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Background
This serum tumor marker is sometimes referred to as the test for ovarian cancer. As so much of medical news reported in the popular media, this is not entirely true. It is elevated in a large percentage of the most common type of ovarian cancer, a serous adenocarcinoma of the ovary. However, it is not elevated in other ovarian cancers. Nontheless, its use has significantly advanced the early detection of ovarian cancer.
CLINICAL UTILITY CHARACTERIZATION OVARIAN CANCER This marker is expressed in >80% of nonmucinous epithelial ovarian tumors. It is commonly found in serous, endometrioid, and clear cell carcinomas of the ovary. Serum half-life of the tumor marker CA 125 during induction chemotherapy as a prognostic indicator for survival in ovarian carcinoma.
Hogberg T, Kagedal B.
Department of Gynecologic Oncology, University Hospital, Linkoping, Sweden.
Acta Obstet Gynecol Scand 1990;69(5):423-9 Abstract quote
Patients (n = 72) with newly diagnosed non-mucinous ovarian carcinomas, FIGO stages IIC-IV, and CA 125 levels raised when starting chemotherapy were followed both by serial serum CA 125 tumor marker determinations during induction chemotherapy and by second-look operation after 4-6 cycles of chemotherapy.
Patients with complete response at the second-look operation (n = 19) had an estimated survival of 75% 59 months after the operation, compared with 22% in the 53 patients with persisting disease (p = 0.0004). Patients (n = 23) with a serum CA 125 half-life shorter than 16 days during induction chemotherapy had an estimated survival of 68% 59 months after the second-look operation as compared with 18% in 49 patients with a CA 125 half-life of more than 16 days (p = 0.003).
Thus both second-look operation and serial CA 125 measurements fairly accurately predicted the patient survival, although the groups of patients identified by the two methods differed slightly. There was a strong correlation between the second-look results and the residual tumor after the primary operation. Interestingly, this association could not be found for tumor marker pattern, which could mean that this is an independent prognostic factor.
What do CA 125 and other antigens tell us about ovarian cancer biology?
Welander CE.
Gynecologic Oncology Laboratory, Institute for Gynecologic Oncology, Atlanta, GA.
Acta Obstet Gynecol Scand Suppl 1992;155:85-93 Abstract quote
CA 125 is an antigenic determinant on a high molecular weight glycoprotein. A monoclonal antibody has been produced which recognizes this, and allows us to measure the expression of CA 125 in serum. Tissue distribution of the CA 125 determinant is most commonly seen in serous tumors of the ovary, with highest levels in borderline and frankly malignant serous cystadenocarcinomas. Occasionally cancers of the breast, gastrointestinal tract, and kidney will show elevated levels of CA 125.
Normal tissues which show varying levels of CA 125 include decidual tissue and structures derived from celomic epithelium. CA 125 is clearly tumor associated, but not tumor specific. Quantitative correlation of CA 125 levels with tumor volume has not been demonstrated. This observation limits the clinical usefulness of CA 125 as a screening tool, particularly in premenopausal patients who do not have a diagnosis of ovarian cancer. An undetectable level of CA 125 antigen does not rule out the presence of an early ovarian cancer. When CA 125 is used to monitor disease state in patients with known ovarian cancers (whose tumors do express CA 125), changes in levels of CA 125 do correlate with gross changes in tumor volume.
Good prognostic significance is attributed to a rapid decline in CA 125 levels following induction chemotherapy in patients with advanced ovarian cancer. However, an undetectable serum level of CA 125 does not predict clinical cure for a patient with ovarian cancer.
Further clinical studies continue in the use of CA 125 as a screening tool and as a means to monitor treatment responses of known ovarian cancer.
CA 125 in monitoring clinical course in ovarian cancer patients. A prospective clinical study.
Markowska J, Manys G, Szewierski Z.
Department of Oncology, Medical School, Poznan Lakowa, Poland.
