卵巢癌,卵巢癌的早期诊断已成为提高患者生存率的一项重要的因素。血清癌抗原１２５（ＣＡ１２５）ＥＬＩＳＡ检查已常规用于卵巢癌的诊断和病情监测,本文拟就ＣＡ１２５目前在卵巢癌临床工作中的应用及近年相关新的研究进展作一综述。     

The prognostic value of pretreatment CA 125 in patients with advanced ovarian carcinoma

BACKGROUND:

The objective of the current study was to determine the prognostic significance of a pretreatment serum CA 125 level in patients with advanced epithelial ovarian carcinoma (EOC) who received treatment with a standard chemotherapy regimen.

METHODS:

Patients with International Federation of Gynecology and Obstetrics stage III/IV ovarian carcinoma who were on 1 of 7 Gynecologic Oncology Group (GOG) phase 3 trials and received treatment with a standard regimen of intravenous cisplatin and paclitaxel were included. A Cox regression model was used to assess the impact of CA 125 levels drawn before the initiation of chemotherapy on progression‐free survival (PFS) both overall and by subgroup, including surgical debulking status, disease stage, and histologic subtype.

RESULTS:

In total, 1299 patients who were on the cisplatin/paclitaxel arms of the GOG trials were eligible. The median CA 125 level was 246 U/mL. Only 7.6% of patients had a normal CA 125 level (≤35 U/mL). The lowest median CA 125 level was observed in the group with mucinous tumors; however, 69% of women who had mucinous tumors had abnormal CA 125 levels. Shorter PFS was observed with increasing CA 125 and persisted in multivariate analysis. Overall and in the serous subgroup, a 1‐fold increase in CA 125 level was associated with a 7% increase in the hazard of disease progression (P < .001). This association was even more pronounced in patients who had stage III disease that was debulked to microscopic disease (15%; P = .003) and in patients who had endometrioid tumors (17%; P = .001).

CONCLUSIONS:

A normal CA 125 level in the setting of advanced EOC was rare even after surgical debulking. The pretreatment CA 125 level was an independent predictor of PFS in patients with advanced EOC who received a standard chemotherapy regimen, particularly in the setting of disease that was debulked to a microscopic residual and in the serous or endometrioid subtypes. Cancer 2009. © 2009 American Cancer Society.     

血清中人附睾蛋白4、抑制素A及癌胚抗原125联合检测在卵巢癌诊断中的意义

目的：探讨人附睾蛋白4（HE4）、抑制素A（inhibinA）及癌胚抗原125（CA125）在卵巢癌患者中的诊断价值。方法：应用ELISA法检测卵巢癌组、卵巢良性肿瘤组及正常对照组患者血清中HE4、InhibinA、CA125水平。结果：血清HE4水平：卵巢癌组（133.86±127.94）pmol/L、卵巢良性肿瘤组（42.67±22.77）pmol/L、正常对照组（33.40±19.50）pmol/L;血清InhibinA水平：卵巢癌组（177.22±114.35）ng/L、卵巢良性肿瘤组（76.60±14.10）ng/L、正常对照组（70.70±21.66）ng/L;血清CA125水平：卵巢癌组（750.52±1230.34）U/L、卵巢良性肿瘤组（67.25±106.16）U/L、正常对照组（17.69±6.13）U/L。统计学分析血清HE4、InhibinA数值显示：卵巢癌组与卵巢良性肿瘤组、正常对照组比较,P〈0.05,差异有统计学意义;而卵巢良性肿瘤组与正常对照组比较,P〉0.05,差异无统计学意义。血清CA125卵巢癌组与卵巢良性肿瘤组、正常对照组比较,P〈0.05,差异有统计学意义;良性肿瘤组与正常对照组比较,P〈0.05,差异有统计学意义。卵巢癌诊断中的阳性率分别是：HE4 71.8%、InhibinA 66.7%、CA125 61.5%,三者联合阳性率为92.3%。结论：HE4、InhibinA、CA125在卵巢癌诊断中有重要意义,三者联合检测能明显提高卵巢癌的诊断率。     

