The significance of serum leucine aminopeptidase (P-LAP) determination in the gynecological malignancies

We determined Placental-Leucine Aminopeptidase (P-LAP) activity, one of the oncodevelopmental antigens, in sera and in tissues of patients with gynecological cancers. The incidence of P-LAP activity and clinical usefulness of the determination of serum P-LAP activity were studied. The mean level in healthy non-pregnant sera used as controls was 6.0 +/- 2.4mg/dl/h. The mean level of P-LAP activity in patients with benign tumors such as myoma uteri and benign ovarian tumor did not increase in comparison with the controls. The mean level of P-LAP activity in patients with malignant tumor increased with advancing stages, and especially in advanced cervical and ovarian cancer, serum P-LAP levels were significantly higher than in the controls. Serum P-LAP activity correlated with the serum ferritin concentration (r=0.613), but not with the serum alpha-fetoprotein and serum carcinoembryonic antigen concentration. Serial measurements of serum P-LAP activities in patients with gynecological cancer showed that serum P-LAP activity might reflect the progress of cervical and ovarian cancer. Tissue P-LAP activities in 29 ovarian cancers were compared with those in normal tissues. Tissue P-LAP activities in 26 cases out of 29 increased to twice as high as the mean activities in 10 normal ovaries. Our present results suggest the possibility of using P-LAP activity as one of tumor markers for gynecological malignant tumors.     

The clinical significance of tissue polypeptide antigen (TPA) in the patients with gynecologic tumor

In order to estimate the clinical significance of tissue polypeptide antigen (TPA), TPA was measured by radioimmunoassay in sera from patients with various gynecological tumors. They were 40 uterine myomas, 94 cervical cancers, 21 endometrial cancers, 3 vulval cancers, 51 benign ovarian tumors and 78 malignant ovarian tumors including 18 low potential malignant tumors (LPM). The mean TPA values in patients with benign as well as malignant tumors were significantly higher than that of 97 healthy volunteers (68 +/- 17 U/l; Upper limit; 107 U/l). Among the cervical cancer patients, serum TPA level and positive ratio became higher as the disease progressed. In the advanced cases, the mean serum TPA value and positive ratio were 149 +/- 64 U/l and 75%, respectively. The mean TPA value in the endometrial cancer patients was significantly higher than that of myoma patients. Among the patients with ovarian tumor, serum TPA was elevated in 14% of benign cases, 28% of LPM cases, 47% of stage I cases and 82% of the advanced cases. Serum TPA values varied directly with the stage and malignancy of disease. The present study revealed that TPA is a useful markers in the diagnosis of gynecological tumors, especially for ovarian cancers.     

Significance of immunosuppressive acidic protein in the diagnosis and follow-up of patients with ovarian cancer, in particular as a marker for chemotherapeutic effects

Serum immunosuppressive acidic protein (IAP) was determined in patients with ovarian cancer and was examined as a marker for ovarian cancer when, chemotherapy in particular, was applied. Samples were sera obtained from 68 ovarian cancers, 74 benign ovarian tumors, 54 cervical cancers, 57 uterine myomas and 88 healthy controls. Elevated levels of IAP were found in 89.5% of patients with ovarian cancer and this high positive ratio was not affected by tumor histologic features. The measurement of the serum IAP level is useful for the initial diagnosis of ovarian cancer because of low false positive rates (8.1%) in benign ovarian tumors and high positive rates even in the early stage of ovarian cancer. Serial determinations of serum IAP levels were well correlated with the response to the treatment (chemotherapy in particular) and the prognosis of cancer patients, even in the case of patients with leucocytopenia induced by the intensive chemotherapy. In case of recurrent patients (whose lesions were observed in the intraperitoneal space), IAP values tended to increase earlier than other conventional tumor-derived markers. Therefore, IAP may also be a useful follow-up marker for patients with ovarian cancer (particularly, for the early detection of recurrence).     

