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.     

A study of serum CASA and CA 125 levels in patients with ovarian carcinoma

The assays of Cancer Associated Serum Antigen (CASA) and CA 125 were assessed in the management of patients with ovarian cancer. It was shown that CASA is sensitive to ovarian carcinoma, and both CASA and CA 125 are more useful when used in conjunction.     

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.     

Expression of Tumour Markers CA125, CASA and OSA in Minimal/Mild Endometriosis

Ovarian cancer associated antigens CA125, CASA and OSA were measured in serum from 23 patients with mild endometriosis before, during and after medical therapy. Pretreatment CA125 levels were elevated above 35 mu/ml in 4(17%), and above 25 mu/ml in 7 (30%) patients. Mean CA125 levels decreased during treatment, but in only 10 patients did levels reflect disease response. There was no correlation between CA125 levels and disease severity as measured by modified American Fertility Society Scoring. Neither CASA nor OSA were detected in these women.     

Preoperative evaluation of serum CA 125 levels in patients with primary epithelial ovarian cancer

Serum CA 125 levels were measured preoperatively in 100 women undergoing diagnostic laparotomy for palpable adnexal masses. All 11 patients with frankly malignant nonmucinous ovarian carcinoma had serum CA 125 levels greater than 35 U/mL and nine of the 11 had serum CA 125 levels greater than 65 U/mL. If patients with mucinous and borderline lesions were included, serum CA 125 was greater than 35 U/mL in 11 of 18 and greater than 65 U/mL in nine of 18 patients. Among 14 individuals with pelvic masses and CA 125 greater than 65 U/mL, 13 had some form of gynecologic malignancy. These results suggest that CA 125 assay can be used as a diagnostic adjunct for discriminating benign from malignant pelvic masses.     

Normal serum CA125 half-life and normal serum nadir CA125 level in patients with ovarian cancers

The normal serum CA125 half-life and distribution of the normal serum nadir CA125 value in patients with epithelial ovarian carcinoma (EOC) have not been determined yet. Among patients with EOC, 41 patients met the inclusion criteria of the present study: the patients that underwent complete cytoreductive surgery and six cycles of platinum-containing chemotherapy, and who had no recurrent disease more than five years. Serum CA125 half-life (T1/2) during primary surgery and primary chemotherapy was calculated and serum nadir CA125 level was evaluated by logarithmic-transformed serum CA125. Median value of nadir CA125 was 7 U/ml (range 3-20 U/ml), and the mean ln (serum nadir CA125) was 1.96 +/- 0.45. Mean T1/2 was 10.4 days in all patients, and T1/2 value was associated with the preoperative serum levels of CA125. Predicted slope of CA125 regression curve was also influenced by the preoperative CA125 value. The present study provides fundamental information with regard to normal half-life time and normal nadir of CA125 in EOC patients.     

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     

血清CA125值的变化对判断上皮性卵巢癌疗效及预后的临床研究

目的 探讨化疗前后CA125变化对上皮性卵巢癌疗效、预后判定的临床价值.方法 对北京协和医院1989-12-01-2001-12-01初治的203例上皮性卵巢癌患者进行血清CA125的检测,计算化疗2疗程后血清CA125值较化疗前下降的百分比,观察CA125不同组复发中位时间及生存期限的差异.结果 203例患者中有102例复发,CA125下降≥75%组、50%～<75%组、<50%组各组复发的中位时间差异有显著性(F=8.422,P<0.001),且CA125下降<50%组的复发时间短;Kaplan-Meier法计算生存率,得出化疗2疗程后CA125值下降水平≥75%组的中位生存时间为42.8个月,50%~<75%组为34.6个月,<50%组为24.0个月,CA125上升组为9.3个月,以log-rank时序检验比较各组生存率曲线的分布差异有显著性(X2=33.097,P<0.001);COX风险模型分析上皮性卵巢癌预后的多因素结果表明CA125下降水平、FIGO分期、术后残存病灶大小与卵巢上皮癌预后明显相关.结论 化疗2疗程后CA125值与化疗前下降的百分比对上皮性卵巢癌的预后评定有一定的临床价值,检测该指标可协助判断复发,尽早予以相应的治疗措施.     

