Preoperative serum CA-125 levels in early stage ovarian cancer

Preoperative serum CA 125 levels were elevated in only 23% (9/39) of patients with FIGO Stage I invasive ovarian epithelial carcinoma whereas 88% of patients with Stages II-IV disease had elevated CA 125 levels preoperatively. No preoperative serum CA 125 levels in any patient with Stage I disease exceeded 300 U/ml.     

Preoperative and postoperative CA-125 serum levels in primary Fallopian tube carcinoma

Levels of CA-125 were determined pre- and postoperatively in 13 patients with Fallopian tube cancer. Values before surgery were significantly higher (Median 1220 IU/ml, 90 – 5000 IU/ml) compared with postoperative levels (Median 194 IU/ml, 67 – 880 IU/ml) (P=0.0052). Correlation analysis with FIGO stage and grading failed to show any statistical significance, but a trend for a positive correlation with FIGO stage and preoperative values could be observed. The CA-125 antigen is expressed by Fallopian tube carcinoma and should therefore be used in diagnosis and follow-up. Received: 12 July 1993 / Accepted: 6 December 1993     

The role of serum CA-125 levels and CA-125 tissue expression positivity in the prediction of the recurrence of stage III and IV epithelial ovarian tumors (CA-125 levels and tissue CA-125 in ovarian tumors)

Purpose  

The present study investigates the effects of serum CA-125 level and CA-125 tissue positivity on first-year recurrences in patients with stage III/IV epithelial ovarian tumors.     

术前诊断卵巢交界性肿瘤的超声特征

目的探讨卵巢交界性肿瘤的术前超声特点，以便早期诊断。方法总结分析1995年10月-2005年12月，在我院住院手术的卵巢交界性肿瘤患者，术前经阴道超声检查、多普勒血流频谱检测，手术病理证实为交界性卵巢肿瘤的患者共54例，年龄18-82岁。同时与同期手术的卵巢良性上皮性肿瘤60例、I期卵巢癌22例做对比。结果54例卵巢交界性肿瘤中，浆液性19例，黏液性28例，混合型7例。其中浆液性肿瘤与黏液性肿瘤相比，肿瘤体积小（P=0．003）、单房多见（P〈0．001）、其内多有乳头与实性区（P〈0．001）。54例卵巢交界性肿瘤中，29／54（53．70％）例内壁有乳头或实性区，良性肿瘤7／60（11．67％）例内壁有乳头或实性区，I期卵巢癌20／22（90．91％）例内壁有乳头或实性区（P〈0．001）。50例交界性肿瘤行彩色多普勒检查，45／50（90．00％）例可探测到血流信号（与良性肿瘤相比P〈0．001；与I期卵巢癌相比P=0．297），其中29例阻力指数〈0．50。结论经阴道超声检查发现卵巢囊性肿物内出现乳头状突起、实性区或密集房隔、房隔增厚时应警惕有可能为交界性肿瘤，如联合多普勒血流频谱检测肿瘤阻力指数〈0．50更有助于术前诊断。     

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.     

Evaluation of serum CA 125 level as a tumor marker in borderline tumors of the ovary

Serum CA 125 was evaluated as a tumor marker in 85 patients with borderline ovarian tumors. Serum CA 125 levels were elevated preoperatively in 18 of 20 (90%) samples (median 66, range 5–272 U ml⁻¹). Preoperative serum CA 125 levels did not correlate to FIGO stage. Preoperative serum CA 125 levels were elevated in seven of nine (78%) with serous tumors (median 131, range 5–272 U ml⁻¹) and in all 11 with mucinous tumors (median 62, range 41–157 U ml⁻¹). There was no significant difference in the CA 125 levels between these two histologic types. Postoperative serum CA 125 levels, measured 3–6 weeks after primary laparotomy, were significantly lower than the preoperative ones ( P < 0.001). No difference in the postoperative CA 125 levels was found between those with and those without residual disease after surgery. Postoperative serum CA 125 levels were elevated in eight of 60 (13%) without residual tumor. None of these had relapsed at the time of analysis (26–87 months after surgery). Serum CA 125 levels tended to correlate with disease evolution during chemotherapy. Two with disease remissions had falling levels, one with stable disease had falling level and one with disease progression had rising level. Serum CA 125 samples were obtained before second-look laparotomy in seven patients. Two with negative findings at second-look had normal levels. Of five with positive findings at laparotomy only two had elevated serum CA 125 levels. Disease relapse was associated with elevated serum CA 125 levels in only one of six patients.     

CA-125 levels in endometriosis

CA-125 is a cellular antigen detected in many patients with ovarian cancer, but it has also been detected in patients with endometriosis. Preoperative CA-125 levels were drawn from 113 patients before they underwent laparoscopy. Patients were categorized into diagnostic groups on the basis of pathologic findings. CA-125 levels in patients with evidence of intraabdominal adhesions were not statistically different from those in patients with normal pelvic anatomy. However, patients with advanced endometriosis had significantly elevated levels of CA-125 when compared with patients with normal pelvic anatomy (P less than 0.05). The clinical and immunologic implications of elevated CA-125 levels in patients with advanced endometriosis are discussed.     

