Aim: To analyze the use of serum cancer antigen 19-9 (CA19-9), cancer antigen 125 (CA-125) and carcinoembryogenic antigen (CEA) in predicting the malignant potential of mucinous ovarian tumor, and to assess the clinical factors associated with these tumors. Methods: This retrospective study collected the data from 314 patients who were diagnosed with mucinous ovarian tumor. These patients had preoperative serum CA19-9, CA-125, CEA available and underwent surgery at Ramathibodi Hospital between January 2010 and December 2016. The diagnostic performance of CA19-9, CA-125 and CEA was analyzed using the receiver operator characteristic curve. The associations between clinicopathological factors and serum CA19-9, CA-125 and CEA level were also analyzed. Results: A total of 314 patients were recruited in this study. They consisted of 221 patients with benign mucinous ovarian tumor (70.38%), 65 patients with borderline mucinous ovarian tumor (20.70%) and 28 patients with mucinous ovarian carcinoma (8.92%). Multivariate analysis revealed that the tumor size, elevated serum CA19-9, CA-125 and CEA influenced the tumor pathology. The mucinous ovarian tumor with large tumor size, elevated serum CA19-9, CA-125 and CEA more than the cut off values showed a positive correlation with the risk ratio of 1.60 (95% CI = 1.13-2.28; P = 0.005), 1.74 (95% CI = 1.22-2.47; P = 0.002), 1.90 (95% CI = 1.34-2.70; P < 0.001), 1.58 (95% CI = 1.10-2.29; P = 0.020), respectively. CA-125 provided the highest diagnostic performance, with an area under receiver operator characteristic curve of 0.745, to differentiate between borderline, malignant or benign mucinous ovarian tumor. Conclusion: Preoperative elevation of the serum CA19-9, CA-125, CEA and tumor size are useful predictors to differentiate between benign, borderline and malignant mucinous ovarian tumor. The best predictor is CA-125, followed by CA19-9 and CEA.
Failure to detect early-stage epithelial ovarian cancer (EOC) is a major contributing factor to its low survival rate. Increasing evidence suggests that different subtypes of EOC may behave as distinct diseases due to their different cells of origins, histology and treatment responses. Therefore, the identification of EOC subtype-specific biomarkers that can early detect the disease should be clinically beneficial. Exosomes are extracellular vesicles secreted by different types of cells and carry biological molecules, which play important roles in cell-cell communication and regulation of various biological processes. Multiple studies have proposed that exosomal miRNAs present in the circulation are good biomarkers for non-invasive early detection of cancer. In this review, the potential use of exosomal miRNAs as early detection biomarkers for EOCs and their accuracy are discussed. We also review the differential expression of circulating exosomal miRNAs and cell-free miRNAs between different biofluid sources, i.e., plasma and serum, and touch on the issue of endogenous reference miRNA selection. Additionally, the current clinical trials using miRNAs for detecting EOCs are summarized. In conclusion, circulating exosomal miRNAs as the non-invasive biomarkers have a high potential for early detection of EOC and its subtypes, and are likely to be clinically important in the future.
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