Eur J Gynaecol Oncol 1992;13(2):201-4 Abstract quote
CA 125 concentration was estimated using an immunoenzymatic test (Abbott) in sera of 130 women treated for ovarian cancer, before the treatment was started and during chemotherapy.
Serum half-life of CA 125 was estimated in several of the patients after three months of chemotherapy. CA 125 serum level was found to be associated with the clinical course. Before the treatment was started, CA 125 levels showed no prognostic value as to survival but absence of a decrease in CA 125 levels after 2 to 3 months of chemotherapy was unfavourable to survival and required that alteration in treatment scheme be considered. Estimation of CA 125 half-life time after three months of treatment provided a useful prognostic index. Monitoring with the use of CA 125 levels facilitated adequate decision as to the time of performing second-look surgery.
In patients with CR, who showed normal CA 125 levels at earlier stages of treatment, monitoring with the use of the marker was useless, since no elevation of CA 125 level was observed during relapse.
Prognostic value of pre- and postoperative serum CA 125 levels in ovarian cancer: new aspects and multivariate analysis.
Makar AP, Kristensen GB, Kaern J, Bormer OP, Abeler VM, Trope CG.
Department of Gynecologic Oncology, Norwegian Radium Hospital, Oslo.
Obstet Gynecol 1992 Jun;79(6):1002-10 Abstract quote
The prognostic significance of the serum CA 125 level was studied in 687 patients with invasive epithelial ovarian malignancies.
The samples were collected preoperatively in 200 and postoperatively in 487 patients. Median follow-up was 27 months (range 3-84). The serum CA 125 level was elevated preoperatively in 90% of cases, with a median value of 429 U/mL. In patients with evidence of disease at the time of sampling, the CA 125 serum level correlated directly to tumor stage, tumor load, and histologic grade. Using Cox multivariate analysis, the preoperative serum CA 125 level had no independent prognostic significance, whereas the postoperative level did. In patients without residual disease after primary surgery, histologic type (P less than .0001), postoperative CA 125 level with 35 U/mL as the cutoff value (P = .0009), and tumor grade (P = .034) were independent prognostic factors for survival.
For those with residual tumor after primary surgery, histologic type (P less than .0001), postoperative treatment (P = .0002), size of residual disease (P = .0005), and postoperative serum CA 125 level with 65 U/mL as a cutoff (P = .003) were independent prognostic factors.
Serum CA 125 level allows early identification of nonresponders during induction chemotherapy.
Makar AP, Kristensen GB, Bormer OP, Trope CG.
Department of Gynecologic Oncology, Norwegian Radium Hospital, Oslo.
Gynecol Oncol 1993 Apr;49(1):73-9 Abstract quote
CA 125 was measured during induction chemotherapy in 119 patients with advanced epithelial ovarian cancer who had residual disease after primary surgery in order to determine whether patients with poor response to further treatment could be identified during early chemotherapy.
All patients had a prechemotherapy serum CA 125 level higher than 35 U/ml. Blood samples were further obtained 4 weeks after the first, second, and third course. Four weeks after the second course of chemotherapy, all 20 patients with PCR, or microscopic disease at second-look, all 17 who achieved complete clinical remission, and 36 of 40 who achieved partial remission had serum CA 125 of 65 U/ml or less or had a decrease of 50% or more of the prechemotherapy level. Survival analysis showed that patients with a serum CA 125 level of 65 U/ml or less 4 weeks after the second course of chemotherapy had the best prognosis. In patients with a serum CA 125 level higher 65 U/ml at that time, a decrease of 50% or more of the prechemotherapy level indicated a prognosis better than that with a lesser decrease.
The combined criteria for serum CA 125 (level > 65 U/ml 4 weeks after the second course and a decrease < 50% of the prechemotherapy level) allowed for identification of a real high-risk group with a median survival of 8.9 months and was identified by Cox regression multivariate analysis as the most powerful indicator for survival (P < 0.0001).
The prognostic value of serum CA 125 in patients with advanced ovarian carcinoma: an analysis of 573 patients by the Medical Research Council Working Party on Gynaecological Cancer.