CA-125 serum levels and pregnancy outcome in in vitro fertilization

This is a prospective cohort study of CA-125 levels drawn on the day of hCG administration in 386 women undergoing IVF treatment. The CA-125 levels were not helpful in determining pregnancy outcome, as indicated by poor sensitivity (40.8%) and specificity (52.7%), as well as an area under the receiver operator characteristic curve close to 0.50.     

Is CA-125 monitoring useful in patients with epithelial ovarian carcinoma and preoperative negative CA-125 serum levels?

Between December 1983 and December 1988 we examined the postoperative tumor marker development and correlated this to the clinical course of the disease in 56 patients suffering from primary epithelial ovarian carcinoma of International Federation of Gynecology and Obstetrics stages I-III and with a preoperative CA-125 serum level less than or equal to 65 U/ml. In 54% of all cases there was a reduction of more than 50% of the CA-125 serum level within the first 3 months after surgery. Nine out of thirteen patients with progressive disease (69%) showed an increasing CA-125 serum level with a median lead time of 6 months (0-11 months) prior to clinical diagnosis. These preliminary results indicate that the monitoring of cancer patients with CA-125 tumor marker seems to be a useful method of early diagnosis of progressive disease even in patients with preoperative serum levels lower than 65 U/ml.     

CA-125 levels in human uterine fluid.

OBJECTIVE: To measure uterine fluid CA-125 concentration and to determine if any menstrual cycle phase dependent changes exist in its level. Serum levels are measured for comparison. DESIGN: CA-125 levels in uterine fluid were measured during the follicular and luteal phases of the menstrual cycle. In a sequential study, paired uterine fluid and serum samples were obtained once in both midfollicular and midluteal phases of the same menstrual cycle. RESULTS: CA-125 in uterine fluid during the follicular phase (n = 14) ranged from 16.4 x 10(3) to 616.5 x 10(3) U/mL, and from 6.2 x 10(3) to 567.3 x 10(3) U/mL in the luteal phase (n = 11). In the paired sequential uterine fluid and serum samples, (1) the means (+/- SEM) CA-125 in uterine fluid were 81.5 x 10(3) +/- 37.9 x 10(3) U/mL and 91.4 x 10(3) +/- 56.8 x 10(3) U/mL in the midfollicular and midluteal phases, respectively (P = 0.75); (2) the CA-125 levels in serum increased in the midluteal phase (P less than 0.05); and (3) compared with serum, uterine fluid levels were greater with a wider range. CONCLUSIONS: When compared with serum CA-125, uterine fluid contains high concentrations varying over a wide range without fluctuation between the follicular and luteal phases of the menstrual cycle.     

Immunohistochemical detection of CA-125 and carcinoembryonic antigen in ovarian tumors in relation to corresponding preoperative serum levels

The immunohistochemically detectable expression of CA-125 and CEA in ovarian tumor tissue from 187 patients was related to corresponding preoperative serum levels. A strong positive association between tissue expression and the serum level of both the CA-125 and CEA antigens was found in cases of invasive epithelial ovarian carcinoma. However, this relationship was absent for CA-125 in borderline cases and patients with benign ovarian tumors, although the antigen frequently was detectable in them. The presence of ascites could be verified in 3 of 10 cases with benign CA-125 negative tumors, but elevated CA-125 levels in serum. 'False negative' CA-125 levels were found in 6 borderline and 7 true invasive carcinoma cases despite positive tissue staining. Eight of those patients had limited stage I disease. The data suggests that although the tissue expression of the CA-125 and CEA antigens in invasive ovarian carcinoma has an important influence in the corresponding serum level, compartment barriers and low cell turnover in benign, and to a lesser extent borderline, cases result in low serum levels. In addition, other factors influence serum levels of CA-125, such as secondary peritoneal response with or without ascites, which may cause 'falsely elevated' CA-125 results in benign disease.     