术前测定血清CA125、CA199、CA724、CEA和GM-CSF在鉴别附件包块性质中的作用

探讨术前测定患者血清CA12 5、CA19 9、CA72 4、CEA和GM -CSF水平在鉴别附件包块良恶性质中的作用。方法 :74例附件包块患者术前 1周内采外周血 ,用固相免疫放射法测定各种肿瘤标志物浓度 ,并与术后组织学诊断比较。计算各标志物单独和联合应用诊断卵巢癌的相应诊断参数。结果 :( 1)CA12 5(临界值 70U/ml)鉴别卵巢肿瘤性质的敏感性和特异性分别为 85 71%和 82 61% ,CA19 9(临界值 30U/ml)分别为 4 2 86%和 73 33% ,CA72 4 (临界值 3 8U/ml)分别为 53 57%和 90 90 % ,CEA(临界值 5ng/ml)分别为 4 6 4 3%和 4 8 89% ;( 2 )联合应用肿瘤标志物 :CA12 5联合CA19 9的敏感性和特异性分别为 89 2 9%和 73 33% ;CA12 5联合CA72 4的敏感性和特异性分别为 89 2 9%和 75 56% ;CA12 5联合CEA的敏感性和特异性分别为 92 86%和 4 0 0 0 % ;( 3)如果去除 9例子宫内膜异位症 ,CA12 5、CA19 9、CA72 4和CEA的特异性分别增至 89 19% ,80 55% ,94 2 9%和4 7 2 2 %。结论 :此项研究应用的肿瘤标志物中以CA12 5最为敏感。将CA12 5临界值定为 70U/ml时诊断效果最佳。CA72 4的特异性最高 ,但诊断卵巢癌的敏感性低。CEA的诊断价值有限 ,GM -CSF则无价值。CA12 5与其他肿瘤标志物联合检测时诊断的特异性会部分丧失。?     

Chemotherapy-induced changes of CA 125 in patients with epithelial ovarian cancer

OBJECTIVES: CA 125 is a tumor marker widely used to diagnose, monitor, and follow-up women with epithelial ovarian cancer, as the marker is well related to the amount of vital tumor cells. However, CA 125 before the operation or during the first 2 courses of chemotherapy does not provide enough information concerning survival to serve as a prognostic marker. The present investigation was inspired by studies describing a paradoxical increase of tumor markers (CEA, CA 125, and CA 15-3) in the days after chemotherapy of women with breast cancer. If CA 125 increases within days after chemotherapy, the increase may be caused by death of the cancer cells. It was therefore speculated if a CA 125 spike may serve as an early prognostic parameter. The aim of the present investigation was to evaluate if CA 125 increases within days after the first course of chemotherapy of women with ovarian cancer. PATIENTS: Twenty women with epithelial ovarian cancer were included in the study. CA 125 was measured in each woman on day 0 (the day of, but before initiation of chemotherapy) and 1, 3, 5, 7, 9, and 14 days after chemotherapy. RESULTS: One woman was excluded due to normal CA 125 values. The remaining 19 patients displayed a significant decrease in CA 125 during the 14-day period after chemotherapy. CONCLUSION: In the present study, no chemotherapy-induced increase of CA 125 within the first 14 days after chemotherapy could be demonstrated.     

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。     

Use of CA 125 to monitor patients with ovarian epithelial carcinomas

The CA 125 radioimmunoassay has been increasingly used to monitor the course of patients with ovarian epithelial carcinomas. The purpose of this report is to describe our experience in the use of this assay and to better define its clinical utility. Fifty-one patients had serum CA 125 follow-up during primary chemotherapy. All 51 patients demonstrated either a normal CA 125 level at the completion of chemotherapy or a substantial fall in CA 125 values with treatment. In 48 of 51 patients, the drop in CA 125 levels was temporally related to the clinical regression or remission of tumor. Forty of these patients underwent second-look laparotomy; 23 patients (58%) had residual disease. A total of 45 patients had serum CA 125 determinations at the time of second-look laparotomy. Eight patients with microscopic disease and 11 of 18 patients with gross residual disease had a "negative" (less than 35 U/ml) CA 125 level. The predictive value of an elevated CA 125 level was 1.00. However, the predictive value of a negative value was only 0.50. Hence, a negative CA 125 level cannot be a substitute for a second-look laparotomy. Only 7 of 18 patients (39%) with gross residual disease at second-look surgery had an elevated CA 125 level. Patients with an elevated CA 125 and gross residual tumor at the second-look laparotomy uniformly demonstrated large, bulky disease. Furthermore, the survival of patients with gross residual disease at second-look laparotomy correlated with the preoperative CA 125 value. Serum CA 125 determinations also show promise in the follow-up of patients with a negative second-look laparotomy. The serum CA 125 level from patients with a "negative" second-look laparotomy can become elevated months before recurrent disease is appreciated.     

Primary research on saliva and serum CA125 assays for detecting malignant ovarian tumors

Saliva and serum CA125 levels were assayed in specimens obtained from 55 normal healthy women, 92 patients with benign pelvic masses and 41 patients with malignant pelvic tumors. A saliva CA125 value greater than 3,000 kU/ml and serum CA125 value greater than 65 kU/ml were defined as positive. Only one saliva assay was positive in 55 normal women. The sensitivity of saliva and serum CA125 assays in 16 patients with epithelial ovarian cancer was 81% and 94% respectively. A linear correlation was observed between serum and saliva CA125 levels in 32 patients with malignant ovarian cancer. The false positive rate of saliva and serum CA125 assays in patients with endometriomas and pelvic tuberculosis was 13.6%, 10% and 72.7%, 80% respectively. Therefore, the saliva CA125 assay had better diagnostic value than the serum CA125 assay. In addition, collection of saliva is simple, noninvasive, and inexpensive and could be obtained repeatedly. For these reasons, assays of saliva CA125 levels may provide a new way of screening for malignant ovarian tumors.     

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.     