Fayers PM, Rustin G, Wood R, Nelstrop A, Leonard RC, Wilkinson P, Cruickshank D, McAllister EJ, Redman CW, Parker D, Scott IV, Slevin ML, Roulston JE.
MRC Cancer Trials Office, Cambridge CB2 2BB, Dept. of Medical Oncology, Charing Cross Hospital, London W6 8RF, Dept. of Oncology, Western General Hospital, Edinburgh EH4 2XU, Dept. of Oncology, Christie Hospital, Manchester M20 9BX, Dept. Obstet. & Gynaecol, Aberdeen Maternity Hospital, Aberdeen AB9 2ZA, Dept. of Biochemistry and Beatson Oncology Centre, Western Infirmary, Glasgow G11 6NT, Dept. Obstetrics and Gynaecol, North Staffordshire Royal Infirmary, Stoke-on-Trent ST4 7LN, Clinical Oncology Unit, Bradford Royal Infirmary, Bradford BD9 6RJ, Dept. Obstetrics and Gynaecology, Derby City Hospital, Derby DE3 3NE, Dept. of Oncology, Homerton Hospital, London E9 6SR, Department of Clinical Biochemistry, Royal Infirmary, Edinburgh EH3 9YW, UK.
Int J Gynecol Cancer 1993 Sep;3(5):285-292 Abstract quote
A number of studies have suggested that serum CA 125 levels may be an important prognostic factor for survival of patients with ovarian carcinoma.
We investigated, in a large group of patients from 11 UK centers, which combination of CA 125 measurements provided the best prognostic index, and whether the predictive power could be improved by the addition of other factors. Analysis of the data from 248 patients showed that the absolute value of the third CA 125 sample was the single most important factor for predicting progression at 12 months, with the addition of residual bulk only slightly improving the predictive power. Seventy-four patients had CA 125> 70, and of these 57% were correctly predicted to progress or die within 12 months, but 43% remained alive and progression free. The best predictor for progression produced a false positive rate of 19%.
We therefore conclude that prognostic information based upon CA 125 measurements up to the start of the third course of initial chemotherapy is not accurate enough to be used to manage individual patients
The relationship between postoperative decline of serum CA 125 levels and size of residual disease after initial surgery in patients with advanced ovarian cancer: a CTF study.
Gadducci A, Landoni F, Maggino T, Sartori E, Zola P, Fanucchi A.
Department of Gynecology and Obstetrics, University of Pisa, Italy.
Gynecol Oncol 1996 Nov;63(2):234-7 Abstract quote
This retrospective study assessed 46 patients with advanced ovarian cancer who had elevated preoperative serum CA 125 (>35 U/ml) and who had another serum CA 125 assay 6-9 days after surgery.
Preoperative CA 125 levels were similar in patients with residual disease below 20 mm and in those with larger residuum. The postoperative decline of serum CA 125 was significantly higher in patients with small residual disease at any preoperative serum CA 125 value. By taking 60% as the cutoff of CA 125 decline, the diagnostic accuracy of this parameter in discriminating between patients with residual disease below or above 20 mm improved progressively when we considered patients with increasing preoperative antigen values. However, even in the subset of patients with preoperative serum CA 125 above 400 U/ml, 2 of the 20 patients with less than 20 mm residual disease had a percentage reduction of antigen levels lower than 60%, whereas 5 of the 10 patients with larger than 20 mm residuum had a CA 125 decline higher than 60%.
Therefore, we believe that the perioperative changes of CA 125 levels have a limited clinical relevance in the management of patients with ovarian cancer.
Serum CA-125 measurements > 65 U/mL. Clinical value.
Eltabbakh GH, Belinson JL, Kennedy AW, Gupta M, Webster K, Blumenson LE.
Department of Gynecology, Cleveland Clinic Foundation, Ohio, USA.