Serum arylesterase and paraoxonase activities in patients with ovarian tumors

ObjectiveHigh levels of toxic reactive oxygen species have been found in many types of cancer cells. Serum arylesterase (ARE) and paraoxonase (PON) are esterase enzymes that have strong antioxidant characteristics. The main purpose of our study was to evaluate the activity of ARE and PON in the sera of patients with ovarian cancer and benign ovarian tumors.Materials and methodsThis study included 30 patients with ovarian cancer, 42 patients with benign ovarian tumors, and 19 healthy age- and sex-matched individuals. ARE and PON activities were measured using spectrophotometry.ResultsSerum ARE activity was significantly different among the three studied groups (p < 0.0001). However, posthoc tests revealed that ARE activity was lower in the benign ovarian tumor group (median, 1.53 U/mL; range, 0.43–2.47 U/mL) than in the other groups. There were no differences in ARE activity between patients with ovarian cancer (1.89 U/mL; range, 1.01–2.56 U/mL) and healthy individuals (2.05 U/mL; range, 0.79–2.44 U/mL). We found no differences in PON activity or the PON:ARE activity ratio between the studied groups. Tumor size in the benign ovarian tumor group was positively correlated with ARE activity (R Spearman = 0.46, p = 0.003) and negatively correlated with PON activity (R Spearman = −0.50, p = 0.001). The ARE and PON activities were not influenced by histological type, ovarian cancer grade, or disease advancement.ConclusionARE activity is higher in patients with ovarian cancer than in patients with benign ovarian tumors; however, the serum activity of ARE is similar between patients with cancer and healthy individuals.     

Significantly increased interleukin-1A and interleukin-1 soluble type II receptor levels in women with ovarian cancer

OBJECTIVES: Recent studies indicate that interleukin-1 alpha (IL-1 alpha) is an autocrine growth factor for some ovarian cancer cells and suggest that IL-1 alpha plays an important role in the progression of this disease. However, soluble IL-1 receptors as IL-1 sRII, can modulate the effects of IL-1 alpha by acting as IL-1 alpha antagonists. The aim of our study was to compare serum IL-1 alpha and IL-1 sRII levels in patients with benign and malignant gynaecological tumours and in control. MATERIALS AND METHODS: Pretreatment serum samples were obtained from 72 women with gynaecological tumors. This study included 37 patients with gynaecological cancers (21 with cervical cancer, 16 with ovarian cancer), and 35 women with benign gynaecological disorders (20 with ovarian tumour, 15 with uterine myoma). As a control group, sera were obtained from 20 healthy female volunteers. The levels of IL-1 alpha and IL-1 sRII were measured by ELISA (R&D Systems, Inc, Minneapolis, USA). RESULTS: Serum IL-1 alpha and IL-1 sRII levels in women with ovarian cancers were significantly higher than those in cervical cancer, and in patients with benign disorders, and in healthy control (p < 0.0001). CONCLUSIONS: Our results suggests that IL-1 alpha has a strong association with ovarian cancer.     

Differential diagnosis of ovarian cancer, benign ovarian tumor and endometriosis by a combination assay of serum sialyl SSEA-1 antigen and CA125 levels