Preoperative CA-125 levels in patients with hereditary compared to sporadic epithelial ovarian carcinoma

OBJECTIVE: The aim of this study was to determine whether a significant difference in preoperative CA-125 levels exists between patients with BRCA-associated hereditary ovarian carcinoma and those with sporadic ovarian carcinoma and whether the CA-125 level predicts the probability of optimal cytoreductive surgery. METHODS: From a retrospective cohort of 189 consecutive ovarian cancer patients genotyped for BRCA mutation status, data on preoperative CA-125 levels were available for 49/88 (56%) hereditary cases and 43/101 (43%) sporadic cases. Data on the extent of surgical cytoreduction were obtained for all 92 patients with available CA-125 data. Comparison of preoperative CA-125 levels between hereditary and sporadic groups was assessed using the Kruskal-Wallis chi(2) test. Correlation of surgical cytoreduction with preoperative CA-125 level was assessed using Fisher's exact test. RESULTS: Mean preoperative CA-125 levels were not significantly different among BRCA1 (2289 U/ml), BRCA2 (2586 U/ml), and sporadic (3307 U/ml) cases (P = 0.5). For hereditary cases, optimal cytoreduction was achieved in 59% of patients with preoperative CA-125 levels of <500 U/ml and in 52% of patients with preoperative levels >500 U/ml. For sporadic cases, optimal cytoreduction was achieved in 62% of patients with CA-125 levels of <500 U/ml and in 20% of patients with levels >500 U/ml (P = 0.01). CONCLUSIONS: Preoperative CA-125 levels are not significantly different for patients with hereditary compared to sporadic ovarian carcinoma. The probability of optimal cytoreduction is independent of the preoperative CA-125 level for hereditary cases, but optimal cytoreduction is significantly less likely for sporadic cases with CA-125 levels of >500 U/ml.     

Effects of paclitaxel on CA-125 serum levels in ovarian cancer patients

OBJECTIVE: As in vitro activation of ovarian carcinoma cells in terms of CA-125 secretion by taxanes has been demonstrated, we were interested in whether taxanes also modulate CA-125 expression in vivo. METHODS: Serum CA-125 was determined immediately before and 24 h after paclitaxel-containing chemotherapy in 53 ovarian carcinoma patients. To test the quality of the analysis methods and the biological variation of untreated patients, serum CA-125 levels of two control groups were analyzed. RESULTS: Median CA-125 concentration was 107 kU/liter 24 h after chemotherapy treatment compared with 99 kU/liter the day before paclitaxel treatment. Changes in CA-125 serum levels observed immediately after paclitaxel treatment were not correlated to treatment response. However, overall change in CA-125 serum concentration was a good predictor of response to paclitaxel containing treatment. Patients achieving a complete or partial response had a significant reduction of median CA-125 levels, whereas tumor progression was associated with increased CA-125 levels. Only for the group of patients obtaining a complete response was a decrease in the median relative CA-125 value observed. CONCLUSION: Paclitaxel-induced modulation of CA-125 expression could not be confirmed in vivo.     

CA-125 serum levels in the diagnostic and clinical approach to ovarian cancer

The CA 124 serum level is a useful marker in monitoring epithelial ovarian carcinoma. More elevated serum levels when compared to the conventional cut-off (ie 35 U/ml), after the first surgical and/or chemotherapeutic approach, give evidence for the presence of an endocelomic and/or retroperitoneal tumour or are indicative of relapses. Also, they are well correlated with the endoperitoneal cytology pattern. Good correlation exists between the serological amount of CA 125 and tumoral mass before surgical removal whereas its efficacy in the differential diagnosis between primary ovarian tumours and metastatic disease ad well as its diagnostic specificity towards pelvic bulks, before removing them, is limited. Higher specificity seems to be obtained on increasing the cut-off threshold over 70 U/ml.     

Cancer of the ovary. Comparative value of serum CA-125, immunochemistry and biological tests of inflammation

The marker CA-125 is not specific of malignant ovarian tumors but, when its titration is positive, its evolution permits to follow correctly the development of the tumor. The authors report their experience with 180 titrations coupled with the titration of inflammation markers.     

The effect of continuous ambulatory peritoneal dialysis on serum CA-125 levels

Malignant and non-malignant serosal fluids were found to be associated with high serum levels of CA-125, suggesting that the presence of fluid in the serosal cavities may stimulate its release. In this study, we investigated the relationship between serum CA-125 levels and peritoneal irritation during continuous ambulatory peritoneal dialysis (CAPD). We performed a clinical study in 24 stable patients (15 amenstrual females and 9 males), aged 46 +/- 14 years on CAPD. The control group consisted of 32 healthy volunteers (20 females, 12 males) aged 44 +/- 12 years. CA-125 levels were determined prior to the CAPD dwell (without dialysate in abdomen) and during the CAPD dwell (dialysate in abdomen 4 hours after). As a result, serum CA-125 levels were found to be 14.86 +/- 5.98 U/ml and 15.23 +/- 6.05 U/ml respectively, whereas it was 8.32 +/- 5.54 U/ml in the control group. Serum CA-125 levels were found to be significantly elevated in CAPD patients when compared with healthy volunteers. However, serum CA-125 levels detected prior to and after CAPD did not differ between the groups. Interestingly, all of the patients in our study group were detected to have normal serum CA-125 levels (< 35 U/ml). We concluded that CAPD-induced abdominal artificial ascites did not affect serum levels of CA-125. Moreover, short and non-inflammatory mechanical pressures in the CAPD procedure do not have any effect on serum CA-125 levels.