J Reprod Med 1997 Oct;42(10):617-24 Abstract quote
OBJECTIVE: To review the prevalence of various conditions associated with serum CA-125 values > 65 U/mL, to calculate the odds ratios of different ranges of high CA-125 in predicting cancer and to study the effect of menopause and the presence of a mass on the predictive value of high serum CA-125.
STUDY DESIGN: A retrospective review of the diagnoses in 313 consecutive women seen at the Cleveland Clinic Foundation whose serum CA-125 was > 65 U/mL was performed. Statistical analysis was performed using crosstabulation, chi 2, Fisher's exact test and the odds ratio.
RESULTS: In patients with serum CA-125 > 65 U/mL, gynecologic cancers, nongynecologic cancers and non-malignant conditions constituted 74.3%, 10.2% and 13.1% of diagnoses, respectively. In patients with serum CA-125 > or = 1,000 U/mL, the same conditions were responsible for 89%, 7% and 3% of diagnoses, respectively. Endometriosis and metastatic breast cancer were the most common benign condition and nongynecologic cancer associated with serum CA-125 > 65 U/mL. The presence of an abdominopelvic mass significantly increased the risk of malignancy (P < .00005). Approximately 90% of patients with CA-125 > 65 U/mL and no mass had nonmalignant disease. The diagnoses of serum CA-125 values > 65 U/mL varied significantly in premenopausal versus postmenopausal patients. Postmenopausal patients had a higher incidence of gynecologic (P = .002) and nongynecologic (P = .0008) cancers and lower incidence of benign conditions (P < .0005). The odds ratio that CA-125 levels were associated with cancer increased as the level of CA-125 increased. The odds ratio of malignant versus benign disease was significantly higher in post-menopausal patients for all intervals of CA-125 levels until the level of > or = 1,000 U/mL was reached.
CONCLUSION: In patients seen at a tertiary center, serum CA-125 measurements > 65 U/mL were associated with nonmalignant conditions in 13% of patients. Although higher serum CA-125 levels were more associated with gynecologic malignancies, no level of CA-125 occurred exclusively with gynecologic cancers. In postmenopausal patients with serum CA-125 values > 65 U/mL and in patients with serum CA-125 values > 65 U/mL and an abdominopelvic mass, subspecialty consultation should be considered before proceeding to surgery.
Predictive value of the combined serum CA 125 and TPS during chemotherapy and before second-look laparotomy in epithelial ovarian cancer.
Senapad S, Neungton S, Thirapakawong C, Suphanit I, Hangsubcharoen M, Thamintorn K.
Department of Obstetrics and Gynecology, Siriraj Hospital, Mahidol University, Bangkok, Thailand
Anticancer Res 2000 Mar-Apr;20(2B):1297-300 Abstract quote
CA 125 and TPS levels were measured in the serum of 33 patients with advanced non-mucinous epithelial ovarian cancer. These patients were in clinical complete response (CR) after postoperative chemotherapy. The median level of CA 125 decreased rapidly after the first cycle of treatment, and then decreased slowly throughout the rest of the treatment. Patients with a positive second-look had significantly higher CA 125 levels than those with pathological CR. The median level of TPS decreased linearly throughout the treatment. The negative predictive value of the level of CA 125 was 72.7% (95% CI 39.3-92.7) using 10 U/ml as cut-off, while that of the level of TPS was 73.3% (95% CI 44.8-91.1), using a cut-off value of 50 U/L. The combined CA 125 and TPS criteria had a better negative predictive value of 88.9% (95% CI 63.9-89.1).
Use of ca-125 to define progression of ovarian cancer in patients with persistently elevated levels.
Rustin GJ, Marples M, Nelstrop AE, Mahmoudi M, Meyer T.
Department of Medical Oncology, Mount Vernon Hospital, Northwood, Middlesex, United Kingdom.
J Clin Oncol 2001 Oct 15;19(20):4054-7 Abstract quote
PURPOSE: To determine an accurate definition for progression of ovarian cancer in patients with a persistently elevated serum CA-125.