We used a combination assay of serum sialyl SSEA-1 antigen (SLX) and CA125 levels, and evaluated the clinical usefulness of this technique for a differential diagnosis of ovarian cancer, benign ovarian tumor and endometriosis. In 82 patients with ovarian tumors, the sera of 20 (64.5%) of 31 with ovarian cancer and 15 (48.4%) of the 31 with endometriosis (endometrial cyst) were positive for both SLX and CA125, but serum SLX level was 5 U/ml or less in these 14 SLX- and CA125-positive patients with endometriosis. The sera of 16 (80.0%) patients with benign ovarian tumor were negative for both tumor markers. The sera of 3 (9.7%) of 31 with ovarian cancer and the sera of 2 (6.5%) of 31 with endometriosis were negative for both markers. The diagnostic accuracy (true positive rate X true negative rate) of the combination assay for ovarian cancer was 49.0% when the cutoff value of the serum SLX was 38 U/ml but improved to 78.5% when the value was set at 50 U/ml. When the cutoff value of serum SLX was set at 50 U/ml and that of serum CA125 at 35 U/ml, 27 of 37 patients who were positive only for CA125 had endometriosis. From the above observations, a combination assay of serum SLX and CA125 is a promising method for the differential diagnosis of malignant and benign ovarian tumors. Our results also suggest that to improve the diagnostic accuracy, the cutoff value of the serum SLX level should be 50 U/ml for ovarian tumors alone.     

Use of lysophosphatidic acid in the management of benign and malignant ovarian tumors

OBJECTIVE: To establish whether LPA determination improves the differentiation of benign from malignant ovarian tumors. METHODS: Total LPA and LPA species in the serum were determined using a novel method in 142 patients with ultrasound (US) suspecious ovarian tumors and in 78 healthy women. All women underwent determination of CA125 in the serum, a vaginal US examination and morphology scoring of the tumor. RESULTS: The levels of total LPA and its species in women with ovarian tumors were significantly higher from those in healthy women (p < 0.001). No significant difference was found in the levels of total LPA or any of its species between the women with benign and those with malignant ovarian tumors. CONCLUSIONS: Determination of serum LPA would be an appropriate test for ovarian tumor presence, especially in women of reproductive age. The method however does not differentiate benign from malignant ovarian tumors.     

Peripheral and ovarian venous concentrations of steroid and gonadotropin hormones in postmenopausal women with epithelial ovarian tumors

Peripheral serum concentrations of estrone (E1), estradiol (E2), testosterone, androstenedione, dehydroepiandrosterone sulfate (DHEAS), cortisol, prolactin, LH, and FSH were measured in 28 postmenopausal women with epithelial ovarian tumors (12 ovarian cancer, 5 borderline malignant, 11 benign neoplasms) and in 15 controls before bilateral salpingo-oophorectomy and 1 and 8 weeks postoperatively. The levels of these hormones were also measured in ovarian venous blood of 15 patients with ovarian tumors. E2 was significantly higher in the tumor group than in controls preoperatively and the levels of E1 and E2 decreased after radical operation. Hormone levels were similar in the benign and malignant tumor groups. Only DHEAS levels in peripheral serum were significantly lower in ovarian cancer patients than in the group with benign neoplasm. This was not the case in testosterone and androstenedione measurements. The measured levels of the hormones in ovarian venous blood were highest in mucinous ovarian tumors. E2 and testosterone levels were higher in mucinous ovarian tumors than in others. LH(hCG)-receptor levels were measured in 24 specimens and none of these showed detectable concentrations of LH(hCG) receptor. The results indicate that of all epithelial tumors mucinous ovarian tumors had hormonal activity most often, and malignancy had no effect on hormonal activity.     

血清可溶性间皮素相关肽在卵巢良恶性肿瘤鉴别诊断中的应用

目的探讨血清可溶性间皮素相关肽(SMRP)在卵巢良恶性肿瘤鉴别诊断中的临床意义。方法血清标本取自2008年1月至2010年7月白求恩国际和平医院100例卵巢肿物患者及40例健康志愿者,ELISA试剂盒测定血清SMRP,化学发光法测定血清CA125,比较血清SMRP和CA125在卵巢良恶性肿瘤中的分布,绘制SMRP的ROC曲线,确定最佳截断值,评价诊断效能。结果卵巢癌组血清SMRP高于良性肿瘤组和健康对照组(P=0.000),良性肿瘤组与健康对照组相比差异无统计学意义(P=0.072)。SMRP的最佳截断值为1.103nmol/L,敏感度(77.27%)稍低,但特异度(97.92%)明显高于CA125。与临床诊断一致性方面,SMRP略优于CA125。结论血清SMRP可能是卵巢良恶性肿瘤鉴别诊断的良好指标。     