血清CA125监测卵巢上皮性癌术后复发界值探讨

目的探讨CA125在监测卵巢上皮性癌术后复发的界值。方法回顾性总结分析四川大学华西二院2005年1月至2009年12月收治的卵巢上皮性癌170例手术后患者,未复发组135例,复发组35例,以绝经后体格检查正常的105例妇女及除卵巢恶性肿瘤之外的65例术后无复发的妇科恶性肿瘤患者作为对照组。以CA125值为5kU/L、10kU/L、15kU/L、20kU/L、25kU/L、30kU/L、35kU/L分别作为界值,比较各界值对判断卵巢上皮性癌术后复发的敏感度、特异度。结果卵巢上皮性癌术后无复发患者、绝经后妇女及妇科恶性肿瘤术后患者CA125中位数值分别为7.5kU/L、8.4kU/L、6.9kU/L;均数±标准差分别为(8.3±3.6)kU/L、(9.1±4.2)kU/L、(7.3±2.6)kU/L。以15kU/L为界值判断复发,敏感度、特异度分别为74.3%、97.0%。结论以15kU/L为CA125界值配合影像学检查监测卵巢上皮性癌术后病情变化,敏感度提高,能够早期发现微小癌灶存在,早期治疗,延长患者生存期。     

Evaluation of serum CA 125 levels in the monitoring of ovarian cancer

Serum CA 125 levels were evaluated in 227 patients with ovarian cancer. CA 125 levels were elevated in 86% of the patients. All histologic types, including mucinous tumors, were associated with raised CA 125 levels. There was a positive correlation with tumor burden and an inverse correlation with degree of differentiation. In patients undergoing radical operation an elevated CA 125 level was a bad prognostic index. Serial CA 125 measurements were assessable in 112 patients undergoing chemotherapy. Rising or falling levels correlated with disease in 92% of the cases. The CA 125 level increased before clinical progression with a median lead time of 3 months. Only patients who showed objective response to chemotherapy had a decrease in antigen levels of greater than or equal to 30% 4 weeks after the first course of chemotherapy and a normalization of CA 125 levels 3 months after initiation of chemotherapy. Rising levels were always associated with progression. These data suggest that CA 125 may aid in early identification of nonresponders. However, a normal CA 125 level does not exclude the presence of disease.     

The prognostic significance of the half-life of serum CA 125 in patients responding to chemotherapy for epithelial ovarian carcinoma

Various prognostic factors were studied in 29 patients with stage III or IV ovarian cancer who responded to initial chemotherapy after initial diagnostic surgery. The half-life of CA 125 in serum during initial chemotherapy was the most important prognostic indicator for survival (P less than 0.001) and the chance of achieving complete remission (P = 0.012). A CA 125 half-life of less than 20 days, 20-40 days and greater than 40 days appears to identify patients with a good, intermediate or poor prognosis, the two year actuarial survival being 76%, 48% and 0% respectively. The change of achieving a complete remission was 15% and 67% respectively for patients with a serum CA 125 half-life of greater than 20 or less than 20 days.     

晚期卵巢上皮性癌患者初次治疗过程中血清CA125水平变化与其预后的关系

目的 探讨晚期(Ⅲ～Ⅳ期)卵巢上皮性癌(卵巢癌)患者初次治疗过程中血清CA125水平变化与其预后的关系.方法 选择1998年1月-2003年12月间中山大学肿瘤防治中心妇瘤科收治的142例晚期卵巢癌患者,回顾性分析其初次治疗过程中血清CA125水平的变化,采用Kaplan-Meier法计算其累积生存率,并采用Cox风险比例回归模型分析血清CA125水平的变化对患者预后的影响.结果 根据患者治疗前血清CA125水平不同分为≤500、>500～1500和>1500 kU/L,其3年累积生存率(分别为64%、71%及64%)比较,差异无统计学意义(P>0.05).术后接受3个疗程化疗后,血清CA125水平降至正常(0～35 kU/L)的77例患者的3年及5年累积生存率分别为84%及56%,明显高于血清CA125水平仍为异常的48例患者(分别为42%、15%,P<0.01).多因素分析表明,残留灶直径(P<0.01)及3个疗程化疗后血清CA125水平(P<0.01)是影响晚期卵巢癌患者预后的独立的因素.进一步分层分析表明,接受了满意的肿瘤细胞减灭术(残留灶直径≤1 cm)的患者中,3个疗程化疗后血清CA125水平降至正常者的3年及5年累积生存率分别为88%、64%,明显高于化疗后血清CA125笛水平仍为异常者(分别为52%、18%,P<0.01);同样,接受了不满意的肿瘤细胞减灭术(残留灶直径>1 cm)的患者中,3个疗程化疗后血清CA125水平降至正常者的3年和5年累积生存率分别为74%、32%,明显高于化疗后血清CA125水平仍为异常者的33%、13%(P<0.01).结论 3个疗程化疗后血清CA125水平正常与否可预测晚期卵巢癌患者的预后,且无论初次手术是否为满意的肿瘤细胞减灭术,3个疗程化疗后血清CA125水平降至正常者较未降至正常者预后好.