PATIENTS AND METHODS: A retrospective analysis was performed on 300 patients with epithelial ovarian carcinoma with at least one measurement of CA-125. The date of progression according to clinical or radiologic criteria was ascertained in the 88 patients with persistently elevated CA-125 levels (> 23 U/mL). This was compared with the date of progression according to CA-125, defined as the date on which the CA-125 level first increased to >/= twice its nadir level, confirmed by a second sample also >/= twice the nadir.
RESULTS: Eighty of the 88 patients had evidence of progression by both standard and CA-125 criteria, giving a sensitivity of 94%. In six of these patients, no sample was taken to confirm CA-125 doubling. In 13 patients, CA-125 doubling occurred after the date of clinical progression. Only one patient had a false-positive prediction of progression according to CA-125; the patient died as a result of a myocardial infarct before evidence of clinical progression.
CONCLUSION: In patients whose CA-125 level decreases to normal after chemotherapy, a doubling from the upper limit of normal has been shown to predict progression. In those with persistently elevated levels, doubling of CA-125 from its nadir level has now been shown to accurately define progression. If confirmed, these CA-125 criteria should be used as additional end points in clinical trials.
UTERINE CANCERS >60% elevated Value of preoperative CA 125 level in the management of uterine cancer and prediction of clinical outcome.
Sood AK, Buller RE, Burger RA, Dawson JD, Sorosky JI, Berman M.
Department of Obstetrics and Gynecology, University of Iowa Hospitals and Clinics, Iowa City, USA.
Obstet Gynecol 1997 Sep;90(3):441-7 Abstract quote
OBJECTIVE: To enhance cost-effective management of uterine cancer by predicting the likelihood of extrauterine disease and survival on the basis of preoperative parameters.
METHODS: A retrospective review of preoperative CA 125 levels from 210 women with endometrial carcinoma was performed. The relationship of preoperative CA 125 levels to various preoperative and postoperative histopathologic factors was investigated.
RESULTS: Elevated CA 125 (greater than 35 U/mL) correlated (P < .05) with higher stage, higher grade, increased depth of myometrial invasion, positive cytology, pelvic or para-aortic lymph node metastases, and reduced actuarial survival (P < .001). Multivariate analysis of preoperative factors showed that an elevated CA 125 level was the most important predictor for poor survival (P < .001). Moreover, a preoperative CA 125 level greater than 65 U/mL was the most significant predictor of extrauterine disease and carried a 6.5-fold higher risk (95% confidence interval 2.5, 17.1). A logistic model to predict extrauterine disease was developed. The model has a sensitivity of 62%, specificity of 91%, positive predictive value of 69%, and negative predictive value of 88%.
CONCLUSION: A CA 125 level should be included as part of the preoperative workup for all patients with uterine cancer. Patients with a preoperative CA 125 level less than or equal to 20 U/mL should be considered as candidates for vaginal hysterectomy unless unfavorable histology or a high-grade (grade II or III) tumor is present. In our series, this approach would have eliminated 24% of the abdominal staging procedures, with a risk of less than 3% for extrauterine disease, while lowering treatment-related morbidity and cutting costs in the treatment of this common female cancer.
Preoperative CA 125 in endometrial cancer: is it useful?
Dotters DJ.
Sacred Heart Medical Center, Eugene, OR 97405, USA.
Am J Obstet Gynecol 2000 Jun;182(6):1328-34 Abstract quote
OBJECTIVE: We sought to determine the clinical utility of preoperative CA 125 measurement in determining the need for lymphadenectomy in patients with endometrial carcinoma.Study Design: A prospective nonrandomized study was performed over a 2-year period. Patients referred with the diagnosis of endometrial carcinoma had CA 125 levels determined before surgical staging. Operative findings were then correlated with preoperative CA 125 values. Standard statistical calculations were used to determine sensitivity, specificity, positive predictive value, and false-positive and false-negative rates. The Student t test was used to determine differences between mean values.