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。     

恶性肿瘤特异性生长因子在卵巢肿瘤中的临床应用价值

目的探讨血清恶性肿瘤特异性生长因子(TSGF)在卵巢恶性肿瘤的诊断及疗效监测中的临床应用价值。方法使用TSGF快速诊断试剂盒,对170例患者的196份血清进行检测,其中69例为卵巢恶性肿瘤,18例卵巢交界性肿瘤,42例卵巢良性肿瘤,41例盆腔良性病变;同时取20例正常妇女血清标本作为对照。所有标本同时检测CA125。结果卵巢恶性肿瘤组血清TSGF阳性率明显高于其他各组(P<0.01)。晚期肿瘤的血清TSGF诊断敏感性高于早期(P<0.05)。卵巢高分化恶性肿瘤及交界性肿瘤血清TSGF敏感性明显低于中、低分化组(P<0.01)。TSGF诊断卵巢恶性肿瘤的敏感性和特异性分别为78.3％和48.2％,CA125为73.9％和55.4％,二者差异无显著性(P>0.05)。TSGF+CA125联合检测诊断卵巢恶性肿瘤的敏感性为87.0％,较TSGF、CA125单项检测敏感性明显提高(P<0.05),治疗前后血清TSGF水平下降不明显(P>0.05)。TSGF对卵巢恶性肿瘤的疗效监测价值似乎不大。结论 TSGF测定诊断卵巢恶性肿瘤的敏感性和特异性分别为78.3％和48.2％,其水平与细胞分化、临床分期有关。TSGF和CA125联合检测可明显提高卵巢恶性肿瘤的检出率,但TSGF对卵巢恶性肿瘤的疗效监测似无明显临床价值。     

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.     

CCL18在上皮性卵巢癌患者血清中的表达及意义

Objective?To investigate the expression and clinical significance of chemokine 18 (CCL18) in serum of patients with epithelial ovarian cancer (EOC). Methods?104 patients with EOC, 42 patients with benign ovarian diseases and 20 healthy women were enrolled and divided into malignant group, benign group and control group respectively. The serum CCL18 levels of the three groups were measured, and their relationship with clinicopathological features of EOC patients were explored. Results?The level of CCL18 in malignant group was significantly higher than that benign group and control group. (P<0.01) The level of CCL18 in patients with EOC was correlated with FIGO stage, the level of CA125 and response to chemotherapy (P<0.05). It was not correlated with age, degree of differentiation, pathological type, lymph node metastasis and ascites (P>0.05). The area under the ROC curve was 0.814, and the best cutoff value was 1.80, with a sensitivity of 0.712 and a specificity of 0.887. Conclusions?The expression level of CCL18 in serum of patients with epithelial ovarian cancer is increased, and related to FIGO stage, serum CA125 level and chemotherapy response. It could be used as a potential tumor marker of ovarian cancer.     

CA 15-3 as a tumor marker in gynecological malignancies

Serum levels of CA 15-3 were measured in 778 samples from 270 patients with benign and malignant gynecological conditions. Malignant tumors were present in 180 patients including 58 cases with cancer of the ovary, 47 of the endometrium, 61 of the cervix, and 14 of the vulva. The 90 cases with benign conditions included 24 patients with ovarian tumors, 28 with fibromyomatosis, 18 with endometriosis, and 20 with endometrial hyperplasia. Of 180 cancer patients, CA 15-3 serum levels were elevated (greater than 30 U/ml) in 74 cases (41%) and the frequency of abnormal marker values increased with clinical stage. Of 90 patients with benign conditions, high CA 15-3 levels were found in 5 cases (6%) with benign ovarian tumors. Elevated levels of the marker were most commonly seen in ovarian cancer patients (71%). In endometrial, cervical, and vulvar cancer abnormal CA 15-3 values occurred in 32, 26, and 14%, respectively. In endometrial cancer the percentage of positive marker levels increased with more infiltrating and/or less differentiated tumors. A positive correlation was found between residual tumor after surgery and CA 15-3 levels. Serial measurements in sera of patients who underwent chemotherapy showed a good correlation with response to treatment. CA 15-3 values were correlated with clinical course of disease in 87% of cases.     

