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Summary Serum CA 125 regression after cytoreductive surgery and during the first three courses of chemotherapy was studied in 60 ovarian cancer patients and compared to known prognostic factors.Various methods reported in the literature to calculate a CA 125 half-life value were compared. Using two exponential regression models (Van der Burg et al., 1988;Buller et al., 1991), mean half-lives in stage I-II patients after complete cytoreductive surgery were respectively 10.7 days (range: 5-23) and 9.8 days (range: 7-15). Within stage III-IV patients, a significant positive correlation was seen between survival and (a) stage III (P = 0.002), (b) residual tumour 1 cm (P = 0.02), (c) CA 125 normalisation after three courses (P = 0.003) and (d) CA 125 half-life < 20 days (P = 0.02-0.004, depending on the method used for half-life calculation).The median survival times of patients with and without a CA 125 normalisation after three courses were 27 and 14 months respectively (P = 0.003). When

In the search for a method to facilitate the preoperative discrimination of ovarian carcinomas from colorectal carcinomas serum levels of 6 tumor markers were measured in 47 patients presenting with ovarian cancer and compared to levels found in 24 female patients with advanced, untreated colorectal cancer. The markers studied were CA 125, CA 15.3, CA 19.9, CEA and two recently developed mucin markers, CA M29 and CA M26. Levels of CA 125, CA 15.3, CEA and CA M29 showed significant differences between both groups. In predicting ovarian cancer, sensitivity was highest for CA 125 at 94% (35 U/ml cutoff level). However, the specificity of CA 125 was at 71% low. Specificity increased significantly by using a combination of a CA 125-positive score ( > 35 U/ml) and a simultaneous negative CEA score (≤ 5 ng/ml) (specificity 100%, sensitivity 81 %). A CA 125/CEA serum ratio > 25 resulted in the highest discriminative power with a specificity of 100% and a sensitivity of 91 % resulting in an overall test accuracy of 94%. It is concluded that the serum tumor markers used, especially a combination of CA 125 and CEA, are helpful in the preoperative differential diagnosis between adenocarcinomas of ovarian and colorectal origin.

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Serum levels of CAI25 and CA15.3 were measured in 70 patients presenting with an ovarian neoplasm, of whom 38 had an ovarian malignancy and 32 a benign ovarian tumor. CAI25 levels exceeded 35 Ulml in 71 O h of ovarian carcinomas and in 25% of benign ovarian tumors. In the entire group of 70 patients, CAI25 levels (> 35 U/ml) were elevated in 35 patients, of whom 27 had ovarian cancer. CA15.3 levels were found t o be elevated (> 30 U/ml) in 9% of benign ovarian tumors and in 50°h of ovarian malignancies. Of 8 patients with a false positive CAI25 (> 35) elevation, only one had an elevated CA15.3 level whereas in 27 correct positive patients 19 also had elevated CA15.3 levels. Of all 20 patients with both markers elevated, I 9 patients (95%) had ovarian cancer. When a cut-off level of 65 U/ml was used for the tumor marker CA125, all patients with simultaneous elevation of both markers were found to have an ovarian malignancy. Using a panel of CAI25 (> 35 U/ml) and CA15.3 (> 30 U/ml) and requiring a simultaneous marker elevation, the sensitivity of the test decreased from 71% to 50% but the corresponding specificity of the test rose from 75% t o 97%. Specificity was as high as 100% if in the same panel of tests a 65 U/ml cut-off for CAI25 was taken. A comparison of early stage 1-11 ovarian cancer with benign ovarian tumors failed to demonstrate a discriminatory capacity of any test or test combination. We conclude that the use of a panel of tumor markers is advantageous in the pre-operative discrimination of benign and malignant ovarian tumors, since the predictive value for malignancy of a combined marker elevation was as high as 100% in the population studied.

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