RESULTS: Either a CA 125 level of >20 U/mL or a grade 3 tumor or both of these correctly predicted 87% of patients requiring surgical staging. In patients with a preoperative diagnosis of stage I, grade 1 or 2 tumors, a CA 125 level of >20 U/mL correctly identified 75% (9/12) of patients requiring lymphadenectomy compared with only 50% (6/12) identified when a CA 125 level of >35 U/mL was used. Two of 16 low-risk patients with preoperative grade 1 tumors and CA 125 levels of <20 U/mL had occult extrauterine disease at surgery.
CONCLUSION: Measurement of preoperative CA 125 is a clinically useful test in endometrial cancer. CA 125 levels of >35 U/mL strongly predicted extrauterine disease but lacked sensitivity in identifying patients needing staging. Either a CA 125 level of >20 U/mL or a grade 3 tumor or both of these correctly identified 75% to 87% of patients requiring lymphadenectomy. Until more data are collected, abdominal hysterectomy should be the procedure of choice for patients with grade 1 tumors and CA 125 levels of <20 U/mL.
ENDOMETRIOSIS Elevated Serum and peritoneal CA-125 levels as diagnostic test for endometriosis.
Colacurci N, Fortunato N, De Franciscis P, Fratta M, Cioffi M, Zarcone R, Cardone A.
2nd Department of Gynecology and Obstetrics, School of Medicine, Second University of Naples, Italy.
Eur J Obstet Gynecol Reprod Biol 1996 May;66(1):41-3 Abstract quote
OBJECTIVE: To evaluate the clinical utility of CA-125 in the diagnosis of endometriosis and to compare the sensitivity of the serum and the peritoneal test as indicator of disease.
STUDY DESIGN: Peritoneal fluid was obtained at laparoscopy. The quantitative determination of CA-125 in serum and in peritoneal fluid was performed by IRMA-mat CA-125 'two-step method', a two-site immunoradiometric assay, using 35 and 60 U/ml as cutoff.
SETTING: Second Department of Gynecology and Obstetrics, Second University of Naples, Italy.
PARTICIPANTS: A total of 26 women infertile undergoing diagnostic laparoscopy that exhibited endometriosis in 14 patients, normal pelvis in 12 patients (control group).
INTERVENTIONS: None.
RESULTS: CA-125 levels in peritoneal fluid were higher than those found in serum and were significantly elevated (P < 0.05), when compared with the control group, both in women with endometriosis stage I-II and stage III-IV. In serum, CA-125 levels increased only in advanced stage of endometriosis.
CONCLUSIONS: Levels of CA-125 in peritoneal fluid seem to be a more sensitive indicator of disease than serum levels (0.86 vs. 0.36), especially in early stage endometriosis (0.80 vs. 0.20) which tends to be overlooked by the CA-125 serum test.
SCREENING FOR OVARIAN CANCER Under evaluation, used in conjunction with multiple markers Recent developments in ovarian cancer screening.
Menon U, Jacobs IJ.
Gynaecology Cancer Research Unit, St Bartholomew's and the Royal London Medical and Dental School, London, UK.
Curr Opin Obstet Gynecol 2000 Feb;12(1):39-42 Abstract quote
There has been growing interest in the possibility of screening for ovarian cancer. This article addresses papers published following a systematic review of all prospective ovarian cancer screening studies since 1998. In the past year, new markers have been reported and previous strategies have been refined. A randomized controlled trial of ovarian cancer screening has shown a survival benefit in women who developed ovarian cancer in the screened group.
Although the results do not justify ovarian cancer screening in the general population, the data support the need for a larger randomized trial powered to assess the impact of screening on mortality.
OTHER CA-125 in peritoneal fluid from patients with nonmalignant gynecologic disorders.
Ismail MA, Rotmensch J, Mercer LJ, Block BS, Salti GI, Holt JA.
Department of Obstetrics and Gynecology, University of Chicago, Illinois 60637.