Selenium concentrations in serum, hair and tumor tissue from patients with ovarian tumors

Selenium (Se) concentration was determined in 150 samples of serum, 135 samples of hair and 96 samples of ovarian tissue from patients with malignant or benign ovarian tumors and normal subjects. The serum Se level in patients with malignant ovarian tumors was significantly lower than that in patients with benign ovarian tumors and normal subjects. No difference of Se concentrations of hair among different groups was observed. Se level in malignant ovarian tumor tissue was significantly higher than that in benign ovarian tumor tissue and normal ovarian tissue. The low serum Se level in patients with malignant ovarian tumors was probably the result of protective migration of Se from blood to the cancer tissue.     

Serum MAGE-4 protein in ovarian cancer patients

OBJECTIVE: We measured serum levels of MAGE-4 protein in patients with ovarian cancer to investigate the relationship between serum MAGE-4 positivity and prognosis. METHODS: Serum levels of MAGE-4 protein were measured with an ELISA system. RESULTS: Serum levels of MAGE-4 in patients with ovarian cancer were significantly higher than levels in patients with benign diseases. Serum MAGE-4 protein was considered positive in 22% of primary ovarian cancer patients. The positive rate was the highest in sera of patients with surface epithelial-stromal tumors, particularly serous adenocarcinomas (24%). The survival time after a primary surgical operation in ovarian cancer patients with serum MAGE-4 positivity was significantly shorter than that of MAGE-4-negative cases. CONCLUSION: These results suggest that serum MAGE-4 protein is a potential prognostic factor of reduced survival in ovarian cancer patients.     

Prognostic significance of vascular endothelial growth factor expression in ovarian cancer patients: a long-term follow-up

Abstract.   Rudlowski C, Pickart A-K, Fuhljahn C, Friepoertner T, Schlehe B, Biesterfeld S, Schroeder W. Prognostic significance of vascular endothelial growth factor VEGF expression in ovarian cancer patients: a long-term follow-up. Int J Gynecol Cancer 2006; 16(Suppl. 1): 183–189.
The purpose of the study was to determine vascular endothelial growth factor (VEGF) concentrations in ascites from ovarian cancer and to correlate these data with VEGF expression in ovarian tumors, serum VEGF concentrations, and clinicopathologic characteristics. Ascites, serum, and tumor tissue from 65 ovarian carcinomas and eight borderline tumors were collected. VEGF concentration in peritoneal fluids and sera was determined using enzyme immunoassay. VEGF tumor expression was evaluated immunohistochemically. Significantly higher VEGF concentrations were found in ascites from malignant tumors (median, 2575 pg mL⁻¹) compared with borderline tumors (median 181.9 pg mL⁻¹) and benign peritoneal fluid (184.5 pg mL⁻¹). Both VEGF ascites concentration and tumor expression correlated with advanced tumor stages and ascites volume. Elevated VEGF ascites levels were negatively correlated to patient survival. No differences between VEGF serum levels could be observed between ovarian cancer patients and patients with benign cysts. This study showed for the first time the clinical significance of elevated VEGF ascites level in ovarian carcinomas. VEGF is expressed by ovarian tumor cells and locally released in the malignant peritoneal fluid but is not increased in the serum of preoperative ovarian cancer patients. The enhanced VEGF level support novel therapeutic perspectives by VEGF inhibition.     