彩色多普勒超声联合肿瘤标志物CA125、CA724对卵巢良恶性肿瘤的鉴别诊断价值

目的:探讨彩色多普勒超声检查联合肿瘤标志物血清CA125、CA724对卵巢良恶性肿瘤的鉴别诊断价值.方法:收集绵阳市第三人民医院2014年1月至2016年3月手术治疗的卵巢肿瘤患者212例,分析患者的彩色多普勒超声各项指标及血清CA125、CA724水平.以病理诊断作为金标准,计算超声诊断及三项指标联合诊断的准确率、灵敏度及特异度等.结果:超声诊断结果显示,在卵巢恶性肿瘤组中,超声诊断与病理诊断符合率为56.5%(26/46),卵巢良性肿瘤组诊断符合率为88.0%(146/166),良性卵巢肿瘤组超声病理诊断符合率高于恶性肿瘤组,差别有统计学意义(P<0.001).卵巢恶性肿瘤组患者的血清CA125和CA724水平均高于良性肿瘤组,差别有统计学意义(P<0.05).卵巢恶性肿瘤组三项指标联合检测诊断阳性率明显高于良性组(78.3% vs 37.3%,P<0.001).三个单项检测指标中,CA125的灵敏度最高,CA724的特异度最高,超声检查的准确度、阳性预测值、阴性预测价值最高.联合检测中,彩色多普勒超声检查联合CA125诊断卵巢癌的准确度、灵敏度、特异性、阳性预测值、阴性预测价值高于三项指标的联合诊断,亦高于两项肿瘤标志物的联合诊断.结论:超声联合血清肿瘤标志物一定程度上可以提高卵巢良恶性肿瘤的鉴别诊断率.     

联合检测HE4与OPN及CA125对卵巢癌诊断价值的探讨

目的:探讨血清人附睾分泌蛋白4(HE4)、骨桥蛋白(OPN)和CA125水平联合检测对卵巢恶性肿瘤的诊断价值.方法:在30例卵巢癌患者(卵巢癌组)、30例卵巢良性肿瘤患者(卵巢良性肿瘤组)和30例患子宫肌瘤等妇科疾病但卵巢正常者(对照组)中,采用酶联免疫吸附试验(ELISA)法检测HE4、OPN,全自动化学发光分析系统检测血清CA125.HE4参考范围0～80ρmol/L;OPN计算临界值为30 ng/mL,≥30 ng/mL为阳性;CA125≥35 U/mL为阳性.通过制作受试者工作特征(ROC)曲线,以曲线下面积(AUC)反映诊断的准确性.结果:1)各组血清肿瘤标志检测结果显示,卵巢癌患者HE4,CA125、OPN水平明显高于对照组以及卵巢良性肿瘤组,差异有统计学意义,F值分别为39.23、84.03和104.09,P＜0.01;而卵巢良性肿瘤患者与对照组之间差异均无统计学意义,P＞0.05.2)HE4在不同组织类型卵巢癌中的表达不同,卵巢浆液性癌(95.23％)和内膜样癌(100.00％)中高表达,透明细胞癌(0)和黏液性癌(0)不表达.3)OPN在卵巢癌Ⅲ～Ⅳ期患者中的含量明显高于Ⅰ～Ⅱ期患者,且与肿瘤转移有关,有淋巴结转移患者明显高于无转移者.4)以卵巢良性肿瘤组及卵巢正常组为对照,CA125+ HE4+OPN、CA125+HE4、CA125+OPN、HE4和CA125为盆腔恶性肿瘤诊断指标,ROC曲线下面积依次为0.91.0.90、0.85、0.85和0.80.在特异性为98.3％时,各肿瘤标志诊断盆腔恶性肿瘤的敏感度依次是73.3％、70.0％、66.6％、63.3％和20.0％.特异度为95.0％时,敏感度80.0％、76.6％、70.0％、70.0％和40.0％.特异度是90.0％时,敏感度83.3％、80.0％、76.6％、73.3％和56.6％.结论:CA125+ HE4+OPN3种肿瘤标志联合检测对提高卵巢恶性肿瘤的诊断价值有一定的意义.     