J Reprod Med 1994 Jul;39(7):510-2 Abstract quote
To assess the diagnostic value of measuring CA-125 levels in peritoneal fluid from women with nonmalignant gynecologic disorders, we determined CA-125 levels in peritoneal fluid and in serum collected simultaneously from 46 women undergoing gynecologic surgery.
Patients with benign ovarian disease, non-ovarian gynecologic pathology and severe endometriosis had, on average, higher CA-125 levels in peritoneal fluid than did patients with a normal pelvis and those with mild endometriosis. There was no obvious correlation between peritoneal fluid and serum levels of CA-125.
Our data show that (1) measurement of serum CA-125 levels is not useful for distinguishing between different benign gynecologic disorders, and (2) levels of CA-125 in peritoneal fluid in benign gynecologic disorders are comparable to the reported lower range of levels observed in women with intraperitoneal malignancies.
BREAST CANCER Prognostic value in predicting overall survival of two mucinous markers: CA 15-3 and CA 125 in breast cancer patients at first relapse of disease.
Berruti A, Tampellini M, Torta M, Buniva T, Gorzegno G, Dogliotti L. Ospedale
San Luigi Gonzaga, Torino, Italy.
Eur J Cancer 1994;30A(14):2082-4 Abstract quote
The role of circulating tumour markers in providing prognostic information has been scarcely studied.
We evaluated the prognostic significance of two mucinous markers: CA 15-3 and CA 125 in 115 breast cancer patients at first recurrence of disease.
At diagnosis of advanced disease bone involvement was found in 64 patients, lung in 57, skin lymph nodes in 21, liver in 20, and brain in 5. Patients were recruited and treated in the same institution with conventional chemo- or endocrine therapy. The follow-up ranged from 3 to 54+ months (median 35). Serum samples were drawn at first recurrence of disease before the start of any endocrine and/or chemotherapy. Patients with CA 15-3 < 30 U/ml survived significantly longer than those with CA 15-3 > 30 U/ml (median 50+ versus 26 months, P < 0.02). Similarly, overall survival of patients with CA 125 < 35 U/ml was significantly higher in comparison with patients with CA 125 > 35 U/ml (median 34.5 versus 18.5 months, P < 0.001). CA 125, but not CA 15-3, maintained its prognostic value in the subgroup of patients with visceral metastases.
Both markers were found to be independent prognostic variables in multivariate analysis according to Cox's model. CA 15-3 and CA 125 appeared to be powerful prognostic indicators, in addition to visceral metastases, in patients with advanced breast cancer.
INTERFERING DISEASES OR SUBSTANCES THAT ALTER LEVELS CHARACTERIZATION Chemotherapy May show a false decline Benign conditions associated with raised serum CA-125 concentration.
Buamah P.
Department of Clinical Biochemistry, Queen Elizabeth the Queen Mother Hospital, Kent, England.
J Surg Oncol 2000 Dec;75(4):264-5 Abstract quote
A retrospective audit carried out in the Department of Clinical Biochemistry, covering a period of 42 months, showed 19 benign conditions, that gave rise to elevated serum CA-125 concentrations. These included six patients with non-malignant gynaecological disease, six patients with abdominal disorders, and seven patients with lung disease. These observations confirm that false-positive elevations can occur and that care must be taken before attributing an elevated serum CA-125 as an indicator of ovarian malignancy.
Effects of paclitaxel on CA-125 serum levels in ovarian cancer patients.
Paulsen T, Marth C, Kaern J, Nustad K, Kristensen GB, Trope C.
Department of Gynecologic Oncology, The Norwegian Radiumhospital, Oslo, Norway.