Amylase activity and fast-migrating amylase isoenzymes in serum and cyst fluid from patients with ovarian neoplasms

160 patients with various ovarian tumors were studied to establish whether total amylase activity and the occurrence of fast migrating amylase isoenzymes in serum could serve as indicators of ovarian cancer. It was found that patients with benign and malignant ovarian tumors could not be classified by means of total amylase activity. Electrophoretic separation of the amylases revealed fast-migrating forms in serum from 10 of 47 patients with malignant ovarian neoplasms; 8 of these 10, and altogether 19 of the 47 patients had a serous cystadenocarcinoma. Two of the 109 patients with benign ovarian tumors also showed the pattern with fast-migrating amylases; both of them had a serous cystadenoma. Four patients with borderline tumors showed normal amylase patterns. Tumor origin of these fast-migrating amylase forms in serum was substantiated by 1) amylase reactive cells detectable in tumor tissue, and 2) surgical removal of tumor followed by complete disappearance of the fast-migrating amylase forms in serum. Normal serum amylase patterns do not exclude the presence of a malignant ovarian tumor, but occurrence of these abnormal amylase forms in serum may indicate that an ovarian tumor is a cystadenocarcinoma.     

一氧化氮及一氧化氮合酶与卵巢肿瘤凋亡的关系

目的探讨卵巢良、恶性肿瘤患者血清、肿瘤组织、腹水中一氧化氮(nitricoxide,NO)及其合酶(nitricoxidesynthase,NOS)含量与肿瘤凋亡的关系。方法用分光光度计测定NO、NOS、iNOS活性,流式细胞仪检测细胞凋亡。结果恶性卵巢肿瘤患者血清、肿瘤组织中NO、NOS、iNOS高于良性肿瘤患者(P<0.05);腹水或腹腔冲洗液中iNOS亦高于良性(P<0.05),但腹水中NO、NOS与良性无差异(P>0.05)。恶性肿瘤细胞凋亡率高于良性(P<0.05)。结论NO、NOS、iNOS与卵巢肿瘤的恶性行为及凋亡有关,检测患者血清、组织、腹水中的NO、NOS、iNOS对鉴别良、恶性肿瘤有一定参考价值,可作为观测卵巢癌疗效及预后的指标。     

Serum sialyl Tn antigen as a prognostic marker in patients with epithelial ovarian cancer]

Circulating serum sialyl Tn (STN) antigen levels were measured in 89 patients with epithelial ovarian cancer, 157 benign disease, and in 126 healthy controls. Serum antigen levels were increased in 48.3% of patients with ovarian cancer. The false positive rate is significantly low (4.0% in healthy controls and 9.6% in benign disease). The levels of STN antigen were significantly higher in sera of patients with cancer than in those in benign and healthy controls (p less than 0.05). The rise in serum STN antigen levels correlated to the size of the primary tumors. Of the histological type, it is interesting to note the high sensitivity in mucinous-type ovarian cancer. Survival at 1, 2, 3, 4 and 5 years for patients with STN-negative (serum STN levels less than 50 U/ml) versus STN-positive (serum STN levels greater than or equal to 50 U/mol) was 96.2, 92.3, 86.5, 82.7, and 76.9% versus 59.5, 29.7, 18.9, 10.8, and 10.8%, respectively (p less than 0.05). The overall survival probability was worse in patients with STN-positive sera. Percent progression-free survival at 1, 2, 3, 4 and 5 years for patients with STN-negative versus STN-positive was 90.4, 86.5, 76.9, 59.6, and 51.9% versus 35.1, 16.2, 8.1, 8.1, and 5.4%, respectively (p less than 0.05). The overall progression-free period of survival was shorter in patients with STN-positive sera. Multivariate regression analysis revealed that positive STN, stage, PS and histologic grade were the four variables of most importance in predicting survival. These results indicate that a positive STN antigen level in sera is an independent predictor of poor prognosis in ovarian cancer.