Difference in mesothelin‐binding ability of serum CA125 between patients with endometriosis and epithelial ovarian cancer

The epithelial ovarian carcinoma (EOC) is an aggressive malignant tumor, and is currently the leading cause of gynecologic cancer death. CA125 is the most commonly used serum marker for EOC, but shows a high‐false‐positive rate for several benign diseases such as endometriosis. The purpose of our study is therefore to identify a useful biochemical tool for detecting qualitative differences between CA125 from patients with endometriosis and EOC, and to facilitate differential diagnosis of these diseases. In our study, using two different CA125‐binding molecules, i.e., recombinant mesothelin and an anti‐CA125 monoclonal antibody, a novel sandwich ELISA for determining the serum levels of CA125 with mesothelin‐binding ability (CA125^meso) was developed, and tested for patients with endometriosis (n = 59) and EOC (n = 36). We found that both the serum CA125^meso level and the ratio of the serum CA125^meso to CA125 levels (CA125^meso/CA125) were significantly higher in patients with EOC than in patients with endometriosis (p < 0.00005 and p < 0.000001, respectively). Furthermore, receiver operating characteristic analysis showed that the CA125^meso assay was superior to the conventional antibody‐based CA125 assay in discriminating endometriosis from EOC. Thus, mesothelin‐binding ability may be a useful indicator for qualitatively evaluating CA125 in patients with endometriosis and EOC.     

血清CA125测定在妇科肿瘤中的应用价值

目的　探讨血清CA12 5水平的测定在妇科肿瘤临床中的应用价值。方法　采用放射免疫分析方法测定 86例妇科肿瘤患者血清CA12 5抗原水平。结果　卵巢上皮癌组CA12 5水平为 2 14 .5 4± 16 8.2 9u/ml,其敏感性为 96 .4% ,特异性为 84.5 % ,该组经手术和化疗后CA12 5水平比治疗前显著降低 (P <0 .0 0 1) ;子宫内膜异位症组CA12 5水平明显高于子宫肌瘤组及卵巢良性肿瘤组。结论　血清CA12 5水平测定对卵巢上皮癌的诊断及预后评估具有重要意义 ,结合临床亦可为子宫内膜异位症的诊断提供有价值的参考。     

CA 125 half-life and CA 125 nadir during induction chemotherapy are independent predictors of epithelial ovarian cancer outcome: results of a French multicentric study.

BACKGROUND: CA 125 assays enable treatment-response monitoring in ovarian cancer. PATIENTS AND METHODS: A multicentric study of CA 125 kinetics under induction chemotherapy was performed in 631 patients. CA 125 half-life was calculated by mono-compartmental logarithmic regression. Nadir CA 125 concentration and time to nadir were also studied. Survival analyses for disease-free survival (DFS) and overall survival (OS) used univariate (Kaplan-Meier) and multivariate (Cox) models. RESULTS: For 553 stage IIC-IV patients, 459 (83.0%) relapsed and 444 (80.3%) died from cancer. Median (range) follow up time was 32 months (2-214 months). Median (range) for CA 125 kinetics were: 263 kU/l (5-52000 kU/l) before 1st course, 15.8 days (4.5-417.9 days) for CA 125 half-life, 16 kU/l (3-2610 kU/l) for nadir and 85 days (0-361 days) for time to nadir. Pre-chemotherapy CA 125, its half-life, nadir concentration and time to nadir all had a univariate prognostic value for DFS and OS (P<0.0001). In Cox models, CA 125 half-life, residual tumour (P<0.0001 for both), nadir concentration (P=0.0002) and stage (P=0.0118) were the most powerful prognostic factors for DFS. For OS, the significant variables were similar, with age ranking last (P=0.0319). CONCLUSION: Among well-established prognostic factors in ovarian cancers, CA 125 half-life and nadir concentration bear a strong and independent prognostic value.