Gynecol Oncol 2000 Mar;76(3):326-30 Abstract quote
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. Clin Exp Obstet Gynecol 2000;27(1):69-71 Related Articles, Books, LinkOut The effects of abdominal and bimanual pelvic examination and transvaginal ultrasonography on serum CA-125 levels. Sari R, Buyukberber S, Sevinc A, Ates M, Balat O, Hascalik S, Turk M. Inonu University, School of Medicine, Department of Internal Medicine, Turgut Ozal Medical Center, Malatya, Turkey. The need for the early detection of ovarian cancer continues to be one of the most important issues in women's health care. The three most extensively evaluated screening methods for ovarian cancer are pelvic examination, transvaginal ultrasonography, and serum CA-125 levels. The answers to questions such as should the levels of CA-125 be measured before bimanual pelvic examination or transvaginal ultrasonography or do abdominal examinations effect the levels of CA-125 are obscure. Fifty-four otherwise healthy female volunteers at the preovulatory phase of the menstrual cycle complaining of vaginal candidiasis were divided into 3 groups. Abdominal (group 1), bimanual pelvic (group 2), and transvaginal ultrasonography (group 3) examination was performed and serum CA-125 levels were evaluated prior to examination and 10 minutes, 6 hours, and 24 hours after the examination. As a result, serum CA-125 levels (U/ml) were found to be 8.13 +/- 4.76, 8.23 +/- 5.05, 8.32 +/- 4.88, and 8.33 +/- 4.94 in the group of abdominal examination, respectively, 8.23 +/- 4.89, 8.45 +/- 5.15, 8.77 +/- 4.96, and 8.79 +/- 5.50 in the group of bimanual pelvic examination, respectively, and 8.19 +/- 4.56, 8.30 +/- 5.10, 8.81 +/- 5.56, and 8.88 +/- 5.71 in the group of transvaginal ultrasonography, respectively. The serum CA-125 levels detected prior to examinations were statistically insignificant when compared with the results obtained at 10 minutes, 6 hours, and 24 hours later in all three groups. We concluded that physical examination, either abdominal or pelvic, and transvaginal ultrasonography do not change the serum levels of CA-125.
CONCLUSION: Paclitaxel-induced modulation of CA-125 expression could not be confirmed in vivo.
The effects of abdominal and bimanual pelvic examination and transvaginal ultrasonography on serum CA-125 levels.
Sari R, Buyukberber S, Sevinc A, Ates M, Balat O, Hascalik S, Turk M.
Inonu University, School of Medicine, Department of Internal Medicine, Turgut Ozal Medical Center, Malatya, Turkey.
Clin Exp Obstet Gynecol 2000;27(1):69-71 Abstract quote
The need for the early detection of ovarian cancer continues to be one of the most important issues in women's health care. The three most extensively evaluated screening methods for ovarian cancer are pelvic examination, transvaginal ultrasonography, and serum CA-125 levels. The answers to questions such as should the levels of CA-125 be measured before bimanual pelvic examination or transvaginal ultrasonography or do abdominal examinations effect the levels of CA-125 are obscure.
Fifty-four otherwise healthy female volunteers at the preovulatory phase of the menstrual cycle complaining of vaginal candidiasis were divided into 3 groups. Abdominal (group 1), bimanual pelvic (group 2), and transvaginal ultrasonography (group 3) examination was performed and serum CA-125 levels were evaluated prior to examination and 10 minutes, 6 hours, and 24 hours after the examination. As a result, serum CA-125 levels (U/ml) were found to be 8.13 +/- 4.76, 8.23 +/- 5.05, 8.32 +/- 4.88, and 8.33 +/- 4.94 in the group of abdominal examination, respectively, 8.23 +/- 4.89, 8.45 +/- 5.15, 8.77 +/- 4.96, and 8.79 +/- 5.50 in the group of bimanual pelvic examination, respectively, and 8.19 +/- 4.56, 8.30 +/- 5.10, 8.81 +/- 5.56, and 8.88 +/- 5.71 in the group of transvaginal ultrasonography, respectively.
The serum CA-125 levels detected prior to examinations were statistically insignificant when compared with the results obtained at 10 minutes, 6 hours, and 24 hours later in all three groups.
We concluded that physical examination, either abdominal or pelvic, and transvaginal ultrasonography do not change the serum levels of CA-125.
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